# Vital signs (pulse + respirations)



## medichopeful (Oct 3, 2009)

We were taught that when taking vital signs, we should take the pulse, then immediately begin counting respirations without telling the patient (so they don't begin to change their rate).

Though I haven't taken very many sets of vital signs, I have been having a little trouble with this.  I realize it is a very basic thing, so I feel pretty stupid posting it here.  But I guess it's better to ask for help and feel like an idiot than not ask for help and do something wrong.

I don't have any problem _finding _the pulse or seeing the respirations (except sometimes).  What I have a problem with is keeping track of both.  Because what will happen is, I will take the pulse for 30 seconds, then begin to watch respirations with my hand still where the radial pulse is.  I have to concentrate on counting respirations, which subsequently screws up my original count of the pulse.

Does anybody have any suggestions to get over this?  Did anybody have trouble with this when they first started?  Is it just something that I will get over when taking vitals becomes "second nature?"  Again, I realize that this is a pretty stupid issue to be having, but for some reason I'm having it.  Other than this simple issue, I haven't been having TOO much trouble with the class.  A few things here and there, but nothing major.

I have considered just taking the pulse once, recording it, and then taking the respirations while pretending I am taking the pulse a second time.  But the problem with this is, it is misleading to the patient.

Thoughts?


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## Lifeguards For Life (Oct 3, 2009)

medichopeful said:


> We were taught that when taking vital signs, we should take the pulse, then immediately begin counting respirations without telling the patient (so they don't begin to change their rate).
> 
> Though I haven't taken very many sets of vital signs, I have been having a little trouble with this.  I realize it is a very basic thing, so I feel pretty stupid posting it here.  But I guess it's better to ask for help and feel like an idiot than not ask for help and do something wrong.
> 
> ...



Easy, If the pulse is regular count the pulse for 30 seconds, and multiply that number by two. Then for the second half of the minute, count respirations for 30 seconds and multiply that number by two. In this manner in one minute you will have the pulse in beats per minute and the number of respiration in one minute.
Though if in those first 30 seconds, you find the pulse to be regularly irregular or irregularly irregular you will need to count it for a full minute. In that case palpate the pulse for a full minute, then just begin to count their respirations when you are done. If you don't draw attention to it your patient will not notice.


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## foxfire (Oct 3, 2009)

I had that problem too when I first started. So you are not dealing with a stupid issue.
One thing that I did was remember the pulse count and log that away in my mind as I was getting the resp while still holding the radial pulse. It took alot of practise, but once you do it enough times it will become second nature. 
I have seen the resp. change alot when they know that you are counting there breaths, so I don't let them know that I am doing it. I have never really thought about the idea of misleading the patient.
hope that helps.


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## medichopeful (Oct 4, 2009)

Lifeguards For Life said:


> Easy, If the pulse is regular count the pulse for 30 seconds, and multiply that number by two. Then for the second half of the minute, count respirations for 30 seconds and multiply that number by two. In this manner in one minute you will have the pulse in beats per minute and the number of respiration in one minute.
> Though if in those first 30 seconds, you find the pulse to be regularly irregular or irregularly irregular you will need to count it for a full minute. In that case palpate the pulse for a full minute, then just begin to count their respirations when you are done. If you don't draw attention to it your patient will not notice.



No no, I know HOW to do it.  The problem I have is remembering the first number while I get the second one.  Like foxfire said, it will probably just come with experience.  Thanks for the help, though!


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## medichopeful (Oct 4, 2009)

foxfire said:


> I had that problem too when I first started. So you are not dealing with a stupid issue.
> One thing that I did was remember the pulse count and log that away in my mind as I was getting the resp while still holding the radial pulse. It took alot of practise, but once you do it enough times it will become second nature.
> I have seen the resp. change alot when they know that you are counting there breaths, so I don't let them know that I am doing it. I have never really thought about the idea of misleading the patient.
> hope that helps.



Yeah, it will probably come with practice.  I'm still new at this, so I'm not used to it yet.

I don't really know if the idea of misleading the patient is a great thing to do, so I'm hesitant to do it.  though, I am misleading the patient by counting respirations while holding their wrist...


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## Dominion (Oct 4, 2009)

No need really, just get pulse for 30 secs, write it down on glove or on tape on your thigh, keep holding their pulse and start counting respirations.  The patient 99.5% of the time is not going to know whats up. However with experience (IFT is GREAT for this particular experience ) you will learn to get your pulse and resp at the same time, remember the two numbers, then grab your BP and write it all out.  When I worked IFT I took two sets of vitals (if possible) on every patient I touched, doing 9-15 runs a day.  After about a month I was very good at grabbing lots of info at once, just takes practice.  However I still forget answers to my assessment questions, i'll ask a patient the same question 2 or 3 times


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## Akulahawk (Oct 4, 2009)

You're not misleading your patient. You're just not letting them know you're counting their breathing rate. If they know you're doing it, they'll alter the rate... whether they realize it or not... because they become conscious (aware) of their breathing.


