Quickly recognizing inadequate breathing is one of the most important skills to master as an EMT.
Inadequate Breathing Difficulty breathing, shortness of breath Rate that is too fast or too slow Rhythm that is irregular Diminished or absent breath sounds
Inadequate Breathing continued Unequal or inadequate breath sounds Increased effort of breathing Inadequate tidal volume, shallow breathing Cyanotic, pale, or cool & clammy skin
Inadequate Breathing continued Use of accessory muscles Retractions Nasal flaring “See-saw” breathing in children
Considerations for Infants and Children Considerations for Infants and Children
Comparison of the diameter of the child’s trachea versus the adult’s. Adult (20 mm) Infant (4 mm)
Adult vs Child Respiratory Anatomy Proportionately larger tongue Narrower and shorter trachea Trachea easily kinked by improper positioning Chest-wall very pliable Larynx is more anterior Weaker intercostal muscles Requires more use of diaphragm
Any patient in respiratory distress should receive high-concentration oxygen.
Indications for the NRB Mask Any adequately breathing patient with signs or symptoms of respiratory distress Any patient with potential or actual shock (hypoperfusion) Any other patients that would benefit from high-flow oxygen
Nasal Cannula Use a cannula if NRB mask cannot be tolerated.
Indications for the Nasal Cannula Patients who will not tolerate a mask Medical patients without respiratory compromise Stable cardiac patients without signs or symptoms of an acute myocardial infarction Patients with chronic pulmonary disease who are not in respiratory distress