Clinical Skills: Respiratory rate assessment

Meet. Fred.

Fred is awake and alert his posture straight and relaxed skin looks normal, feels normal, capilla refill in his fingernails is under two seconds.

The rate and rhythm of his breath normal, by all accounts, Fred looks good. But what if he didn't?

Fred presents with a decreased level of consciousness? An indication of hypoxia.

Fred's breathing is labored. He's hunched over hands on his knees, tripoding.

He speaks in short bursts of words, between breaths. How are you feeling today, Fred?

Not so great. I'm having troubles catching my breath at rest.

These symptoms indicate respiratory distress. Fred is in respiratory distress.

Fred has a costal angle under 90 degrees. His ribs slope downwards.

Let's make a w on Fred and place our thumbs just under the xiphoid process. We hope to observe symmetrical chest expansion at rest.

Normal respiration is between 10 to 20 breasts per minute. Rhythm and depth are regular, shallower and above 20 is tachypnea.

Hyperventilation is deeper, still over 20. Though, if your depth is normal, but dipping below 10, you're looking at bradypnea.

Whereas hypoventilation is shallower and irregular chene strokes, respiration is a regular pattern of increasing and decreasing depths of breath followed by a period of apnea.

Expect a full cycle to last around 45 seconds. B respiration presents irregular breathing depths followed by a period of apnea.

A full bio is about a minute. A barrel chested fread would have a costal angle over 90 degrees with horizontal ribs, non symmetrical chest expansion may indicate a fluid filled or collapsed lung lobe.

Pregnant women take deeper breaths almost 50% deeper. Their subcostal angle pushes past 90 degrees, reaching on average 100 and three degrees by turn, as people age and enter their elderly years expect physical changes to the thorax, chests stiffen as cartilage calcifies more rounded barrel shaped chests as well as skips develop.