22.5a Primary Assessment

pneumothorax

A trauma patient whose airway and breathing looked fine on initial exam can become symptomatic with a ? that was not at first evident.

bronchospasm

An asthma patient who initially responded to nebulizer treatment can have a sudden ? and worsen acutely.

reassessment

Minute-by-minute ? of the adequacy of every patient’s airway and breathing is essential.

rate, irregularity, speaking

The changes can be subtle increases in ?, worsening or onset of ?, or increased difficulty ?.

primary assessment

Assessment of the respiratory system begins with the ? and should continue through the secondary assessment and the reassessment.

identify any immediate threats

The purpose of the primary assessment is to ? to a patient’s life, specifically airway, breathing, and circulation problems (ABCs).

compressions come before airway and breathing

For a patient in cardiac arrest, ? (CAB).

patent

First, assess the airway to ensure that it is ?.

potential airway problems

Snoring or gurgling indicates ? and must be remedied immediately.

breathing

Next, determine the adequacy of ?.

the airway is patent and breathing is adequate

If the patient is comfortable with a normal respiratory rate, alert, and speaking without difficulty, you can generally assume that ?.

altered mental status

Patients with ? warrant further evaluation.

air movement

Feel for ? with your hand or cheek.

rise and fall

Look for the chest to ? normally with each respiratory cycle.

air movement and equal bilateral breath sounds

Listen for ?.

pneumothorax or hemothorax

The absence of breath sounds on one side can indicate a ? in a trauma patient.

12 and 20 breaths per minute

In an adult patient, the respiratory rate generally ranges between ?.

spontaneous, effortless, and regular

Breathing should be ?.

ventilatory support

Irregular breathing suggests a significant problem and usually requires ?.

asymmetrical movement

Observe the chest wall for any ?.

flail chest

This condition, known as paradoxical breathing, can suggest a ?.

respiratory distress

Patients showing increased respiratory effort; insisting on upright, sniffing, or semi-Fowler’s positioning; or refusing to lie supine should be considered to be in significant ?.

head-tilt/chin-lift or jaw-thrust maneuver

If a patient is not breathing or if you suspect airway problems, open the airway using the ?.

jaw-thrust maneuver

If trauma is possible, use the ? while stabilizing the cervical spine in the neutral position.

breathing status

Once the airway is open, reevaluate the ?.

supplemental oxygen

If breathing is adequate, provide ? and assess circulation.

airway adjuncts

Consider the use of ? for patients that can not maintain their own airway.

artificial ventilation

If breathing is inadequate or absent, begin ?.

chest’s rise and fall

When assisting a patient’s breathing with a ventilatory device, after placing an airway adjunct, or endotracheally intubating, monitor the ? to determine correct usage and placement of the airway adjunct or tube.