Breathing

Breathing and Ventilation

 

1. Expose the Patient's Neck and Chest

Remove clothing as necessary while maintaining the patient's dignity and preventing hypothermia.

 

2. Systematic Assessment Technique

Use the Inspect-Palpate-Percuss-Auscultate approach for a comprehensive evaluation:

 

    i. Inspect

• Observe chest wall movement for symmetry.
• Look for wounds, bruises, deformities, or use of accessory muscles.

 

    ii. Palpate

• Gently palpate the chest and neck for tenderness, deformities, subcutaneous emphysema, and tracheal position.
• Note: Do not perform chest springing.
  • Instead, use gentle single-hand palpation to avoid exacerbating injuries.

 

    iii. Percuss

       Percuss the chest:

• Hyper-resonance: May indicate pneumothorax.
• Dullness: May suggest hemothorax.

 

    iv. Auscultate

• Listen to breath sounds in all lung fields to detect decreased or absent breath sounds.
• Don't Forget: Auscultate the heart
  • To identify any abnormal heart sounds that may indicate cardiac tamponade or other injuries.

 

 

3. Look for:

Tension Pneumothorax

Signs and Symptoms:

• Severe respiratory distress
• Hypotension
• Distended neck veins
• Tracheal deviation away from the affected side
• Hyper-resonance on percussion
• Absent breath sounds on the affected side

Immediate Action:

Decompress the chest via finger thoracostomy or needle decompression.

 

 

Massive Hemothorax

Signs and Symptoms:

• Shock (hypotension, tachycardia)
• Diminished or absent breath sounds on the affected side
• Dullness on percussion
• Flat neck veins (due to hypovolemia)

Immediate Action:

Chest decompression and preparation for chest tube insertion.

 

 

Open Pneumothorax ("Sucking Chest Wound")

Signs and Symptoms:

• An open wound in the chest wall
• Audible sucking sound during respiration
• Respiratory distress
• Subcutaneous emphysema

Immediate Action:

Seal the wound with a three-sided occlusive dressing to prevent air from entering the pleural space during inspiration while allowing air to escape during expiration.

 

 

Tracheal or Bronchial Injuries

Signs and Symptoms:

• Hoarseness
• Subcutaneous emphysema
• Hemoptysis
• Respiratory distress

Immediate Action:

Ensure airway patency and prepare for possible surgical intervention.

 

 

Rib Fractures and Flail Chest

Signs and Symptoms:

• Paradoxical chest wall movement
• Severe pain on inspiration
• Crepitus over rib cage
• Respiratory distress

Immediate Action:

Provide adequate oxygenation and consider analgesia to improve ventilation.