EMS SKILL PATIENT ASSESSMENT / VITAL SIGNSRESPIRATIONS / BREATHING PERFORMANCE OBJECTIVESThe examinee will demonstrate proficiency in performing an accurate respiratory assessment. CONDITIONThe examinee will be requested to perform an accurate respiratory assessment for the initial, focused and/or ongoing assessment. The patient is able to answer all questions and follow commands. The patient may be either seated in a chair or lying supine. The examiner will assess respirations with the examinee to determine the accuracy of the assessment. Necessary equipment will be adjacent to the patient.EQUIPMENTLive model, timing device, goggles, mask, gown, gloves. PERFORMANCE CRITERIA y100% accuracy required on all items designated by a diamond () for skills testing and must manage successfully all items indicated by double asterisks (**). yDocumentation, identified by the symbol (§), must be practiced, but is not a required test item. yAppropriate body substance isolation precautions must be instituted. yReading must be within +/- 2 breaths/minute of examiner’s determination. PREPARATIONSkill Component Key ConceptsTake body substance isolation precautions ** Place a mask on the patient - if suspected airborne disease** Place mask on patient and a HEPA respirator on rescuer - if suspected tuberculosisyMandatory personal protective equipment - gloves ySituational - goggles, mask, gown PRIMARY ASSESSMENTSkill Component Key Concepts Observe or feel for rise and fall of chest or abdomen yEvaluate patient’s respirations as subtly as possible. Patients have a tendency to increase their respirations if they know they are being assessed. yThe rescuer may have to feel the patient’s chest or abdomen to check for rise and fall if tidal volume is decreased or patient is dressed in a large jacket or many layers of clothing. Lay patient’s arm over chest or abdomen, watch movement of shoulders, etc. yInfants are “abdominal breathers” which causes the abdomen to protrude and the chest wall to retract. Assess respirations/Manage breathing: yRate (normal, fast, slow) yEffort/Quality yTidal volume ** Consider O2therapy ** Consider BVM - if inadequate ventilationyRate - determine if fast or slow. Rate is not counted during the initial assessment. yEffort/Quality- evaluated by the use of accessory muscles, patient position (tripod, reclined, etc.) and the ability to speak in words, sentences or unable due to being short of breath.