Hospital and Telephone Triage

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Respiration types and rates

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So we also need to be measuring your respiration rate and the quality of your respirations as well. So the respiration rates in an adult usually 12 to 20, that is considered to be normal, but you are looking at how much effort the patient is using to breathe. Remember that the patient's breathing in oxygen and breathing out carbon dioxide, so if you have a situation, say, diabetic ketoacidosis, they do what is called Kussmaul breathing, which is large, large breaths and they are trying to breathe out all that CO2, get rid of the acid state that the body is going into.

So patients also who have a lung pathology, either from injury or disease, they will start breathing faster, shallow breaths. They are not really getting that air exchange, they are just moving the air in the trachea. So really, you are not getting oxygen and you are not getting rid of carbon dioxide. Respirations are very, very important and they need to be taken into consideration with all the other vital signs, particularly the pulse. So to assess a chest in triage, you are looking at the way the patient is breathing. Do they have equal rise and fall of their chest? Can they speak to you? Can they form sentences, long sentences? Are they gasping?

Does position have anything to do with it? Is it... You see some people, I think I have heard it called tripoding and this sort of stuff. Is that a big indication of lung problems?

People will lean forward. Yeah, it is called tripoding when they put their hands on their knees, their hands on a table or lean over onto a table and they are trying to expand their lungs so they can get more air in.

Is there any tools or any implements that we can use to get a better understanding of this? Is there anything you use to get, apart from the pulse oximetry, to understand the way the lungs are functioning?

Okay. It is not usually using triage, but you can use a stethoscope. If you suspect somebody's having quite a bad asthma attack, somebody is having an allergic reaction, you need to know if the allergy state has got to their lungs or you need to check whether... Following trauma, somebody's lung is not inflating as it should be. You can hear that using a stethoscope if you have been trained to use one.

I was going to say, can anybody use a stethoscope or is it a bit of an art?

Well, yeah, you need the training. You need to know what the breath sounds mean, really, and where to listen on the chest.

Okay, so can you show me where you would listen with a stethoscope on the chest?

Okay. So again, this will have been cleaned before use and we will just... This is a demonstration, so it will be over your clothes, but normally, you will listen, placing the diaphragm onto the skin.

Will it work effectively through clothes or not?

It can, but it is not as good. It is not as good. The transmission of sound is not as good. And also, remember, when you have the stethoscope on, you cannot hear what is going on very well. So you would listen at the midclavicular line.

Does the patient need to do anything in particular?

They just need to carry on breathing as best they can. You will listen to both sides, so you can compare both sides. You will also listen on the back, on both sides, comparing both sides and not forgetting in the axilla there and comparing to the other side. Remembering that this... You are not trying to diagnose what is wrong with the patient, you are listening if the air is getting in and the air is getting out and any breath sounds that should not be there.

So basically, you are comparing one side of the lung to the other side of the lung and they should sound exactly the same and they should be functioning and filling exactly the same.