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EMT Exam: Understanding When Breathing Is (and Isn’t) Normal

Many situations you may encounter as an EMT and on the NREMT exam involve breathing, Ironically, normal breathing is hard to see. That’s because your respiratory system is very effective at its job. There’s so much surface area in the alveoli that gas exchange is very easy.

Therefore, the body needs to exert very little energy to make gases move between the alveoli and capillaries. If everything about the respiratory system is working well, the patient will likely be able to speak in full sentences, spending little energy in the process.

It also takes very little to get the respiratory system to work harder. Suddenly being frightened causes you to breathe a little faster as your body prepares a “flight or fight” response.

Difficulty breathing begins with an increase in rate (tachypnea). The patient may breathe deeper (hyperpnea). If the condition doesn’t improve, accessory muscles, such as those in the shoulders and neck, kick in to maximize the chest cavity on inspiration.

If your patient is experiencing a mild level of respiratory distress, you may notice that he has difficulty completing a long sentence, needing to stop midway to take a breath. Or, he may speak more quickly than normal to try to complete a sentence before he needs to take another breath.

In early stages of distress, the patient may want to only sit up; as the condition worsens, the patient may assume a tripod position, holding his upper body up by putting his hands on his knees and straightening his elbows. In really bad situations, the patient may be forced to stand up in order for the diaphragm to contract and push deep into the abdominal cavity.

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