Awareness
Changes in the way a person breathes can provide ER24 paramedics with important clues about a patient’s injuries or illness.
From the speed and depth of breathing to unusual sounds and patterns, these observations can help paramedics assess a patient’s condition and determine what further assessment or intervention may be needed.
“A patient’s breathing pattern can tell us very quickly if the patient is in some form of distress," says Thaakir Stegmann, an Emergency Care Practitioner at ER24 South Metro.
Paramedics assess the rate and character of breathing, including whether it is unusually fast or slow, shallow, laboured or gasping. They also consider the wider clinical picture, as abnormal breathing can be associated with factors such as acute stress or a panic attack.
Why is a patient’s baseline breathing important?
During an initial assessment, paramedics establish a baseline against which they can monitor changes.
As Stegmann explains, a change from that baseline can provide an important clue. “An increase in breathing rate may indicate worsening distress, while a decrease could mean that an intervention is working or, depending on the patient’s overall condition, that they are deteriorating,” he says.
What does shallow breathing indicate?
Shallow breathing can occur when a patient is fatigued, in significant pain, has taken an overdose or has a respiratory condition such as severe asthma, COPD or respiratory failure. Injuries such as rib fractures can also make deep breathing painful and result in shallower breaths.
What can rapid or slow breathing indicate?
Very rapid breathing can have several possible causes, including low oxygen levels, pain and infection. Stegmann says it can occur with conditions such as an asthma exacerbation, pneumonia and heart failure.
Unusually slow breathing can indicate that the body’s drive to breathe is being impaired. Possible causes include drug overdose, head injury, stroke and respiratory failure.
The breathing rate therefore needs to be interpreted alongside other clinical signs.
What is Cheyne-Stokes breathing?
Cheyne-Stokes breathing is an abnormal pattern in which the depth and rate of breathing gradually increase and decrease, followed by periods of apnoea, when breathing temporarily stops.
Stegmann explains that the pattern involves “increases and decreases in the breathing pattern affecting the depth of the breathing as well as the rate”.
Cheyne-Stokes breathing can occur in people with conditions such as heart failure or stroke, and may also be seen in some sleep-related breathing disorders. It can also occur naturally as a person approaches the end of life.
What does gasping mean?
Stegmann describes gasping as abnormal and almost involuntary. It can occur when the body is not getting enough oxygen or is unable to remove carbon dioxide effectively.
“Abnormal gasping can occur in emergencies such as choking and severe allergic reactions,” he says. “Agonal breathing, a type of abnormal gasping, can also occur during cardiac arrest. In an unresponsive person, abnormal breathing or gasping requires immediate emergency attention.”
What can breathing sounds tell paramedics?
ER24 paramedics also listen to how a patient is breathing.
Sounds such as wheezing, gurgling or crackling can provide additional clues about what may be affecting the patient’s breathing. “Depending on the sound and the wider clinical picture, they may indicate problems such as an airway obstruction, fluid in the lungs or an infection,” says Stegmann.
ER24 paramedics also assess signs such as skin colour, capillary refill, level of consciousness and oxygen saturation. Capillary refill, checked by pressing briefly on a fingertip and watching how quickly the colour returns, can provide an indication of circulation. Level of consciousness shows how alert and responsive a patient is, while oxygen saturation indicates how much oxygen is being carried in the blood.
“All of these signs are used to get a holistic picture of the patient’s oxygenation and breathing conditions,” says Stegmann.
When breathing patterns help paramedics act quickly
Stegmann recalls attending to a patient experiencing an allergic reaction. On arrival, the patient was breathing rapidly and very shallowly. Their skin appeared pale, their oxygen saturation was below 90%, and wheezing was heard when the paramedics assessed their lungs.
Together with information from the patient’s family member, these signs pointed towards an allergic reaction.
“This prompted us to immediately start the patient on oxygen and other clinical interventions to stabilise the patient,” says Stegmann.
He says recognising that the patient’s breathing was significantly outside what would be considered normal according to their protocols helped the team identify the seriousness of the situation quickly and begin treatment without unnecessary delay.
For paramedics, breathing is therefore about more than simply counting breaths. Its rate, depth, pattern and sounds, together with other clinical signs, can provide valuable information about a patient’s condition and help guide urgent care.