A trauma patient may have a clear airway and adequate oxygen available but still be unable to move air effectively. Without adequate ventilation, oxygen cannot reach the alveoli and carbon dioxide cannot be removed — this can rapidly lead to respiratory failure.
Providers should recognize the signs of inadequate ventilation:
- Slow, rapid, or irregular respirations
- Shallow breathing
- Poor chest rise
- Increased work of breathing
- Altered mental status
- Rising EtCO₂
Normal SpO₂ does not always indicate adequate ventilation.
Common trauma causes of inadequate ventilation include:
- Traumatic brain injury
- Airway obstruction
- Chest trauma
- Pneumothorax
- Flail chest
- Spinal cord injury
When inadequate ventilation is identified:
- Open and maintain the airway.
- Administer supplemental oxygen.
- Assist ventilations with a BVM when respiratory effort is inadequate.
- Reassess breathing effectiveness continuously.
Oxygenation and ventilation are not the same thing. A patient can have oxygen available and still be unable to ventilate effectively. If the patient is not moving air, oxygen alone is not enough.