Respiratory Rate

[mbuchanan0119]

I'm about ready to start doing clinicals and ride-time in my EMT-B class, but I'm having some trouble recording Respiratory Rate.

I know all the normal respiratory rates and how to take it, I just have trouble seeing them breathing sometimes. (especially if they have a baggy shirt on) My teacher says that when taking respiratory rate you should try to do it with out them really knowing your doing it. Apparently he says that Pts may change their rate of breathing if they know that your taking it.

Is it normal to maybe place your hand on there back to feel for breaths if your having trouble visually seeing the inspiration and expiration?

I know its sort of a silly question I'm just getting nervous cause I'm gonna be starting clinicals soon and don't wanna make a fool of myself. I'm doing great in my class getting a 96% just having a little trouble.

Thanks Mike

[HERBIE1]

Placing your hand on a chest is indeed one way of checking respirations. Check the abdomen- sometimes it's easier to see it rise and fall vs the chest. Depends also on the depth of their respirations, if they are a mouth breather- like a baby, COPD'er, or someone who is dyspneic. Keep at it- you'll get it. Just like anything else, it takes practice. Listen to as many chests as you can. As an aside- one of the hardest things to learn are breath sounds, and until you know all the variations of "normal", it will be hard to tell what an abnormal sound really is.

One suggestion, try looking at as many folks as you can and see if you can count their respiratory rate. Listening to lung sounds you can also get their respiratory rate AND their heart rate.

Your instructor is correct BTW- if people know you are watching them, they will alter their breathing patterns. Depending on the situation, I try to gauge the person's breathing as one of the first things I do. Walk into a room, look at the person- especially if they do not see you yet- and you can get a pretty good quick baseline reading. As soon as you start interacting with them, their anxiety causes them to speed up.

[DwayneEMTP]

I created a post earlier, that might have actually had something interesting in it (Yeah, probably not) but nuked it somehow before I got it posted. I don't have time to recreate it now, but I wanted to say a couple of things....

First. I'm not of the crowd that believes there's no such thing as a stupid question. I've heard millions of them. (Why do I have to stay awake during clinicals even when we don't have a pt? As he uses his book for a pillow) But not only is your question not stupid, it is not even close to being silly. I'll tell you why.

I have never known anyone to the best of my knowledge that was good at hands off resp rates on those patients that aren't at least slightly obvious. It's hard. Sometimes you simply have to put your hands on the patients to get it. I wish I had a tricky, reliable, tried and true answer, but I've never heard of one. Sometimes it's easier to watch the stomach, sometimes easier and more pleasant to watch the high point of the breasts, sometimes you can see them breathing through their pursed lips, but not always.

The other thing I love about this question is that 99% of basics have this question coming out of school yet only about 5% (These numbers come from a very famous study that involved a gazillion subjects, so I'm confident that they're accurate. And no, I can't remember the name of the study. It was really famous though. The doc in the ER even told me about it. So famous so that if I need to cite it for you...well, just forget it then.) will ask the question. The vast majority of those that choose not to ask are simply going to put 12 for all of their 'well' patients, and 18-20 for all of their 'sick' patients. They are going to lie, because they don't have the balls to learn.

It takes guts to ask a question that you think people are going to think is stupid on a subject that seems as if it should be so friggin' easy! But it's not. But how can that be?? Everyone else can do it, right? Yeah, not so much. Most everyone else pretends to do it...and that should be unacceptable.

You're off to a good start brother....Welcome to the family!

Dwayne

[emtannie]

Dangit Dwayne, once again you posted so eloquently that there is really nothing else to add!

0119, you obviously want to do well on your clinicals, and asking questions is a great way to go. As Herbie and others here have said, and I can't repeat it enough, PRACTICE, PRACTICE, PRACTICE... if you have relatives and friends willing to be guinea pigs, practice on them. Do you have relatives who smoke, are elderly, or asthmatic, who would be willling to let you take vital signs on them?

When I was on my first clinicals (many many many many years ago... lol) I was having trouble taking BP's... a medic I was with let me practice on him until both his arms were bruised. Every time I deal with a student, I remember the patience that medic had with me, and I hope that I can have that patience with others.

Ask away! And all the best on clinicals!

