I am pretty sure my instructor was tripping me up, but how to find equal tidal volume

[Deganveran]

During skills testing for my EMR cert I told my proctor that I was going to observe chest rise and fall for ten seconds in order to determine rate, effort and equal tidal volume. She asked me if I was sure that was how one found ETV. I said yes. A minute later as I continue on with my assessment she asks again if I am sure. She asks a third time while I am taking pulse and I get so frustrated that I accidentily take the pulse with my thumb and fail :/

Looking it up I am damn sure that ETV is found by observing the patient, but is there another way to find it? I've got retesting today and I would hate that to trip me up again.

 

[VentMedic]

During skills testing for my EMR cert I told my proctor that I was going to observe chest rise and fall for ten seconds in order to determine rate, effort and equal tidal volume.

10 seconds may not be long enough. If you have a "normal" respiratory rate of 12, you may only have 1 or 2 breaths to compare equal tidal volume. Patients may also change the breathing patterns when they are touched or know they are being closely observed. Thus, observation for a much longer time period may be required.

However, you should ask your instructor about this so you know the correct answer she is looking for next time.

 

[Deganveran]

10 seconds may not be long enough. If you have a "normal" respiratory rate of 12, you may only have 1 or 2 breaths to compare equal tidal volume. Patients may also change the breathing patterns when they are touched or know they are being closely observed. Thus, observation for a much longer time period may be required.

However, you should ask your instructor about this so you know the correct answer she is looking for next time.

Well equal tidal volume means that both lungs are bilatterally equal, correct? It means there isn't a flailed chest or neumothuorax. This is for the ABC's of initial assessment, later on in BELLSRP I take baseline vitals where I would take someones pulse with my hand on their hand and their hand on their diaphragm to find exact rate of both.

 

[MusicMedic]

Well equal tidal volume means that both lungs are bilatterally equal, correct? It means there isn't a flailed chest or neumothuorax. This is for the ABC's of initial assessment, later on in BELLSRP I take baseline vitals where I would take someones pulse with my hand on their hand and their hand on their diaphragm to find exact rate of both.

From what i was taught, its 30 seconds to check the respiratory rate of a patient. 10 seconds is wayy to short to measure a patient with a respiratory rate of say 8 breaths/min

my recommendation is to check the Respiratory rate right after you check The Patients radial pulse, but still keep acting like your checking their pulse, E.G: Say if you check the patients pulse for 30 seconds, act like your checking it for a whole minute, first 30 seconds for the pulse second 30 seconds for their respiratory rate, while still holding their radial artery. that way like Ventmedic said, it wont distract them from changing their breathing rate or patterns. The moment the patient actively thinks about breathing, is the moment they will start changing their patterns or rate.

sorry if its a bit confusing, i couldn't explain it that well, maybe someone else can explain it better

im guessing this is for your trauma assesment? when your assesing breath sounds and ETV: Look Listen,Feel and use your Stethoscope, its your best friend when it comes to to lungs.

 

[Onceamedic]

I think the responder who advised you to listen to the chest is right on the money. During a rapid trauma exam, just listen for equal breath sounds on both sides at the apex. In your secondary assessment, listen at the apex, under the arms and, with the patient sitting up, at the lung bases in the back.

 

[VentMedic]

I think the responder who advised you to listen to the chest is right on the money. During a rapid trauma exam, just listen for equal breath sounds on both sides at the apex. In your secondary assessment, listen at the apex, under the arms and, with the patient sitting up, at the lung bases in the back.

True.

I was referring more to breathing patterns which may be taught later or in another level especially where it concerns trauma, neuro or some medical patients.

 

[emtzach03]

its been so long...... was observation of the rise and fall also incuding placing your hand on the chest maby she was looking for that as well lung sounds would come in to play on detailed physical exam unless u see signs of JVD during rapid assesment. just how my mind interpreted this :glare:

 

[PhilipM3]

its been so long...... was observation of the rise and fall also incuding placing your hand on the chest maby she was looking for that as well lung sounds would come in to play on detailed physical exam unless u see signs of JVD during rapid assesment. just how my mind interpreted this :glare:

Jugular vein distension?

 

[MSDeltaFlt]

During skills testing for my EMR cert I told my proctor that I was going to observe chest rise and fall for ten seconds in order to determine rate, effort and equal tidal volume. She asked me if I was sure that was how one found ETV. I said yes. A minute later as I continue on with my assessment she asks again if I am sure. She asks a third time while I am taking pulse and I get so frustrated that I accidentily take the pulse with my thumb and fail :/

Looking it up I am damn sure that ETV is found by observing the patient, but is there another way to find it? I've got retesting today and I would hate that to trip me up again.

A day late I know, but I believe your proctor was trying to get you to realize that the pt's Vt was not equal or else she wouldn't have asked you 3 times. Equal Vt on a rapid assessment is another way of saying equal rise and fall. There are 3 ways to assess this.

1. Cut the shirt off and look at the chest to see if both sides rise and fall equally.

2. Just as Kaisu mentioned. Put your stethescope on them and listen to see if both sides of rise and fall equally with equal amounts of air in and out.

3. Put your hands on both sides of the chest and also feel if both sides rise and fall equally.

Notice how all 3 follow the "look, listen, and feel" assessment pattern.

 

[emtzach03]

A day late I know, but I believe your proctor was trying to get you to realize that the pt's Vt was not equal or else she wouldn't have asked you 3 times. Equal Vt on a rapid assessment is another way of saying equal rise and fall. There are 3 ways to assess this.

1. Cut the shirt off and look at the chest to see if both sides rise and fall equally.

2. Just as Kaisu mentioned. Put your stethescope on them and listen to see if both sides of rise and fall equally with equal amounts of air in and out.

3. Put your hands on both sides of the chest and also feel if both sides rise and fall equally.

Notice how all 3 follow the "look, listen, and feel" assessment pattern.

ahhhh yes that would make sense.... perfectly worded

 

[R.O.P.]

During a rapid trauma exam, just listen for equal breath sounds on both sides at the apex. In your secondary assessment, listen at the apex, under the arms and, with the patient sitting up, at the lung bases in the back.

Hi guys- I have the habit of checking breath sounds quickly in the lower lobes (on the back) when the pt is rolled onto a board. Do any of you have an opinion as the the best place to check breath sounds quickly, i.e is one location more telling than another, on a trauma at a noisy scene? Thanks.

 

[Lifeguards For Life]

Hi guys- I have the habit of checking breath sounds quickly in the lower lobes (on the back) when the pt is rolled onto a board. Do any of you have an opinion as the the best place to check breath sounds quickly, i.e is one location more telling than another, on a trauma at a noisy scene? Thanks.

you should be able to hear more clearly listening at your patients back. (correct me if i am wrong vent)

 

[VentMedic]

you should be able to hear more clearly listening at your patients back. (correct me if i am wrong vent)

LOL, you're doing great.


When intubating or when there is a chance for resonating lung sounds, I do a quick listen mid-axillary (just below the armpit) especially with infants and small children.

 

[MusicMedic]

Hi guys- I have the habit of checking breath sounds quickly in the lower lobes (on the back) when the pt is rolled onto a board. Do any of you have an opinion as the the best place to check breath sounds quickly, i.e is one location more telling than another, on a trauma at a noisy scene? Thanks.

Another option would be, say if the patient has c-spine injures and is not on a back board would be to check Midclavicular on both sides as well as the Mid-Axillary line on both sides. although it may not be as clear checking the back im sure, its still rapid.

 

[mct601]

as an EMT student I prefer to use my hands on the chest when checking tidal volume when testing.