Breathing

Question 1

What do you need to do before assessing breathing?

Answer 1

Expose the chest

Question 2

When assessing breathing, what’re you looking for?

Answer 2

Effort and efficacy of breathing

Question 3

List what you are looking for when assessing breathing?

Answer 3

• Oxygen saturations
• Respiratory rate
• Respiratory depth
• Respiratory regularity
• Signs of increased work of breathing (recessions, accessory muscle usage and breathing sounds)
• Chest expansion
• Skin colour

Question 4

What are the normal respiratory rate parameters in children aged 1-2 years?

Answer 4

25-35

Question 5

What are the normal respiratory rate parameters in children aged 2-5 years?

Answer 5

25-30

Question 6

What are the normal respiratory rate parameters in children aged 5-12 years?

Answer 6

20-25

Question 7

What should a child’s oxygen saturations be?

Answer 7

Above 96%

Question 8

What indicates increased work of breathing?

Answer 8

Recessions - tracheal tug, sternal recession, intercostal recession and subcostal recession
Airway noises - stridor, wheeze, grunting, gasping
Use of accessory muscles - abdominal breathing, shoulder shrugging, head bobbing, nasal flaring

Question 9

Distinguish between the upper and lower airway noises?

Answer 9

Upper = stridor (inspiratory) and wheeze (expiratory)
Lower = grunting and gasping

Question 10

What are you looking for when observing chest expansion?

Answer 10

Equal and bilateral air entry

Question 11

What else can be seen on the child that may indicate inefficient breathing?

Answer 11

Skin pallor from vasoconstriction and cyanosis

Question 12

What can be done to assess the efficacy of breathing?

Answer 12

Auscultate, percuss and palpate

Question 13

When auscultating, what are you listening for?

Answer 13

How much air is being moved into and out of the lung

Question 14

What noises may be heard when auscultating?

Answer 14

Silent, crackles, wheeze, equal air entry

Question 15

What would you do if the patient was not breathing?

Answer 15

Start CPR, 5 rescue breaths via bag valve mask connected to 15 litres of oxygen

Question 16

How would you intervene if a child presented with respiratory difficulty and hypoxia?

Answer 16

High flow 15 litres of oxygen via non-rebreathe face mask with reservoir

Question 17

When administering oxygen via a non-rebreathe face mask with reservoir, what must you do first?

Answer 17

Inflate the reservoir bag first

Question 18

How might low respiratory effort or efficacy affect how a child presents?

Answer 18

Initially present with tachycardia - can present with bradycardia if decreased air entry is prolonged
Can have an agitated, drowsy, exhausted or unconscious

Question 19

What is the rationale behind grunting?

Answer 19

To prevent alveoli from collapsing, creating positive airway pressure

Question 20

What is the rationale behind gasping?

Answer 20

To try and get as much oxygen into the lungs as possible showing the patient has impaired gaseous