Taking Resp. during transports.

[thelawisforall_MT.]

Hi everyone,

What methods do you use to take resp. while transporting pt's. in an ambulance. I'm having difficultly assessing them while in-route to the hosp. It's too noisy for a steth. and a lot of times I can't see the pt's chest rise or fall. I have put my hand on their chest to feel for the rise and fall, but it still is pretty difficult. any technique that you can share would be great. Thank you for your time.

Cara.

[hfdff422]

Depends on the patient- On some I watch their belly at the belt line, others you can see their muscles on their chest or at their collar bone, and still others have slight nostril or mouth movements. If it is not obvious, and they are conscious then it is probably OK. I would be concerned that you are unable to hear anything with a stethoscope. Even in the healthiest people, I can hear some sort of lung sounds while the ambulance is moving. I find the best place to get sounds in difficult environments is their sides- especially on women. What kind of stethoscope do you use?

[rocket]

I agree it can be tough to get a good fix on respirations during transport. This is especially true for patients that (at a glance) appear to be breathing "normally" (no obvious accessory muscle use, regular rythmn, etc). These tips are for "normal" breathers:

If the patient is tolerant** I prefer to use my hands to help get a feel for not only the rate but also a little better "picture" of the depth and regularity or respirations. Try laying the palm of your hand over the area that roughly equates to the medial-anterior section of the patient's diaphragm (aim for the very bottom of the ribcage/top of the abdomen; make the xyphoid process the "top" of the area you lay your palm over). Use a light touch. You may have a better feel for movement here than up higher on the chest .

If you have a talkative patient then it can be even harder to get an accurate count. In these cases sometimes I will "pace" the patient's breathing with my own. If I determine that the patient is breathing with a regular rythmn (usually I can get a basic assessment of reguarity in 4-6 resps) then I try to match my breathing to theirs. If the patient starts to talking after this quick assessment I will just keep my breathing at that pace and count it out for 30 seconds and do the math from there. Of course it is always preferred to get the real measurement off of the patient but if you've got somebody in the back who won't be quiet for 30 seconds then this estimate can come in handy. :wink:

Hope that helps,

-Trevor

**As for a "tolerant" patient: Laying a hand on someone (and then leaving it there) without informing them of what you are doing may make them uneasy. An uneasy patient may turn into an untrusting, uncooperative, or argumentative patient; such a patient may make the rest of your assessment and history taking more difficult. You can generally get away with this maneuver by sneaking it into your physical exam or just tellng them what you are about to do.

[PRPGfirerescuetech]

Hi everyone,

What methods do you use to take resp. while transporting pt's. in an ambulance. I'm having difficultly assessing them while in-route to the hosp. It's too noisy for a steth. and a lot of times I can't see the pt's chest rise or fall. I have put my hand on their chest to feel for the rise and fall, but it still is pretty difficult. any technique that you can share would be great. Thank you for your time.

Cara.

1. Get a better scope

2. Toss a pen on their chest. You can see the changes in its movement at that pointe.

PRPG

[thelawisforall_MT.]

Thanks for your replies, they have been helpful.

Cara

[GAmedic1506]

You phrased your question as just being able to assess respirations while in back of the unit, not towards assessing respirations to make a treatment decision/diagnosis (yes i said diagnosis -- gasp). This is where you need to go a little old school. There was a time not to long ago when we didnt have pulse-oximetry, capnography, or fancy magnified stethoscopes. The question that you really need to answer is, "Is my patient in Respiratory distress or not ?" You should be able to determine this without any of the aforementioned equipment. If they are in distress, treat the symptoms. You should have done a good primary assessment before you took off, and you should be able to tell if the patient that is in distress is improving or worsening without hearing a single lung-sound. I am in no way saying you shouldnt use technology, or shouldnt reassess your patients frequently, but you should be able to make that assessment without expensive equipment. The use of accessory muscles, the presence of retracting / nasal flaring, and the patient's LOC are far more useful assessment tools than trying to figure out if that is a wheeze or a rhonchi in the lower left lobe of a 300lb patient.

[thelawisforall_MT.]

I should have been more specific with my question. I live in rural Montana and a lot of the pt's. we have are transports from one hospital to another. Time, anywhere from 1 hour to 3 hours away. So the breathing with these pt's. are not labored, but shallow breather's, so thus my question before mentioned. I have only been doing this now for about 2 months and not have had the pleasure of dealing with a pt. with breathing difficulty, which would be easier to see the resp. rate and quality, which would tell me what interventions that are required to be done. Essentially, making sure that my reassessments are acurate throughout the transport.

Cara

[Ace844]

I should have been more specific with my question. I live in rural Montana and a lot of the pt's. we have are transports from one hospital to another. Time, anywhere from 1 hour to 3 hours away. So the breathing with these pt's. are not labored, but shallow breather's, so thus my question before mentioned. I have only been doing this now for about 2 months and not have had the pleasure of dealing with a pt. with breathing difficulty, which would be easier to see the resp. rate and quality, which would tell me what interventions that are required to be done. Essentially, making sure that my reassessments are acurate throughout the transport.

Cara

Please do a search for some more information on this subject. There is a wealth of clinical information, assessment things etc.. in realtion to the respiratory system, and various disorders here. I believe this may be quite beneifical to you. Also, you should be careful of the wording you use in your posts as one may get the wrong impression about you and what your trying to sya. For example:

So the breathing with these pt's. are not labored, but shallow breather's, so thus my question before mentioned.

Just reading this leads me to believe that you have no idea how respiratory distress presents, and or that the pts you are 'transferring' may have medical conditions which would cause them to have 'emergent conditions' which may present as 'shallow breathing'!!! Meanwhile I'm going to continue to do some more research and request help from others on the streets here.. Best of luck,

ACE844

[whit72]

Thelawisforall wrote:

So the breathing with these pt's. are not labored, but shallow breather's, so thus my question before mentioned

ACE wrote:

Just reading this leads me to believe that you have no idea how respiratory distress presents, and or that the pts you are 'transferring' may have medical conditions which would cause them to have 'emergent conditions' which may present as 'shallow breathing'!!! Meanwhile I'm going to continue to do some more research and request help from others on the streets here.. Best of luck,

Boy.....I knew that statement wasn't going to go uncontested.... LOL

[Ace844]

Thelawisforall wrote:

So the breathing with these pt's. are not labored, but shallow breather's, so thus my question before mentioned

ACE wrote:

Just reading this leads me to believe that you have no idea how respiratory distress presents, and or that the pts you are 'transferring' may have medical conditions which would cause them to have 'emergent conditions' which may present as 'shallow breathing'!!! Meanwhile I'm going to continue to do some more research and request help from others on the streets here.. Best of luck,

Boy.....I knew that statement wasn't going to go uncontested.... LOL

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