Keeping track of respirations

[vienessewaltzer]

I'm in my EMT course and am still having issues with this. I know there have probably been other threads on this, but I've read most of them and tried a good number of the techniques (hand on shoulder, doing it while taking pulse, etc) It seems like it would be easier to do on an ambulance with the patient in the supine position via tricking the patient into thinking that you're taking a pulse. Most people have such subtle respiring that you can't tell, especially if they're wearing baggy clothing. In my EMT course we have a vital signs sheet that we're supposed to fill out by doing vital signs on 20 people. We are supposed to do this every 2 weeks. I finished my first 10 having no issues with BP, pulse, pupils, and lung sounds, but when it comes to respiration counting I just can't find a feasible technique in getting this data. The patients obviously have no significant physiological issues, and thus their breathing is normal. They're wearing clothes (obviously) so watching their thorax/abdomen just doesn't work. They're not wearing a NRB so I can't watch for fogginess. This is probably the hardest vital sign to achieve on a normal patient for me! I will have to get a little more creative on respiration rate. Are there anymore suggestions for this? I've already sent an email to my instructor, but any more help would be greatly appreciated.

 

[Theo]

Never had much of a problem getting respirations. Now, getting used to taking a BP in the back of a moving rig... a whole other issue.

That said, if you're already taking lung sounds go ahead and stick around 30 more seconds and listen to the patient's respirations. Make sure to only count the inspirations.

 

[lightsandsirens5]

Never had much of a problem getting respirations. Now, getting used to taking a BP in the back of a moving rig... a whole other issue.

Got to get in sync with the rhythm of the amb. After a while, you will get good at it. I used to do Palp when I first started, then I started using the Doppler, now I can hear it with a regulat steth.

That said, if you're already taking lung sounds go ahead and stick around 30 more seconds and listen to the patient's respirations. Make sure to only count the inspirations.

Exactly what I do. And it helps me remember to do lung sounds which I am absolutly wonderful at forgetting.

 

[vienessewaltzer]

Never had much of a problem getting respirations. Now, getting used to taking a BP in the back of a moving rig... a whole other issue.

That said, if you're already taking lung sounds go ahead and stick around 30 more seconds and listen to the patient's respirations. Make sure to only count the inspirations.

Doesn't that skew the results if the pt already knows you're listening to their lungs?

 

[Theo]

I have found that it really hasn't been much of a factor on the patients that I've used it on. As far as they know, I'm just listening to lung sounds. Plus, there's usually enough distractions to keep someone from concentrating on controlling their breathing.

In the event that you do come across a patient, that for whatever reason is thrown off by knowing that you're taking their respirations, fall back on the saying... "treat the patient, not the numbers."

If a patient is in true respiratory distress, then they're not going to mask it well. On the flip side, if I have someone that is speaking clearly, has good tidal volume, and is puposely controlling their respirations to the point that they come in at 10 respiration/minute. I'm not going to start bagging them based on the number.

The important thing is finding a technique that you feel comfortable with and accurately gets the results. But, it's always nice to have a couple backup options.

 

[Frozin]

It seems like it would be easier to do on an ambulance with the patient in the supine position via tricking the patient into thinking that you're taking a pulse.

Actually, it gets harder in the rig i've been working now for about a month and found that to be the hardest thing to get, especially on obese PTs.

Most people have such subtle respiring that you can't tell, especially if they're wearing baggy clothing. In my EMT course we have a vital signs sheet that we're supposed to fill out by doing vital signs on 20 people. We are supposed to do this every 2 weeks. I finished my first 10 having no issues with BP, pulse, pupils, and lung sounds, but when it comes to respiration counting I just can't find a feasible technique in getting this data.

I usually lean to one side to get level with the Pt's chest, then it makes it easier to see the rise and fall, of either the chest, cloths, belts, or abdomen.
It is easier when a patient is semi fowlers or supine.

The patients obviously have no significant physiological issues, and thus their breathing is normal. They're wearing clothes (obviously) so watching their thorax/abdomen just doesn't work. They're not wearing a NRB so I can't watch for fogginess. This is probably the hardest vital sign to achieve on a normal patient for me! I will have to get a little more creative on respiration rate. Are there anymore suggestions for this? I've already sent an email to my instructor, but any more help would be greatly appreciated.

You'll get it once your in the back of a rig.

 

[vienessewaltzer]

I've done this on a few more volunteers, and I have to say tight clothing makes this a breeze. I'm certainly starting to get the hang of it by holding the patients wrist for a longer "pulse" and counting the respiration rate. Thanks for all the suggestions!

 

[WolfmanHarris]

Doesn't that skew the results if the pt already knows you're listening to their lungs?

I find this concept is harped on unnecessarily sometimes.

Ask yourself, would a pathological process be altered significantly by the patient's awareness? Not significantly. What's the difference between 12 bpm and 16bpm in a patient in no distress, at rest?

Let's say your patient is tachypnic as a result of anxiety. You say, "I'm going to assess your breathing." They focus and calm down a bit. Sure your result may not be accurate to their rate before, but their condition has improved hasn't it. You can then go ahead state "Pt's RR ~28, decreased to 20 bpm with coaching."

In terms of continuous monitoring of respiratory status, I am a HUGE fan of capnography w/ nasal cannula.

 

[ah2388]

agree with the Etc02 cannulas...<3 those things for that + many other reasons

 

[Focallength]

honestly, its only important to be able to recognise abnormal rates and thats pretty easy. As far as documentation...theres a bit of estimating, but being able to recognise 8 BPM and 20+ is easy just look at them. In class there really wasnt a focus on getting the actuall BPM unless they were having respiratory problems and then your more focused on helping them breathe than counting respirations. the same sort of thing applies to pulse rate, youll be able to feel a normal rate and youll be more concerned with a rapid or thready pulse and again you can get that easy same as regular vs. irregular. If your patient has an abnormal rate you dont really want to dwell on getting the actuall number. if you need to you can get it en-route. But if you dont get it no one is going to jump down your throat for getting a normal reading. Even when documenting you can write WNL and put Clear and equal all 4 quadrants.

Like wise if they are in resp distress. BPM < 12 (or any lower or greater than normal number) diminshed lung sound LLQ audible wheezing upon exhalation. The point is to document that you examined them. Even when you report it the nurses dont care what the exact rate is they want to know if they are normal or abnormal and if they are abnormal they want to know why. Going into the ER you just report " Patient was found in respiratory distress sitting in the tripod position, rapid and deep respirations, normal pattern, acessory muscle use, lung sounds diminished in both lower quadrants."

Practice it try breathing only 8+ times a minute and try breathing 20+, youll be able to easily recognise low or rapid rates.

Im sure youve learned it in class but theres a lot of things you do in class that you dont do on the job.

just my .02 YMMV

 

[ExpatMedic0]

In terms of continuous monitoring of respiratory status, I am a HUGE fan of capnography w/ nasal cannula.

Agreed with the above.
Hey wolfman what does your title PCP stand for? "Primary Care Physician"? Thats how we use the abbreviation in our reports. Or are you a Primary Care Paramedic?

 

[Aprz]

I see you've tried doing it while you're taking a pulse, and your hands on their shoulder, but have you tried resting their wrist on their abdomin or chest while you're taking their pulse, and breaking it into two steps: 15 seconds for their pulse and 15 seconds for their respiration? It's not hard to say something cheezy like "Let me feel that pounding heart", which would emphasize more to them that you are taking their pulse or something lame. You could also move their wrist below their nose and infront of their chest to feel them exhale from their nose instead of putting it directly on the chest.