EMR – Emergency Medical Responder

EMRs must recognize abnormal breathing patterns that indicate respiratory distress or failure. Each pattern suggests specific underlying conditions.

Tachypnea is an abnormally fast respiratory rate. In adults, this means more than 20 breaths per minute. Tachypnea often indicates hypoxia, fever, pain, anxiety, metabolic acidosis, or early respiratory distress. The body attempts to compensate for inadequate oxygenation by increasing breathing rate.

Bradypnea is an abnormally slow respiratory rate. In adults, this means fewer than 12 breaths per minute. Bradypnea may indicate drug overdose, head injury, hypothermia, or impending respiratory arrest. This is a critical finding requiring immediate intervention.

Apnea is the absence of breathing. Periods of apnea lasting more than 15 to 20 seconds are significant and may indicate respiratory arrest. Apnea requires immediate airway management and ventilatory support.

Cheyne-Stokes respiration is a pattern of gradually increasing then decreasing respiratory depth followed by a period of apnea. This cycle repeats regularly. Cheyne-Stokes breathing indicates brainstem injury, stroke, congestive heart failure, or approaching death.

Kussmaul respiration is deep, rapid, and labored breathing. This pattern represents the body's attempt to blow off excess carbon dioxide in response to metabolic acidosis. It commonly occurs in diabetic ketoacidosis but may also indicate kidney failure or other metabolic emergencies.

Biot respiration, also called ataxic breathing, is an irregular pattern with periods of apnea interspersed with breaths of varying depth. This pattern indicates severe brainstem damage and carries a poor prognosis.

Agonal respirations are slow, irregular, gasping breaths that occur in dying patients. These are not effective for oxygenation and should be treated as respiratory arrest. Patients with agonal respirations require immediate ventilatory support.

Respiratory distress occurs when the body cannot maintain adequate gas exchange through normal breathing mechanisms. Recognizing these signs allows early intervention before respiratory failure develops.

Use of accessory muscles indicates increased work of breathing. Patients may use neck muscles including the sternocleidomastoid and scalenes, shoulder muscles, and abdominal muscles to assist breathing. This is abnormal and indicates the patient is working hard to breathe.

Nasal flaring is the widening of the nostrils during inhalation. This is particularly common in infants and young children and indicates respiratory distress. The body attempts to reduce airway resistance by enlarging the nasal passages.

Retractions are inward movements of the skin and soft tissues during inhalation. They occur when negative pressure in the chest pulls on tissues between the ribs (intercostal retractions), above the clavicles (supraclavicular retractions), above the sternum (suprasternal retractions), or below the sternum (substernal retractions). Retractions indicate significant respiratory distress.

Tripod positioning is when a patient sits leaning forward with hands on knees or another support surface. This position optimizes the mechanics of breathing by allowing better diaphragm movement and use of accessory muscles. Patients who assume this position are experiencing significant respiratory distress.

Pursed-lip breathing is exhaling through lips held in a small circle. This technique creates back pressure that keeps airways open longer during exhalation. It is commonly seen in patients with chronic obstructive pulmonary disease (COPD) and indicates chronic respiratory compromise.

Cyanosis is a bluish discoloration of the skin and mucous membranes caused by inadequate oxygenation. Central cyanosis involves the lips, tongue, and trunk and indicates severe hypoxia. Peripheral cyanosis involves the fingers, toes, and earlobes and may indicate circulatory problems or cold exposure in addition to hypoxia.

Altered mental status ranging from anxiety and agitation to confusion and unresponsiveness may indicate hypoxia. The brain is extremely sensitive to oxygen deprivation, and mental status changes often precede other signs of respiratory failure.

Abnormal breath sounds include wheezing, stridor, crackles, and rhonchi. Wheezing is a high-pitched whistling sound indicating lower airway constriction. Stridor is a high-pitched sound heard during inhalation indicating upper airway obstruction. Crackles are popping sounds indicating fluid in the alveoli. Rhonchi are rumbling sounds indicating mucus in larger airways.