# Counting Respirations



## bama_j_ram (Feb 7, 2010)

I am in the EMT Basic program right now and i had a question for you veterans out there. Now as a newbie, i have a little bit of a hard time with counting respirations by looking at the chest. I was wandering if any of you count resp rate by using your stethoscope and act like you are listening to there heart, but really be counting resp rate. Because i can hear breathing way better that way.
                          Thanks for any feedback,
                                                bama_j_ram


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## lightsandsirens5 (Feb 7, 2010)

That works.

If they are wearing an NRB, you can count by watching it fog up when they exhale.

I like to get pulse and resps at the same time. I grab their wrist with my right hand, lie it across their abd, and count pulse in my head and resps on my left hand. Don't even think about the number with the resps, just every time your hang goes up and down, stick out another finger. Count for however long they teach you and multiply. This method also eliminates having to sit there and stare at the pt for 15-30 seconds while they wonder what you are doing.


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## bama_j_ram (Feb 7, 2010)

i appreciate that, never heard about the hand across the abdomen while taking the pulse. but if you think i will get an accurate resp rate from auscultation, then that is great, cause i can hear so good that way
                       thanks a ton,   bama_j_ram


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## Hockey (Feb 7, 2010)

Try to place your hand on their shoulder facing downward.  You can feel the chest rise and fall.  Not only that, the patient may look at that as a comfort/caring touch.  Twice the benefit


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## mycrofft (Feb 7, 2010)

*Step 1: Loudly demand that they breath normally......*

Pulse, resp at the same time.

The receiving doc will be happier with "Unlabored, *about* 18/min and reg", or "labored, *about* 18 to 24/min with dim BS left lower",  than "17.5/min", period.

Unless the doc is a stickler and has bad experience with EMT's.


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## VentMedic (Feb 7, 2010)

Respiratory rates change especially if it is the patient's first time in an accident or having a serious illness and the sirens are blasting while the ambulance is speeding to the hospital. Air exchange will then be a huge factor as quality of each breath should be assessed. A rapid respiratory rate may not mean "hyperventilation" if there is very little gas exchange or the patient is actually "hypoventilating" with rapid shallow breaths that move very little air. This could be from a disease process, supine patient in a poor position for air exchange, anatomical deformity such as scoliosis or kyphosis, obesity and pain.


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## emt_irl (Feb 7, 2010)

on scene initially id do the pulse check while checking resps with the patients arm over their chest. i was though that since my first responder days.

but inside the ambulance id usually go for counting the fog on the o2 mask be it nrb or simple etc..


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## emtstudent04 (Feb 7, 2010)

*Counting resp and pulse check*

I use the grab the wrist and put it over the patients chest that seems to work the best for me. Just make sure that you always tell the patient what ur going to do cuz if u dont they might freek out and pull away from u or think that ur touching them the wrong way and if they think that it can turn out to cause more probs like battery and u dont want that at all. So always always communicate with the patient and let them know exactly what ur going to do EVERYTIME. Good Luck!


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## exodus (Feb 7, 2010)

emtstudent04 said:


> I use the grab the wrist and put it over the patients chest that seems to work the best for me. Just make sure that you always tell the patient what ur going to do cuz if u dont they might freek out and pull away from u or think that ur touching them the wrong way and if they think that it can turn out to cause more probs like battery and u dont want that at all. So always always communicate with the patient and let them know exactly what ur going to do EVERYTIME. Good Luck!



Problem with that, as soon as you tell them you're counting their breaths they will think about their breathing and will skew your results.


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## emtstudent04 (Feb 7, 2010)

exodus said:


> Problem with that, as soon as you tell them you're counting their breaths they will think about their breathing and will skew your results.



Ya thats true. what i do is tell them im going to check ur pulse and thats when i grab there wrist and put it over there chest and its worked everytime for me unless an engine has arrived and done the vitals for me.


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## emt_irl (Feb 7, 2010)

exodus said:


> Problem with that, as soon as you tell them you're counting their breaths they will think about their breathing and will skew your results.



thats the only time your allowed lie to your patient.. tell them your checking pulse when your really doing resps.


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## MMiz (Feb 7, 2010)

Practice, practice, practice.  I usually took a patient's pulse for 30 seconds, and spent the next 30 seconds counting respirations by looking for the rise and fall of the chest.  Of course you don't tell your patient you're counting respirations, or else they'll become sell conscious and you won't get an accurate result.  I've had nurses in the clinical setting do it by listening with their scope, but with practice you should become adept at taking vitals in the pre-hospital setting.


