Pulse, Respiratory Times

rcEMT

rcEMT

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I am a little confused by my instructors. My book tells me that I should take both pulse and respiratory rate for 30 seconds. My instructors have told the class to takes these rates for 6, 10, 12, 15, 20, or 30 seconds depending on which one you talk to. So I was wondering what do you do? Thanks in advanced for you answers.
 
The longer you take it for, typically the more accurate it will be, but it really ends up being personal preference and a patient-by-patient decision.

Personally I keep it to 15-20 seconds per thing, then multiply.
 
15 seconds, 30 if anything is off or if I'm having trouble.
 
JPINFV said:
15 seconds, 30 if anything is off or if I'm having trouble.
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Ditto. I take it for 15 seconds and multiply it by 4 (obviously) unless they are having any cardiac or cardiac-ish complaints, have a hx of cardiac issues, or other situations in which I am more comfortable taking it for 30 (and multiplying by 2, obviously)
 
I generally hate answers that begin with "it depends.."

It depends on the severity of the patients complaint and the general impression.

The more stable the patient presents, the more appropriate it becomes to determine a pulse rate in a shorter time span.

My advice to you would be to plan on assessing for a minute, and adapt as you gather more information.

If you have a stable patient, with a minor chief complaint, and the pulse is regular, you may be able to stop at 15 seconds.

If you have the same patient above, but with an irregular pulse, it becomes less appropriate, and warrants a longer time frame to determine a more accurate pulse.

There are also times when just knowing the pulse is "too fast" or "too slow" will suffice in the initial stages of your assessment.

Education and experience will help you to determine the needs of individual patients.
 
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I have been taught 15 secs for a regular strong pulse, a full minute otherwise. However I count pulse for 15 seconds and hold the radial as if I am counting the pulse for a further 15 seconds in which time I am counting and checking quality of breaths. Reason for this is if someone knows you are counting/looking at their breaths then they often change them.
 
Martyn said:
I have been taught 15 secs for a regular strong pulse, a full minute otherwise. However I count pulse for 15 seconds and hold the radial as if I am counting the pulse for a further 15 seconds in which time I am counting and checking quality of breaths. Reason for this is if someone knows you are counting/looking at their breaths then they often change them.
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oldest trick in the book, but works brilliantly.

lately ive been lazy and using a pulse oximeter for pules rates but id grab the radial for a few seconds to check quality/strength etc. That would be for concious patients.

for uncounious i palpate with my fingers on the Carotid just to be sure
 
emt_irl said:
lately ive been lazy and using a pulse oximeter for pules rates but id grab the radial for a few seconds to check quality/strength etc.
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How do you know that your pulse ox is picking up the signal properly?
 
I count for 30 myself. Gosh I've seen ambos who are so lazy; they either make up vital signs that do not exist or they rely on flash gadgetry to get them e.g. automatic BP, SPO2 for RR, ECG for HR etc.

I have had Officers tell me "why do you get a manual BP, the machine will do it for you", well, there is your answer.
 
MrBrown said:
I count for 30 myself. Gosh I've seen ambos who are so lazy; they either make up vital signs that do not exist or they rely on flash gadgetry to get them e.g. automatic BP, SPO2 for RR, ECG for HR etc.

I have had Officers tell me "why do you get a manual BP, the machine will do it for you", well, there is your answer.
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Yeah, we recently bought a Zoll with Auto BP and SP02 on it. Our folks depend on that machine WAY to much!
 
I'm not a huge fan of the automatic vitals-taker contraptions, though if you are in a rush for time during a serious emergency, they can be helpful.

If the pulse is strong and regular, 15 seconds will do. If there is something off, go for 30 or 60. Oh, and if you are taking the apical pulse, always do it for 60.

Respirations depend on your experience, really. If you are inexperienced with taking them, count the pulse for 15, and then count the chest rise/fall for 15 more with your hand still in place. The pt will think you are still counting the pulse, and their respirations will change if they know you are counting the respirations.

If you are experienced, you probably don't have to use any little tricks like that. I have a partner who can tell how fast someone is breathing from ten feet away. :wacko:
 
JPINFV said:
How do you know that your pulse ox is picking up the signal properly?
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well any machiene can be off but if generally feels ok and the lifepack or simular monitor says the rate is :... i'll agree with it. im not lazy all the time though
 
Pulseox only takes an average of the pulse felt, so it can be off by 5-10 or more. Lifepaks and other monitors only sense the electrical activity and not the actual pulse... you'll be a bit SOL if your patient is in PEA.
 
Another thing to think about is that the primary purpose of the pulse display on a pulse ox is to correlate the readings. If the pulse ox pulse is off, so is the Sp02. However if you never check for a pulse, then you're simple correlating it off of itself.
 
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