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## Shishkabob (Oct 4, 2009)

You're making it more difficult than it has to be.  Do the pulse, write it down, put you hand back on their wrist and do ventilations.  They will be none the wiser.


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## Akulahawk (Oct 4, 2009)

Linuss said:


> You're making it more difficult than it has to be.  Do the pulse, write it down, put you hand back on their wrist and do ventilations.  They will be none the wiser.


+10000 

This works. It really does. Try it...


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## Shishkabob (Oct 4, 2009)

Another thing you can do is include your pt in on their care.  Take their ventilatory rate, then ask them to remember a number for you. 

"Mr Smith, I want you to remember a number fir me, ok?  Remember 20"

this does several things.  They don't feel useless in what's going on and helps you guage their mental status just a little bit more.  

Much like asking a CVA pt to hold the arm of their effected side.  





Obviously don't so this on pts who can't handle the task, and don't do it if you can't remember the number yourself.


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## ngbacon (Oct 4, 2009)

Linuss said:


> Another thing you can do is include your pt in on their care.  Take their ventilatory rate, then ask them to remember a number for you.
> 
> "Mr Smith, I want you to remember a number fir me, ok?  Remember 20"
> 
> ...





I like this suggestion


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## medichopeful (Oct 4, 2009)

Linuss said:


> You're making it more difficult than it has to be.  Do the pulse, write it down, put you hand back on their wrist and do ventilations.  They will be none the wiser.



That's what I was thinking.  Basically, do pulse and respirations at different times, but just pretend to do pulse the second time while I do respirations instead.


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## Wee-EMT (Oct 4, 2009)

Make it simple. Count pulse for 15 seconds, double it, then double it again. Do the same for resps and write it on your glove.


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## VCEMT (Oct 4, 2009)

I usually get a pulse while talking to the patient and holding their hand caringly. While that is going on, fire will get the resps or I'll get while auscultating. It isn't hard to do. You would think the patient will start taking deep breaths as if it were a doctor's exam. However, they generally do not until instructed to.


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## Scout (Oct 6, 2009)

Try going resps first, its a smaller number.


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## akflightmedic (Oct 6, 2009)

Something that will change with experience, is on the majority of patients, you do not care what the exact count of respirations are right up front.

Getting an actual number count usually comes later in the assessment process for me because while observing the patient you can tell it they are too slow, too fast or normal breathing. You take what you see and compare it with your other symptoms and signs and go from there.

Treatment is not solely indicated by a magic number, it is but a small slice of the pie.

What I am saying is yes get familiar on how to do respiration and pulse count but do not beat yourself up over it. It will get easier and then the day will come when you realize how trivial it was stressing over it. Observation and assessment skills are far more important than counting, cause when you cut to the chase, it is those two things and not a number which dictates your treatment.


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## vquintessence (Oct 6, 2009)

akflightmedic said:


> *Something that will change with experience, is on the majority of patients, you do not care what the exact count of respirations are right up front.*



+102909843 pts
Was waiting for that to come up; personally didn't have the ambition to potentially start a petty debate.

Honestly guys... how many people wait 30 seconds for each sign to get the exact respiration and HR?  I palpate for < 10 seconds and can go based on tempo.  Respirations are purely a basic estimation.  Obviously there are situations where a more accurate count is desired... but a significant # of pts don't require dead on perfection.  Not to mention the truly sick pts whom you encounter won't allow you to be able to get such concrete numbers.


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## mycrofft (Oct 6, 2009)

*vquint beat me to it*

If you are not in a hurry, don't hurry. You can spend the time while you are counting things looking at your patient, their clothes, and note any odors. If you are in a hurry, and stop a second and ask yourself WHY sometimes, you can get a horseback guess at resp rate and pulse while you take the BP, and note the *nature *of the pulses and resps (often overlooked today).
Would other responders care to reflect on how use of automated vital sign monitors affects this?


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## Akulahawk (Oct 7, 2009)

mycrofft said:


> If you are not in a hurry, don't hurry. You can spend the time while you are counting things looking at your patient, their clothes, and note any odors. If you are in a hurry, and stop a second and ask yourself WHY sometimes, you can get a horseback guess at resp rate and pulse while you take the BP, and note the *nature *of the pulses and resps (often overlooked today).
> Would other responders care to reflect on how use of automated vital sign monitors affects this?


It is amazing what you can notice about a patient... while you're actually hands-on. An ECG and NIBP won't tell you that your patient has a bounding pulse... And odors about the patent can be quite telling about their medical condition, living conditions... and there's this _wonderful_ odor of liver failure that I'll never forget...

Me thinks we do (and impress on students) too much monitor... not enough patient.


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## Aidey (Oct 7, 2009)

UTIs have a unique odor too.


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