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## lightsandsirens5 (Feb 8, 2010)

emtstudent04 said:


> I use the grab the wrist and put it over the patients chest that seems to work the best for me. Just make sure that you always tell the patient what ur going to do cuz if u dont they might freek out and pull away from u or think that ur touching them the wrong way and if they think that it can turn out to cause more probs like battery and u dont want that at all. So always always communicate with the patient and let them know exactly what ur going to do EVERYTIME. Good Luck!


 

Thats why I go with the arm over the upper abd. No pt wigging out on you, upper abd usually moves more than enough to feel.



> Problem with that, as soon as you tell them you're counting their breaths they will think about their breathing and will skew your results.


 
Again, same reason as above. I have yet to see a pt perceive their arm across their abd as a threat. Neither have any of my crewmates who use this method.


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## CAOX3 (Feb 8, 2010)

bama_j_ram said:


> I am in the EMT Basic program right now and i had a question for you veterans out there. Now as a newbie, i have a little bit of a hard time with counting respirations by looking at the chest. I was wandering if any of you count resp rate by using your stethoscope and act like you are listening to there heart, but really be counting resp rate. Because i can hear breathing way better that way.
> Thanks for any feedback,
> bama_j_ram



I never really thought about it.  I guess as you go it will just be something you note as your assessing your patient.

Im usually more concerned with the quality of the respiration.


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## exodus (Feb 8, 2010)

CAOX3 said:


> I never really thought about it.  I guess as you go it will just be something you note as your assessing your patient.
> 
> Im usually more concerned with the quality of the respiration.



Same. I can usually estimate Resps pretty quick. And if they are way out of wack and have Sob, it's extremely easy to count the resps. 

Student  - So you running with r/m?


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## emtstudent04 (Feb 8, 2010)

i wish i was running with r/m. im trying to get hired somewhere right now but no one is hiring right now. i have been doing ride alongs with fire departments to gain more experiance till i get hired somewhere. what about you??


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## exodus (Feb 8, 2010)

emtstudent04 said:


> i wish i was running with r/m. im trying to get hired somewhere right now but no one is hiring right now. i have been doing ride alongs with fire departments to gain more experiance till i get hired somewhere. what about you??



Working with a private company. I'd wait as long as  could, and try to get on with AMR or R/m.


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## emtstudent04 (Feb 8, 2010)

Ya i wanna work for either company mainly r/m. But right now the way the economy is ill take any company and just keep trying with AMR or r/m.


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## mycrofft (Feb 8, 2010)

*WHen they get breath conscious, I tell em about purple elephants*

"So don't think about purple elephants".
"What?"
"Shh. Just don't think about purple elephants".
"What?"
"SO what did you think about?". 
"Uh purple elephants". 
Not only do they stop thinking about their resps, they often relax a bit.
Or demand to be let out right then and there.


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## MrBrown (Feb 9, 2010)

mycrofft said:


> "So don't think about purple elephants".
> "What?"
> "Shh. Just don't think about purple elephants".
> "What?"
> ...



When I was tripping of my nut because the doc dosed me up on promethazine in the brief periods I was not unconscious I clearly remember dancing on the ceiling with purple elephants and a yellow dog

And nobody believe me that they didn't exist!!


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## EMSBLONDIE24 (Feb 10, 2010)

Some people are very obvious "belly breathers," in which case you can simply watch their abdomen rise and fall. This is the case with many of my patients, I can count respirations without needing to make contact. If the respirations aren't easily visible, I place the patients arm over their chest with my hand wrapped around their wrist to feel the rise and fall of their chest. The patient then believes you are taking their pulse. Sometimes the physical contact is calming as well to the patient...


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## emtstudent04 (Feb 10, 2010)

EMSBLONDIE24 said:


> Some people are very obvious "belly breathers," in which case you can simply watch their abdomen rise and fall. This is the case with many of my patients, I can count respirations without needing to make contact. If the respirations aren't easily visible, I place the patients arm over their chest with my hand wrapped around their wrist to feel the rise and fall of their chest. The patient then believes you are taking their pulse. Sometimes the physical contact is calming as well to the patient...




Well put thats exactly what i do. its just something that works well for me but everyone does things differently and im always open for learning something new and different.


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## demure (Feb 13, 2010)

During my EMT clinical hours I made the mistake of staring at a patients bare chest while counting respirations. The second he noticed me doing so, he shot me the a very angry look, because he thought I was checking him out. 

Nowadays I put a hand on their upper chest and tell them what I'm doing or try to get it with pulse... but I'm bad at multitasking.


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