A primary assessment in an emergency setting provides a rapid evaluation to identify and address immediate life threats. This initial survey systematically checks for conditions that could quickly worsen without intervention. Assessing a person’s breathing is a fundamental component of this assessment, as it quickly determines if they are receiving adequate oxygen. A prompt and accurate evaluation of breathing can guide responders to take appropriate actions, potentially improving outcomes.
How to Listen for Breathing
During a primary assessment, listening for breathing involves specific steps to ensure an accurate evaluation. Position yourself by kneeling beside the person, placing your ear close to their mouth and nose. This proximity allows for the detection of subtle sounds of air movement. While listening, simultaneously observe the person’s chest for visible rise and fall, and feel for air movement on your cheek. This assessment should be conducted for a duration of no more than 10 seconds to quickly determine the presence and quality of breathing.
Sounds of Normal Breathing
Normal breathing is characterized by its quiet, effortless, and regular nature. When listening closely, normal breath sounds are typically soft and low-pitched, often described as a gentle rustling sound. These sounds indicate unobstructed airflow through the respiratory system, with no signs of distress or unusual noises. Healthy breathing maintains a consistent rhythm and depth, reflecting effective oxygen intake and carbon dioxide release. A smooth, soft sound during both inhalation and exhalation generally signifies clear and open airways.
Sounds of Abnormal Breathing
Absent Breathing
The complete absence of any sound or visible chest movement indicates that a person is not breathing. No air movement can be felt at the mouth or nose, confirming the cessation of respiratory effort. This lack of breathing is a critical sign demanding urgent intervention.
Gasping/Agonal Breathing
Gasping, often termed agonal breathing, presents as irregular, noisy, and labored breaths that can sound like snorting, gasping, or even moaning. This breathing pattern is not effective and does not provide sufficient oxygen to the body. Agonal breathing frequently occurs in the initial minutes of cardiac arrest, representing an involuntary reflex from the brainstem due to oxygen deprivation. This is not normal breathing and signals a severe medical emergency.
Noisy Breathing
Wheezing is a high-pitched whistling sound typically heard when air moves through narrowed or partially obstructed airways. This musical sound often suggests conditions such as asthma or other lower airway narrowing. It can be heard during exhalation, inhalation, or both, depending on the severity of the airway restriction.
Gurgling sounds resemble bubbling or rattling, indicating the presence of fluid in the airway. This fluid could be vomit, blood, or secretions, obstructing the passage of air. The sound suggests a partial airway blockage caused by liquid material.
Stridor is a harsh, high-pitched crowing sound, most often heard during inhalation. This distinctive sound indicates a partial obstruction in the upper airway, such as the throat or voice box. Stridor is a serious sign as it suggests a significant narrowing of the major air passages.
Shallow/Labored Breathing
Shallow breathing involves minimal chest movement and reduced air intake, indicating that the person is not taking full, deep breaths. This lack of depth can lead to insufficient oxygen delivery. Labored breathing is characterized by visible effort, where the person might use accessory muscles in the neck or chest to breathe. Both shallow and labored breathing suggest respiratory distress, even if no distinct abnormal sounds are present.
Immediate Actions Based on Breathing Assessment
If breathing is absent or presents as agonal gasps, emergency services should be contacted immediately. For individuals who are unresponsive and not breathing normally, Cardiopulmonary Resuscitation (CPR) should be initiated. Chest compressions help maintain blood flow to vital organs.
If the person is breathing but their breathing is compromised, emergency services should still be called. Continuous monitoring of their breathing is important while awaiting medical assistance.
If the person is unconscious but breathing effectively, placing them in the recovery position can help maintain an open airway and prevent aspiration. This position ensures their tongue does not block the airway and allows fluids to drain. Staying with the individual and providing reassurance until emergency responders take over is also an important step.