Respiratory Rates

Obtaining respiratory rates can be difficult. Patients will be talking, moving and generally non-compliant with allowing you to count respiratory rate. You will need to be diligent in your assessment of this vital sign. It is essential that the patient does not know you are counting their respiratory rate. If they know you are counting it, they will become conscious of their breathing and unknowingly alter breathing and alter the validity of the assessment.

There are a few ways to assess the patient’s breathing without making it obvious. Try assessing their breathing while you are taking their radial pulse. After you have taken their pulse, leave your fingers on their wrist and shift your attention to the rise and fall of their chest. Use the same method of counting for 15 seconds and multiplying by 4 for my breaths per minute.

Alternatively, you can stand back and watch their breathing while something else is happening on the call, without telling the patient anything is being assessed.

Basic Lung Sounds

Assessing lung sounds is an easy skill but challenging to meaningfully interpret. To build our interpretation skill we need to first practice what “normal” or “clear” lungs sound like to build our internal library for comparison when our patient has signs of obstructive abnormal lung sounds.

1. Start by ensuring permission to lift the patient’s shirt.
2. Then place a stethoscope directly on the skin.
   • Location will vary depending on the purpose.
     • When confirming effective ventilations when using a BVM and supraglottic airway you will use the anterior chest, just below the clavicle.
     • When listening for clinical indicators for a respiratory condition, you may choose to listen to the posterior chest, medial to the scapula.
3. Listen to one lung location and compare it to the same lobe of the other lung by moving to the other side.