Respiratory assessment is a critical component of trauma patient evaluation. Injuries involving the chest, lungs, or airway can rapidly impair oxygenation and ventilation, making early recognition of respiratory compromise essential.

During the respiratory assessment, providers should evaluate:

• Respiratory rate
• Respiratory effort
• Chest rise and fall
• Breath sounds
• Oxygenation status
• SpO2 via pulse oximetry — apply early and monitor continuously
• Signs of respiratory distress
• Skin color, temperature, and condition

Assessment findings that may indicate respiratory compromise include:

• Rapid or slow brathing patterns
• Increased work of breathing
• Use of accessory muscles
• Asymmetrical chest movement
• Diminished or absent breath sounds
• Tracheal deviation
• Jugular venous distension (J.V.D.)
• Cyanosis
• Altered mental status

Providers should inspect, palpate, and auscultate the chest to identify injuries that may affect breathing, including penetrating trauma, flail segments, open chest wounds, and pneumothorax.

During palpation, assess for tenderness, crepitus, subcutaneous emphysema, and chest wall instability — findings that may indicate underlying injury not immediately visible on inspection. Subcutaneous emphysema, the presence of air under the skin, may present as a crackling sensation on palpation and can indicate pneumothorax or tracheobronchial injury. 

Respiratory status can change rapidly following traumatic injury. Frequent reassessment is essential to identify deterioration and guide treatment decisions. SpO2 trends are as important as individual readings — a dropping SpO2 warrants immediate reassessment and intervention.

Remember: Apply the pulse oximeter early and watch the trend. Early recognition of respiratory compromise can prevent life-threatening deterioration.