When you breathe with your neck, you overwork your accessory breathing muscles. What’s supposed to help secondarily is now doing the primary job of your diaphragm the muscle responsible for your inhale and exhale. When the diaphragm steps back, it can’t return to its dome shape under the ribs. Instead of your ribs coming down and in on the exhale, they stay flared out. Here’s what should happen: on the inhale, the diaphragm flattens and expands your ribs. On the exhale, your ribs should come bac

Accessory Muscle Use Your decision to intubate a patient depends on a few things: 1) Oxygenation 2) Ventilation 3) Work of breathing 4) Cough/Secretion Clearance A patient with hypoxia without accessory muscle use can have a few different things going on: 1) Normal lung compliance --> consider shunt as a cause of hypoxia. 2) Neuromuscular weakness --> these patients might not be able to mount a strong accessory muscle use 3) Not that sick/distressed If I see a very hypoxic person without accesso