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Respirations

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What is the best way to count patient respirations? I know to watch for chest rise and fall but some patients don't always have visible rise and fall.

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Posted · Report post

Hand over the diaphragm.

Sent from my A500 using Tapatalk 2

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Posted · Report post

etCO2 waveform.

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Posted · Report post

Hold their wrist as in taking pulse. That will keep them from altering their resp rate .

If they know your counting chest rise they won't breath normally.

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I watch for nostril flare. Sometimes, it you have a sheet or a blanket on their chest, the folds will move too. This is good from the attendants chair because then they are not aware they are being watched. I totally hear you about chest rise and fall.

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etCO2 waveform.

Cheater! :ph34r:

Sent from my SGH-T989D using Tapatalk 2

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Respirations are useful for reporting your vital signs. However, the point that should be looked at is if the respirations are adequate for survival of the cells. This along with cardiac perfusion should be monitored much more than the number of breaths per minute. Waveform capnography is cool, but in the initial stages of patient assessment, are the respirations, whatever they may be, adequate enough?

Otherwise, to answer your inquiry, all previous posters have garnered through experience how to count respirations by different techniques, All are good, so try them out and figure what best works for you.

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Most useless parameter in emergency medicine.... :bonk:

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I acutally know similar articles but still disagree.

Respiratory rate does give you an very limited view of the patients respiratory condition as it is directly linked to a parameter that is only very rarely measured in an non-intubated patient: The tidal volume.

Only by the combination of both we have a -more or less- valid view of the -theoretic- oxygenation situation that -might- arrive in the patient. The RR can be measured by a trained monkey...The tidal volume is very often measured wrong or not at all....

The main problems with high -or low- respiratory rate is not the problem of the rate itself (although it of course contributes to the oxygen demand) but the oxygenation deficiency that is a result of it.

We are meanwhile in a position to monitor this oxygen deficiency much closer and with much better tools than we did in when main study that "proved" a link between chance to arrest and RespRate was done (Fieselmann, 1993).

In times were prehospital&ED BGA is becoming more and more of a standard -contrary to the wards- we should not trust a parameter that has a "unknown" variable in it....

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Posted · Report post

You must admit that a respiratory rate of 30 is indicative of an issue as opposed to a rate of say 16, as is a rate of say 6

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Completly true..But it still gives you nothing without a lot of Hx and some guesses..... I know patient having a resp of 30 for 25 years...without issues that are anyhow relevant for emergency medicine most of those 25 years.

On the other hand: If I (who has a normal RR of 6-8) would have a Resp of 30 something is reallllllly wrong...

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Yeah, and I've also known little old ladies who have had a heart rate on the 30-40s for years with no ill effects. Or my father whose resting BP was usually 90/50. We didn't put the LOLs on a pacer, or give my dad a fluid challenge. That doesn't mean that we should invalidate every vital sign taken just because the minority of people are outside the norm. This is why we obtain a patient history in the first place.

We're expected to be able to use our brains when we assess a client, not just disregard a vital sign because we don't like what it tells us and getting a patient history is just common sense.

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We're expected to be able to use our brains when we assess a client, not just disregard a vital sign because we don't like what it tells us and getting a patient history is just common sense..

Thank you!!!

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Completly true..But it still gives you nothing without a lot of Hx and some guesses..... I know patient having a resp of 30 for 25 years...without issues that are anyhow relevant for emergency medicine most of those 25 years.

On the other hand: If I (who has a normal RR of 6-8) would have a Resp of 30 something is reallllllly wrong...

Uh, that's why assessment of respirations includes more than just rate and tidal volume. Rate, Rhythm/Pattern, Effort/Quality, and Depth, combined with history

Similar to pulse Rate, Rhythm, Quality or skin Color, Temperature, Moisture, all having to be combined with history.

