Breathing Assessment and Adequacy

Breathing Assessment and Adequacy

1. Breathing splits into two questions, and responsiveness picks which one you're answering

Once the airway is open, you check breathing. The first thing to sort out is who you're looking at, because a responsive patient and an unresponsive patient get graded differently.

For a responsive patient, there are four possible findings. Breathing is adequate. Or it's too fast. Or it's too slow. Or it's absent, which usually means choking. "Too fast" and "too slow" have real numbers attached, and they're not the numbers you'd guess.

For an unresponsive patient, you don't bother with a specific rate. Breathing is just adequate, inadequate, or absent. Three buckets, not four.

Here's the vocabulary that carries the whole lesson. Pnea is the root for breathing. Tachy- means fast, so tachypnea is fast breathing. Brady- means slow, so bradypnea is slow breathing. A- means without, so apnea is no breathing at all. Dys- means difficult, so dyspnea is difficult breathing. That's your patient's own word for feeling like they can't get enough air.

Normal adult rate at rest is 12 to 20 breaths per minute. But the numbers that make you act are not 12 and 20. You start assisting ventilations when the rate is over 28 with signs of distress, or fewer than 8, or when the breaths are too shallow to move real air. A rate of 22 is outside normal and worth chasing, and it hasn't crossed the line for calling breathing inadequate. Don't confuse "outside normal" with "inadequate". Those are two different findings, and the exam separates them on purpose.

Read the fast half carefully, because it has two parts. A rate over 28 by itself is not the trigger. It's a rate over 28 plus signs of distress. The slow half has no such condition: under 8 stands on its own. A fast number only gets your attention, and the work of breathing makes the call. A rate under 8 gets assisted ventilation on the number alone.

Kids breathe faster than adults, and the younger the kid, the faster the normal rate. An infant, 0 to 12 months, runs roughly 30 to 60 breaths per minute. A toddler or preschooler, 1 to 5 years, runs roughly 24 to 40. A school-age kid, 6 to 12, runs roughly 18 to 30. A 40-breath infant is not tachypneic. A 16-breath toddler is not reassuring, for that age, it's slow. A rate that's fine in an adult can be an ominous slow rate in an infant, and a tiring infant slows down right before they arrest. If you have been watching a baby breathe 60 times a minute and the number starts coming down toward 30, that baby is running out of gas, and it's the point where you start bagging.