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Accessory Muscle Breathing, Agonal Breathing, Apneustic Breathing, Asterixis, and Biot's Breathing


Accessory Muscle Breathing
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Definition: Utilization of muscles not typically involved in the resting phase of breathing to aid in respiratory effort. This occurs when the primary muscles of respiration (diaphragm and intercostals) are insufficient to meet the body's oxygen demand.
Mechanism: Involves the muscles of the neck, shoulders, and chest, such as the sternocleidomastoid, scalene, and pectoralis minor, to facilitate inspiration under conditions of respiratory distress.
Clinical Significance: Indicates increased work of breathing and is commonly observed in conditions like chronic obstructive pulmonary disease (COPD), asthma exacerbations, and acute respiratory distress syndrome (ARDS).

Agonal Breathing
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Definition: A pattern of irregular, gasping breaths that often occurs in the setting of critical illness or near death.
Mechanism: Result of the brain's attempt to restore breathing after a period of hypoxia or anoxia. It is not effective ventilation.
Clinical Significance: Considered a sign of significant brain dysfunction and is often observed in cardiac arrest situations before complete cessation of breathing.

Apneustic Breathing
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Definition: A pattern characterized by a deep, gasping inspiration with a pause at the peak followed by a brief, insufficient release.
Mechanism: Thought to result from injury or dysfunction in the pons or upper medulla, which affects the respiratory centers of the brain.
Clinical Significance: Indicates brainstem injury and is often seen in patients with traumatic brain injuries or strokes affecting the lower brainstem.

Asterixis
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Definition: Not a breathing pattern but a neurological sign characterized by a flapping tremor of the hands when the wrists are extended, often associated with metabolic encephalopathy.
Mechanism: Believed to be due to abnormal function of the diencephalic motor centers that regulate tone.
Clinical Significance: Commonly associated with liver failure (hepatic encephalopathy) but can also be seen in renal failure and CO2 retention states.

Biot's Breathing
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Definition: A pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea.
Mechanism: Associated with damage to the medulla oblongata due to strokes, trauma, or pressure changes.
Clinical Significance: Often indicates severe central nervous system damage and is observed in conditions such as meningitis or severe brain injury.

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