I don't understand how respirations are so much different? (Respirations meaning an evaluation on the different qualities of respiration, not just rate or just depth etc)

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To answer the original question, when a patient show little or no visible chest moves, I can put my hand on the diaphragm or lower, on the belly. That works very well. Or else, if I don't want to have physical contact I look at the clavicles and listen to the breathing sounds.

You can combine many things to be sure, but personally I don't like the patients to know I'm checking their breathing, they act less natural.

I agree with Anthony that what matter isn't just one parameter, but all the coherent signs of a distress. I tell my fellow EMTs that we're always looking for a "body of proofs" or a "set of signs".

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I would recommend that you try laying the patients arm across their chest area while doing their pulse, count for 30 secs for pulse, then another 30 for resps & mutiple x2.

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Most useless parameter in emergency medicine.... :bonk:

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For me, I always try to see if you can see the chest rise and fall, and yes some patients might not have a very noticable chest rise and fall, or they might have some very thick/multi-layer clothing on. If you are sitting on the captain's chair or bench seat you can see respirations looking at the clavicle area, you should see some movement. Also, look at the stomach, some patient's stomach will rise and fall with their breathing. Just suggestions.

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Uh, that's why assessment of respirations includes more than just rate and tidal volume. Rate, Rhythm/Pattern, Effort/Quality, and Depth, combined with history

Similar to pulse Rate, Rhythm, Quality or skin Color, Temperature, Moisture, all having to be combined with history.

I don't understand how respirations are so much different? (Respirations meaning an evaluation on the different qualities of respiration, not just rate or just depth etc)

The question posed at the beginning of the threat was dedicated to repiratory rates, though, and that`s what krumel meant, I think.

And the respiratory rate alone, I gotta agree there with krumel, doesn`t poses such an impressive or precise marker (which is what krumel meant I guess).

Fair enough, very low and very high most likely indicate a problem in a patient - but it`s not "accurate" as let`s say SpO2 or RR, which pose a variety of interpretations.

I`m only talking `bout respiratory rate as the quantitative date in itself here, not about possible lung sounds, position of the conscious patient while breathing, possible pathologic patterns, etc.

Apart from that, although skin-colour, temperature and moisture might be connected to your discovery of a pahologic pulse, they may be totally unrelated to that particular vital measurement and attached to an underlying or secondary problem.

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One of the hardest vitals to get!!

If I can't see much chest rise due to clothing, I may casually/ lightly rest my hand on the pts clavicle. I do this while I am listening for chest sounds or other vitals. If the pt is distracted between me and my partner, they are not paying attention to the back of your wrist on their clavicle. Still use SpO2 in combination, just to give idea how things are going. Respiration is one of the vitals the hosp asks for when we do a call-in.

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As has been indicated earlier, respiratory rate is an often missed vital sign that can be a subtle indicator of a patient who is very unwell (the same goes for temperature) however I have seen this is not routinely done in my experience including in hospital

There is benefit to recording respiratory rate in all patients at least initially and then continuing to do so in those patients where clinical judgement indicates it may be helpful

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The question posed at the beginning of the threat was dedicated to repiratory rates, though, and that`s what krumel meant, I think.

But then his statement would be almost pointless, since you're never going to look at respiratory rates just by itself. Might as well throw out pulse quality. If you were to look at it just by itself, it's not very useful (some patients naturally have weak pulses...doesn't mean anything bad). But because the pulse quality by itself doesn't tell us much, we don't then imply that it's a useless sign.
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But then his statement would be almost pointless, since you're never going to look at respiratory rates just by itself. Might as well throw out pulse quality. If you were to look at it just by itself, it's not very useful (some patients naturally have weak pulses...doesn't mean anything bad). But because the pulse quality by itself doesn't tell us much, we don't then imply that it's a useless sign.

very well said ! doctors look at every piece to create the whole puzzle why shouldnt we? it could be that one little thing that we DONT look at that could be the cause and by not looking into it we arent taking care of our patients

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