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During normal inspiration, the chest rises and the abdomen moves outward as a result of contraction of the downward moving diaphragm. Conversely, during inspiration in a patient with inspiratory muscle fatigue, the chest ______ due to accessory muscle contraction and the abdomen paradoxically moves ________ because of upward movement of the weakened diaphragm. This pattern of breathing is said to be paradoxical and indicates diaphragmatic weakness or fatigue

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