Breathing part 2

Following an initial review, the FLAPS TWELVE mnemonic can be used for a more in-depth assessment of Breathing;

  • Feel – Feeling the chest for equal rise and fall indicating good air entry and both lungs are rising. Feeling can also help identify if there are any deformities, swelling, crepitus, or subcutaneous emphysema.
  • Look – Again, a visualisation of the chest will indicate if there is good and equal rise and fall, and any other obvious injuries or abnormalities.
  • Auscultate – Auscultating all lobes of the lungs will indicate any pathophysiological events happening within. Is there bilateral and equal air entry, is there any wheezing/crackles/rales/rubs/abnormalities?
  • Percuss – Percussion helps identify if there is normo-resonance, hyper-resonance, or hypo-resonance. If hyper, this may indicate that there is excessive air built-up within the area of percussion. If hypo, then this may indicate that there is a build-up of fluid/blood within the area of percussion.
  • Search – A search around the sides of the chest, under the armpits, and of the back may reveal a hidden wound or deformity.
  • Trachea – Feeling the location of the trachea can help identify if there is a potential tension-pneumothorax happening as it will be displaced from centre.
  • Wounds – Searching for any wounds around the neck or chest that may be affecting Airway and Breathing.
  • Emphysema (subcutaneous) – Is there any subcutaneous emphysema forming around the chest or neck areas indicating air escaping from the lungs/tracheas through injury/perforation.
  • Larynx – Is the Larynx in-tact, if it is injured or deformed then it may cause some airway compromise.
  • Veins (jugular distention) – Is there evidence of jugular vein distention, indicating a tension pneumothorax.
  • Evaluate – Put all the information you have gathered together, is there any deficits or injuries affecting the patients’ breathing?