Determine a casualty's respiration rate and describe characteristics of the respirations.

Given a simulated casualty.

Score a GO on the performance checklist.

STP 21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.

FM 21-11, First Aid for Soldiers.

STP 8-91-SM, Soldier's Manual: CMF 91: General Medical Tasks.

Respiration (breathing) supplies the body with oxygen needed by the body and removes carbon dioxide, a waste product. Respiration has two phases: inhalation (bringing fresh air into the lungs) and exhalation (expelling air from the lungs). When the muscles of the rib cage and the diaphragm muscle contract, the chest expands (rib cage pulled up and out, bottom of chest cavity lowers). When the chest expands, air rushes into the lungs. When the chest muscles and diaphragm muscle relax, the chest cavity returns to its normal (smaller) size and some of the air in the lungs is forced out. Usually, an adult will inhale and exhale about 500 milliliters (about one pint) each time he breathes. Not all of the air is exhaled. After normal exhalation, around 2300 milliliters (ml) of air remain.

Breathing is usually performed automatically (without conscious thought) by the respiratory control center located in the brain. Serious head injuries can interfere with the control center and make mouth-to-mouth resuscitation or other measures necessary. Determining the effectiveness of the casualty's efforts to breathe

(rate and depth) and other characteristics can be of great help in evaluating a casualty's condition.

Respiration is also affected by the amount of carbon dioxide in the blood. An increased in carbon dioxide causes in an increase in respiration rate. The respiratory rate is also affected by extremes in body temperature and by emotions such as anger, fear, and anxiety.

You will normally have the casualty to lie on his back while you observe the rise and fall of his chest for one full minute. One respiration consists of one inhalation (chest rises) and one exhalation (chest falls). If possible, count the casualty's respirations when he is not aware that you are counting (his awareness could cause his breathing rate and depth to change. If you are taking the casualty's pulse, simply continue to act as though you are still taking his pulse while actually observing his chest.

Count the casualty's respirations for one full minute. Count each rise and fall of the casualty's chest as one respiration. Do not count an incomplete cycle.

19-3. LOOK FOR CHARACTERISTICS OF NORMAL AND ABNORMAL RESPIRATION

The normal range of respiration rate in an adult when resting is 12 to 20 respirations per minute.

Normal respiration results in deep and even movement in the chest. The depth of respirations refers to the amount of air inhaled and exhaled with each breath. If respirations are shallow, the rib cage does not expand to its normal size. If respirations are deep, the rib cage expands fully.

Normal breathing is effortless, automatic, regular (even) in rhythm, and does not produce noise or discomfort.

The exhalation phase of breathing normally takes longer than the inhalation phase.

Difficulty in breathing is referred to as dyspnea.

If the casualty's respiration rate is above the normal range, his respirations are called rapid. If his respiration rate is below the normal range, his respirations are called slow.

If the movements (rise and fall) of the chest and abdomen are minimal, insufficient air is being taken in with each inhalation. These respirations are called shallow.

A pattern of shallow and slow respirations is called hypoventilation.

A pattern of sustained rapid, deep respirations is called hyperventilation.

If the respirations are shallow and rapid, the casualty is said to be short of breath.

An irregular breathing rhythm may indicate the presence of injury or illness.

Abnormal breathing is labored and requires effort. Difficult breathing sometimes is accompanied by pain and noises (wheezing, rattling, bubbling, etc.).

A person with difficulty in breathing may lean forward with his arms braced against his knees.

A person with breathing difficulties may be restless or anxious.

A person with breathing difficulties may be pale, ashen (gray), or cyanotic (blue) in the face and lips. The mucous membranes inside the mouth may also be bluish due to the decrease of oxygen in the blood.

The cough is a protective mechanism for removing lung secretions and foreign matter such as dust and blood from the respiratory tract.

The characteristics of the casualty's respirations may change as his condition changes (becomes better or worse). Continue to monitor the casualty's respirations. Report abnormalities and changes to medical personnel. Be prepared to administer mouth-to-mouth resuscitation if the casualty stops breathing or his breathing becomes ineffective.

Performance checklist follows.