51 - primary Assessment Breathing

KYJ 51 - B = Breathing
Part 2 of 5 part series on Primary Survey.
Breathing

After clearing and securing airway patency, the next step in trauma patient assessment and management, is to assess for spontaneous breathing effort and effectiveness.  10 pieces of assessment criteria can be used to assess breathing.
•Rate - should be 12-20/min
•Depth - shallow or deep breathing?
•Symmetry- is the left and right chest rising equally?
•Air entry- left =right?
•Skin colour - pink is good, blue is bad!
•Jugular veins- flat, or bulging?
•Tracheal position- midline alignment?
•Chest wall integrity- foreign bodies, wounds, bruising, redness or swelling?
•Palpate-bony crepitus? Instability?
•Laboured breathing- is there accessory muscle use?

With a selection of these assessments, the clinician is able to determine how oxygen will be administered.  The international gold standard for ALL breathing TRAUMA patients , is  non-rebreather bag mask (NRBM) at 12-15lpm, which delivers between 75-90% Oxygen.

All trauma patients should get this regimen, unless they have ineffective breathing and require oxygenation invasively- ETT or Surgical airway

When oxygenating COPD patients who retain CO2, recognise that few patients in this population experience Hypoxic drive, which can affect their stimulus to breathe. Hyperoxygenation in this patient can lead to respiratory depression and respiratory acidosis. Watch them carefully and monitor ABGs.