Assessing breathing in patients

Limes

Limes

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I find it difficult to assess breathing in patients. Sometimes I'll bring their arm towards their chest to feel their chest rise and fall, or to the belly if it's a younger kid. I never tell a patient when I'm assessing their breathing, else they would unconsciously control their breathing.

But there's times when I really can't get their breathing rate, at all. I can't feel any rise or fall, but sometimes I can see it. Any tips?
 
I can't remember the last time I've "felt for" a respiratory rate. Just watch them. I assume you don't have EtCO2?
 
Stethoscope
 
I take it you are talking about assessing breathing as part of normal assessment of a conscious patient? In that case, really all you need to know is "in distress / not in distress", and "breathing fast, breathing slow, or breathing normal". There is literally no reason at all to try to count a specific number of breaths per minute. Following that up with lung auscultation tells you all you need to know.

If you are talking about assessing an unresponsive or sedated patient, the best thing to do is simply put your hand close to the nose and mouth and make sure you can feel air moving out regularly. In that case watching their chest move tells you very little, because people can be breathing but not exchanging air well due to passive (or FB) airway obstruction.
 
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Limes said:
No I do not. I'll trying watching them next time, I'll see how well that works out.


That'll work, but in a noisy environment? Don't think that'll work.
Click to expand...
Unless you are right in front of a speaker at a rock concert a decent stethoscope will work pretty well.
 
I am probably wrong for saying this, but I wish respirations was a vital sign that was only or mostly qualitative rather than quantitative. I don't find the actual number to be useful, and how it trends is too slow to be significant. It's kind of like heart rate in ACLS. Is it too fast or to slow? The same thing is probably more true for respiratory rate than heart rate.
 
Fast/Slow? Regular/Irregular? Labored/Unlabored?.... If so, I use end tidal (which you said you don't have) which identifies the effectiveness of their breathing.

Otherwise, 16. [emoji1417]


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RR is also just one sign in a overall presentation of patients. There are many factors, both pathological and benigning, that affect a person RR.
 
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