Breathing and Ventilation

Question 1

What does B stand for in the primary assessment?

Answer 1

breathing and ventilation

Question 2

What do you have to do first to assess for breathing and ventilation?

Answer 2

expose chest

Question 3

How do you inspect for breathing/ventilation?

Answer 3

• spontaneous breathing
• symmetrical rise/fall of chest
• depth, pattern, and rate of respiration
• respiratory difficulty (accessory muscle or diaphragmatic breathing)
• skin color (normal, pale, flushed, cyanotic
• contusions, abrasions, or deformities)
• open pneumothoraces (sucking chest wound)
• JVD and displaced trachea (tension pnuemothorax)
• inhalation injury (signed nasal hair, carbonaceous sputum)

Question 4

What do you want to auscultate for in breathing?

Answer 4

presence, quality and equality of breath sounds

Question 5

Where do you want to auscultate for breath sounds?

Answer 5

• bilaterally
• second intercostal space midclavicular line
• bases of the fifth intercostal space at the anterior axillary line

Question 6

What do you want to palpate for in breathing/ventilation?

Answer 6

• bony structure, rib fx (may impact ventilation)
• subcutaneous emphysema (sign of pneumothorax)
• soft tissue injury
• jugular venous pulsations at the suprasternal notch or supraclavicular area

Question 7

What interventions do you do if breathing is absent?

Answer 7

• open airway (jaw thrust and cervical spinal stabilization)
• insert oral airway adjunct
• assist ventilations with a bag-mask device
• prepare for a definitive airway

Question 8

What do you do if breathing is present?

Answer 8

administer O2 at 15 L/min via nonrebreather mask with reservoir bag

Question 9

What happens when there is an inability to maintain adequate oxygenation?

Answer 9

hypoxemia resulting in anaerobic metabolism and acidosis

Question 10

Do trauma patients need early supplemental oxygen?

Answer 10

yes

Question 11

Why do you want to monitor and titrate oxygen?

Answer 11

to avoid detrimental effects of hyperoxia

Question 12

How do you determine if ventilation is effective?

Answer 12

• end tidal carbon dioxide (ETCO2) is 35-45 mm Hg

- SpO2 of 94% or higher

Question 13

What signifies depressed ventilation?

Answer 13

ETCO2 above 50 mm Hg

Question 14

What do you do if ventilation is ineffective?

Answer 14

• assist ventilation with bag-mask device attached to O2 at 15 L/min, 10 to 12 breaths/min or every 5-6 seconds
• determine need for a definitive airway

Question 15

What needs to be identified prior to moving from B to C in the primary assessment?

Answer 15

identify life threatening pulmonary injuries

Question 16

What are examples of pulmonary injuries?

Answer 16

• open pnuemothorax
• tension pneumothorax
• flail chest
• hemothorax