Observe before touching
Note position, ability to speak, alertness, visible distress, accessory-muscle use, retractions, nasal flaring, and tripod posture.
How → Why → Practice
Decide whether the patient is breathing adequately—not just how fast.
Assess rate, depth, effort, rhythm, chest movement, speech, skin signs, and mental status. Then classify the finding, choose the appropriate EMT response, and document objectively.
0 of 3 lessons complete
Lesson 1
HOW: Assess breathing quality
Count respirations without announcing it, then describe the entire breathing pattern.
Count the rate
Count discreetly. Use a full minute when respirations are irregular, very slow, very fast, or difficult to see.
Assess depth and rhythm
Describe respirations as shallow, normal, or deep and as regular or irregular.
Inspect chest movement
Look for equal rise, symmetry, paradoxical motion, reduced movement, or fatigue.
Listen and feel
Listen for audible wheeze, stridor, grunting, or poor air movement. Auscultate lung sounds when indicated.
Judge adequacy
Combine breathing findings with skin signs, mental status, pulse, and oxygen saturation. Treat inadequate ventilation promptly.
Breathing-quality checklist
Rate + rhythm + depth + effort + chest rise + speech + air movement + perfusion + mental status.
Signs of adequate breathing
- Appropriate rate for age and condition
- Regular rhythm and adequate depth
- Equal chest rise with minimal effort
- Normal speech and mental status
- Reasonable skin signs and oxygenation
Signs of inadequate breathing
- Very slow, very fast, or irregular respirations
- Shallow depth or poor chest rise
- Exhaustion, decreasing effort, or altered mental status
- Cyanosis, poor air movement, or inability to speak
- Paradoxical movement or severe accessory-muscle use
Lesson 2
WHY: Understand ventilation and respiratory failure
A normal respiratory rate does not prove that ventilation is adequate. Depth, effort, and patient response matter.
Ventilation
Ventilation moves air into and out of the lungs. A patient can have an acceptable rate but inadequate tidal volume.
Oxygenation
Oxygenation describes oxygen transfer into the blood. SpO₂ helps, but it must be interpreted with the whole patient.
Compensation
Early distress may show tachypnea, anxiety, retractions, and accessory-muscle use while the patient maintains mental status.
Failure
Slowing respirations, decreasing effort, poor chest rise, altered mental status, and cyanosis may signal impending arrest.
FindingMeaningConcern
Rapid, deepPossible compensation for acidosis or hypoxiaIdentify cause and reassess
Rapid, shallowLow tidal volume despite high rateMay be inadequate
Slow, shallowDepressed respiratory drive or fatigueVentilatory support may be required
Unequal chest risePossible unilateral injury or obstructionHigh-priority assessment
Decreasing effortFatigue or respiratory failurePrepare to assist ventilations
Knowledge check
Full scenario mode: complete this assessment for the active patient. Teaching sections and patient changes are locked until you leave the scenario.
Lesson 3
PRACTICE: Assess, classify, act, and document
Read the patient presentation, perform the assessment, and decide whether ventilation is adequate.
Randomized patient
Patient encounter
Assessment finding
Practice feedback