Breathing

The breathing assessment is the next critical assessment of the trauma victim. The assessment is focused on the patient's ability to ventilate and oxygenate.The chest and neck should be inspected for respiratory motion, deviated trachea, open chest wounds, and breath sounds. Oxygen saturation readings are a good indicator of how well the patient is being oxygenated. Generally, the airway assessment quickly leads into the breathing assessment (Cole, 2004).

Critical findings of the breathing assessment include the absence of spontaneous ventilation, absent or asymmetric breath sounds (indicative of pneumothorax or malpositioning of the endotracheal tube), dyspnea, hyperresonnance or dullness on chest percussion (suggesting hemothorax or tension pneumothorax), and gross chest wall instability or defects that compromise ventilation (i.e flail chest, sucking chest wound) (Dries & Hays, 2007).

While intubation may help to establish an airway, other interventions such as tube thoracostomy (chest tube insertion) may be necessary to relieve the effects of pneumothoraces. Chest tube placement is performed by the physician, but the nurse should be alert to the possibility of necessary tube thoracostomy, and should have the necessary supplies ready and easily accessible (Trauma.org, 2004). The tube is inserted into the pleural space to allow for release of air, blood or tension within the chest wall.