[DwayneEMTP]

... Listen to as many chests as you can. As an aside- one of the hardest things to learn are breath sounds, and until you know all the variations of "normal", it will be hard to tell what an abnormal sound really is.

One suggestion, try looking at as many folks as you can and see if you can count their respiratory rate. Listening to lung sounds you can also get their respiratory rate AND their heart rate. (I forgot all about this and it's the best one of all! Dwayne)

All of that is such awesome advice! I listen to every patients lung sounds unless there is something preventing it, (time restraints, higher priorities, etc) for this very reason. When I was a basic I was so excited that I got to follow the RT around and listen to all of these sick people! I was going to know every unhealthy lung sound known to man!! He had me listen to this one old man who looked sickly and it sounded like there was a friggin' tornado in his lungs every time he breathed. I said, "Holy crap! What was up with that guy!?!" And he said, "Those were normal sounds...hehehe." He was teaching me that knowing sick sounds didn't mean shit when I didn't know normal...It was a great lesson.

Seems like I'm just following you around Herbie. If I wasn't in such a hurry to post and get gone I could have skipped my post all together. I think you hit all of the big stuff.

Dwayne

[HERBIE1]

All of that is such awesome advice! I listen to every patients lung sounds unless there is something preventing it, (time restraints, higher priorities, etc) for this very reason. When I was a basic I was so excited that I got to follow the RT around and listen to all of these sick people! I was going to know every unhealthy lung sound known to man!! He had me listen to this one old man who looked sickly and it sounded like there was a friggin' tornado in his lungs every time he breathed. I said, "Holy crap! What was up with that guy!?!" And he said, "Those were normal sounds...hehehe." He was teaching me that knowing sick sounds didn't mean shit when I didn't know normal...It was a great lesson.

Seems like I'm just following you around Herbie. If I wasn't in such a hurry to post and get gone I could have skipped my post all together. I think you hit all of the big stuff.

Dwayne

Thanks, Dwayne. I think we operate on similar wavelengths. Not a good sign for you, bud. LOL

Often if a patient has a funky or weak pulse, I go back to the chest a 2nd time to listen and confirm a pulse rate. Maybe I'm getting hard of hearing in my old age...

In training, I recall listening to poor quality tapes of abnormal lung sounds and thinking "what the hell am I listening to"? The rales sounded like wheezes which also sounded like rhonchi. None of it made sense until I started hearing it in the context of a live patient, watching their respiratory patterns and rates, and correlating their signs and symptoms with what I was hearing. Suddenly the light bulb came on, and it all started to come together. I can't tell you how many times I have found unexpected rales in the posterior bases of a patient who I thought was clear. All it takes is one person in pulmonary edema who codes and you cannot revive them to be REALLY aware of their respiratory status and get a good baseline set of lung sounds.

Quick- but related story- to toot my own horn. A couple weeks ago, my next door neighbor(actually their babysitter) asked if I could come over and take a look at their 10 year old kid. Seems he suddenly developed chest pain, and was crying. Mom was on the way home- ETA about 15 minutes, and asked the sitter if I could come over and check on him. Normal, healthy kid but scared, and to make a long story short, I did a BP, pulse, and quick exam. Everything seemed to be fine- anxiety was my thought. I also checked his lung sounds- clear a bell- BUT- I also heard something else. I picked up a heart murmur. I repeated the lung sounds, and yep, something was there.

Mom shows up, says they had a similar episode a couple weeks ago, had it checked out, and everything was benign. She also mentioned that the doctor noted a murmur, but felt it was nothing to worry about. I was VERY glad mom said this since it validated what I heard, so I then felt it was OK to mention that I heard the murmur as well. She thinks the kid is freaked out because he heard the doctor say he had a "problem" with his heart. She packed him up, and went to the hospital. Apparently the doctor did a full cardiac workup- echo, EKG, Xray, blood work, etc, and they were supposed to follow up with a cardiologist as a precaution but everything seemed to be OK. Still unsure if the pain was related to the murmur or simply anxiety (my guess).

Now I do recall learning about assessing heart sounds, but obviously there is little use for that in prehospital care, and it's certainly not something I listen for.

The point of all this- besides an ego stroke- LOL- is that unless I understood what I was "supposed" to hear, I would have never realized anything was wrong.