21d • EMT Talk
NREMT Patient Assessment Lecture
Abnormal Breathing Patterns
Biot’s / Ataxic Breathing
What it is:
- Completely irregular breathing with random apnea periods
What it suggests:
- Brainstem injury, ↑ ICP
EMS Assessment:
- Observe for unpredictable pattern
- Prepare for airway control
Cheyne-Stokes Breathing
What it is:
- Cyclic pattern: gradually increasing → decreasing → apnea
What it suggests:
- Brain injury, stroke, CHF
EMS Assessment:
- Watch for waxing/waning respirations
- Monitor mental status
Kussmaul Breathing
What it is:
- Deep, rapid respirations
What it suggests:
- Metabolic acidosis (DKA)
EMS Assessment:
- Note depth + rate
- Check blood glucose
Eupnea
What it is:
- Normal breathing
EMS Assessment:
- Rate: 12–20 (adult)
- Regular, non-labored
Apneustic Breathing
What it is:
- Prolonged inspiratory phase with short exhalation
What it suggests:
- Brainstem (pons) injury
EMS Assessment:
- Look for gasping, holding inhale
Eye Findings
Mydriasis
What it is:
- Dilated pupils
Causes:
- Hypoxia, stimulants, brain injury
EMS Assessment:
- Check pupil size + light response
Miosis
What it is:
- Constricted pupils
Causes:
- Opioids, organophosphates
EMS Assessment:
- “Pinpoint pupils”
Anisocoria
What it is:
- Unequal pupil sizes
What it suggests:
- Brain injury / increased ICP
EMS Assessment:
- Compare pupils side-to-side
Nystagmus
What it is:
- Involuntary eye movement
Causes:
- Alcohol, drugs, neurological issues
EMS Assessment:
- Observe for rapid side-to-side eye movement
Neck & Circulation
JVD (Jugular Venous Distention)
What it is:
- Visible neck vein distention
How to Assess
- Position patient at ~45° angle
- Look at internal jugular vein
What it suggests
- Right-sided heart failure
- Fluid overload
- Tension pneumothorax / tamponade
Flat Neck Veins
What it is:
- Collapsed jugular veins
What it suggests:
- Hypovolemia / dehydration
Lung Sounds
Crackles / Rales
What it is:
- Fluid in alveoli
Sounds like:
- “Popping” or “bubbling”
Causes:
- CHF, pulmonary edema
EMS Assessment:
- Auscultate lung bases
Unilateral Rales
What it is:
- Crackles on one side only
What it suggests:
- Pneumonia
- Lung injury
Abdominal Findings
Ascites
What it is:
- Fluid buildup in abdomen
Causes:
- Liver failure, CHF
EMS Assessment:
- Distended abdomen
- Fluid wave (advanced)
McBurney’s Sign
What it is:
- RLQ tenderness (appendicitis)
Location:
- 1/3 distance from ASIS to umbilicus
EMS Assessment:
- Palpate RLQ carefully
Cullen’s Sign
What it is:
- Bruising around umbilicus
What it suggests:
- Internal bleeding (pancreatitis, hemorrhage)
Grey Turner’s Sign
What it is:
- Flank bruising
What it suggests:
- Retroperitoneal bleeding
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NREMT Patient Assessment Lecture
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