Posted by: medicblog999 | April 29, 2010

What was his resps?

0-936-1I was looking after a gentleman the other week who had ‘difficulty in breathing’ who clearly did not!

That in itself is not too much of a big story to blog about, however the conversation that ensued afterwards with a couple of crew mates outside of the Accident and Emergency unit made me smile and laugh, so in my book, that does get posted.

As we were chatting, I was asked by Steve what the patients resps were?

16, I replied.

“Of course they were 16, arent they always”

The discussion then took off as we gave each other patient scenarios and then both said exactly the same resp rates out loud. It appears that we all have an automatic immediate resp rate response for certain classes of patients. Now, this isnt something that I am particularly proud of, but I am pretty sure that 99% of us out there will do it. Or am I completely wrong?

  • Normal adult with no shortness of breath  =  16 resps per min
  • Adult with mild exacerbation of COPD         =  26-28 resps per min
  • Adult with severe exacerbation of COPD     =  38-42 resps per min
  • Adult Hyperventilating                                       = 45-50 resps per min
  • Adult heroin overdose (not yet in resp arrest)= 6-8 resps per min

The list can go on and on, and of course will include children of all ages too. The point being that we have grown to be able to take a look at a patient and gauge their respiratory rate down to within a few resps the vast majority of the time, havent we?

I took it upon myself over the next couple of shifts to try my theory. I guessed the resp rate and wrote it on my patient report form, then took 30 seconds and counted the resps without the patient being aware of what I was doing.

Guess what?, I didnt have to change my PRF once. I may have been 1 resp out a couple of times, but that was it.

Of course there are always going to be those times where you take a resp rate accurately and count them out, but the vast majority of the time we seem to just take a look at the patient and go

“Yup, 16!”

What made me laugh though was when I was talking to another colleague Tom, about this potential blog post. We laughed again as we went through the list and the fact that we were coming out with the same resp rates for all of the imagined patients, but when I suggested that sometimes just to mix it up, I would put a 17 down, his answer was

“Oh god no, you cant put odd numbers down, thats just wrong!”

So come on, own up and give me your automatic resp rates for certain classes of patient. Lets see if there is an international unwritten resp rate rule!!

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Responses

  1. Drunk university students are always 12 haha

  2. That about sums it up! Every once in a while someone will challenge me on this and I simply respond, treat the patient, not the number.Oh! Adult panic attack – 30-40

  3. Over emotional young girl (post argument with family/boyfriend) ranges from 6 (breath holding) – 46/min… :)

  4. I'm a final year Nursing Student, based at a certain large teaching hospital which uses an early-warning tool for patient observations. The sicker they are, the more coloured boxes, the higher the early warning score..simples.Many a time within the acute hospital, I have seen rather poorly sick patients with a RR of 20 being recorded – the highest possible rate without going into one of the coloured boxes and thus elevating their early warning score. Coincidence, I think not….

  5. occasionally i add 1 or 2 so all of my prfs dont say 14, it throws the team leaders off when they carry out the prf audit!

  6. LOL, those are pretty accurate.I can remember in my days of doing non-emergency transports, I could pretty accurately guess my patients' pre and post dialysis blood pressures and heart rates, too.My first boss had the unique ability to palpate blood pressures and give you accurate systolic and diastolic readings. I've never met anyone else who could do that, before or since.

  7. Yeah, I'm a big fan of 18 as baseline adjusted to coincide the specific conditions the patient presents with. We all do it.

  8. I used to think I could count respirations by the seer method. Ahh, 14 But then when we got the capnography cannulas that actually count the respiratory rate accurately (by recording the carbon dioxide in the expiration as a wave form), I discovered I was often way off. I most often underestimated the rates of people in distress. I still often use the seer method, as I only use the capnography cannulas sparingly, but if it is a patient where the respiratory rate has clinical significance, I try to be as accurate as I can either actually counting or using the cannula.

  9. I recently had a female pt who got into a fight with her family. With the capnography, she had an ETCO2 reading of 10 and a respiratory rate of 90-100. She eventually passed out and normalized, but in a young adult, that was the fastest I have ever seen a respiratory rate. I had initially “guesstimated” her rate at about 40-50. After the capnography was placed and I actually sat there and counted, I was astounded.

  10. That's experience talking. After you've seen enough of any class of patient you can usually guesstimate the respiratory rate, feel the pulse for about three seconds and get a rate, and often predict the range of the blood pressure. You're right a lot more than you're wrong.

  11. That's experience talking. After you've seen enough of any class of patient you can usually guesstimate the respiratory rate, feel the pulse for about three seconds and get a rate, and often predict the range of the blood pressure. You're right a lot more than you're wrong.

  12. There was once a paid critique that question, “why is it that a person who is drunk and lack sleeps can run without being short in resps?” i dont know where he get that idea but i think that is true.


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