Combat Life Saver

Lesson 19
MEASURE AND MONITOR A
CASUALTY'S RESPIRATIONS

Compiled and edited by,

2LT John C. Miller, PA-C
 Lesson 19
MEASURE AND MONITOR A
CASUALTY'S RESPIRATIONS

INTRODUCTION
Another term for breathing is respiration. It is the
process of filling the lungs with fresh air, then
expelling the air. While the air is in the lungs, some of
the oxygen is removed from the air. The body uses
the oxygen to obtain energy from the food we eat.
This process, however, produces a gaseous by-
product called carbon dioxide.
 MEASURE AND MONITOR A
CASUALTY'S RESPIRATIONS

INTRODUCTION (cont)

The body must get rid of this waste product. When

oxygen is removed from the air in the lungs, it is
replaced with carbon dioxide. In this way, oxygen is
inhaled and carbon dioxide is exhaled. Normal
breathing is easy and does not require effort. An
unusually high or low breathing rate or difficulty in
breathing usually indicates that the casualty has a
problem requiring attention.
 MEASURE AND MONITOR A
CASUALTY'S RESPIRATIONS

❂ TASK
Determine a casualty's respiration rate and describe
characteristics of the respirations.
❂ CONDITIONS
Given a simulated casualty and a timepiece with a
second hand.
❂ STANDARDS
Score a GO on the performance checklist.
COUNT THE CASUALTY'S RESPIRATIONS

You must carefully observe the casualty's chest for

one full minute in order to determine his respiration
rate. One respiration consists of one inhalation where
the chest rises and one exhalation where the chest
falls. You will get a more reliable count if the casualty
is not aware that you are counting his respirations. If
his attention is focused on his own breathing, he may
change the rate, depth, and rhythm of his
respirations. If you are monitoring a casualty, observe
his respirations immediately after you check his pulse
without letting the casualty know that you are through
taking his pulse and are actually observing the rise
and fall of his chest.
 COUNT THE CASUALTY'S RESPIRATIONS

❂ Have the casualty lie on his back.

❂ Take the casualty's radial pulse for one full minute.
❂ Without changing position, begin counting his
respirations out loud.
❂ Begin the time when the casualty begins to inhale.
Do not count the respiration until the casualty has
exhaled.
❂ Count the casualty's respirations for one full minute.
 COUNT THE CASUALTY'S RESPIRATIONS

❂ Question:
• I started timing the respirations when the casualty began to
inhale. I counted the respirations when he completed the
exhalation. Suppose he was just completing an inhalation
when the 60 seconds ended. Would I count the inhalation
as a respiration?
❂ Response:
• No. The casualty must complete both an inhalation and an
exhalation before it is counted.
 LOOK FOR CHARACTERISTICS OF NORMAL
AND ABNORMAL RESPIRATION

❂ The normal range of respiration rates in an adult

when resting is 12 to 20 respirations per minute.
❂ A breathing rate that is slower than 12 respirations
per minute or faster than 20 respirations per minute
may indicate a problem affecting the casualty's ability
to get and absorb oxygen.
❂ A respiration rate below 12 respirations per minute is
called slow.
❂ A respiration rate above 20 respirations per minute is
called rapid.
 LOOK FOR CHARACTERISTICS OF NORMAL
AND ABNORMAL RESPIRATION

❂ Normal respiration are deep and even. The rib cage

expands fully. Contraction and relaxation of the
diaphragm can be detected by observing the
casualty's abdomen.
❂ In shallow breathing, the chest and abdomen move
very little.
❂ A pattern of shallow, slow respirations is called
hypoventilation.
❂ A pattern of rapid, deep respirations is called
hyperventilation.
 LOOK FOR CHARACTERISTICS OF NORMAL
AND ABNORMAL RESPIRATION

❂ If the respirations are shallow and rapid, the casualty

is said to be short of breath. Irregular breathing
rhythm, labored breathing, and noises (such as
wheezing) produced during breathing may indicate
the presence of injury or illness.
❂ Question:
• What medical term is used to describe difficulty in breathing?
❂ Response:
• Dyspnea.
 MONITOR THE CASUALTY'S RESPIRATIONS

If you remain with the casualty, you must monitor his

breathing. If his breathing stops and you are not in a
chemical environment, you must administer mouth-
to-mouth or mouth-to-nose resuscitation. Even if his
breathing does not stop, changes in respiration rate,
depth, and regularity may indicate that his condition
is improving or becomes worse. Report abnormalities
and changes to medical personnel.
 MEASURE AND MONITOR A
CASUALTY'S RESPIRATIONS

CLOSING

Normal breathing should be effortless and even in

rhythm, and should not produce noise or discomfort.
Any change from normal breathing can be a warning
sign that the casualty is in trouble.
Ques ti ons