LOOK (for rise and fall of the chest), LISTEN (for sounds of breathing), and FEEL (breath on your cheek) for indications of trouble breathing (as noted for airway previously).

Respiration rate (breaths per minute) and quality (shallow, labored, etc.) should be noted.

Indications of respiratory distress include:

- Breathing that is progressively difficult
- Decreased breathing sounds
- Distended neck veins
- Opposed to “progressive” respiratory distress
- Hunched over; they need to be in the “position of comfort”
- Agitation due to a lack of oxygen
- High pulse

This is the “R” of MARCH PAWS.