Overview
Increased work of breathing, or respiratory distress, suggest that the patient is having significant difficulty breathing that requires immediate assessment and management.
Look For
- Conscious state - distress / agitation / decreased consciousness
- Speech - phrases → words → none
- Face - nasal flaring, pursed lips
- Accessory muscle use
- Recession - intercostal recession, subcostal recession
- Tachypnoea
- Tachycardia
Respiratory Muscles
Muscles Used at Rest
- Diaphragm - flattens itself
- External intercostals - move ribs up and out
- Exhalation occurs passively at rest.
Inspiratory Accessory Muscles
- Sternocleidomastoid
- Scalenes
Expiratory Accessory Muscles
- Internal intercostals
- Abdominal muscles - rectus abdominis, internal and external obliques, transversus abdominis
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