The Vital SIGNS, Part 3: Respiratory Rate, Temperature and Beyond by ProQuest


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									       vital signs
                       By Rob Curran, DC, EMT

                                                Part 3:
Photos by Dan Limmer

                                                The last in a series
                                                examining the core metrics
                                                of the EMS profession

                                                 Vital signs give EMS providers
                                                 insight to what’s going on inside
                                                 our patients and let us evaluate
                                                 their responses to our interven-
                                                 tions. This multipart series takes
                                                 a fresh look at these vital signs
                                                 and what they actually tell us in
                                                 terms of changing our prehospital
                                                 treatment, predicting the severity
                                                 of presenting problems and even
                                                 predicting survival.
                                                 (RATE AND DEPTH)
                                                    In one way, respiratory rate is similar to pulse:
                                                 It’s measured by simply counting, yet studies
                                                 indicate that even professionals often measure
                                                 it wrong. A study comparing the counting of
                                                 respirations by ED triage nurses and electronic
                                                 devices at a teaching hospital in New York
                                                 City concluded that neither were accurate for
                                                 detecting abnormal respiratory rates of less than
                                                 12 breaths per minute (bradypnea) or greater
                                                 than 20 breaths per minute (tachypnea).1 The
                                                 importance of respiratory rates was brought
                                                 into question by a study finding that respira-
                                                 tory rate measurements correlated poorly with
                                                 oxygen saturation measurements and did not
                                                 screen reliably for desaturation. Patients with
                                                 low SaO2 did not usually exhibit increased
                                                 respiratory rates. Similarly, increased respira-
                                                 tory rates were unlikely to reflect desaturation.
                                                 Overall, only 33% of subjects with oxygen satu-

       38 MAY 2009 EMS
                                                                                                                                       vital signs

  rations below 90% exhibited increased        recorded on call sheets, there is little    perceptions of acute pain assessment
  respiratory rates.2 With regard to pedi-     research to support its importance to       and frequency of providing analgesia
  atric patients, a study found that in        EMS personnel or the need for expen-        and their actual practice. Children and
  babies under six months old, respiratory     sive temperature-recording equipment.       adolescents have less documentation

  rates counted using a stethoscope were       One study conducted in a Zambian            of pain assessment and receive fewer
  20%–50% higher than those counted            hospital evaluated the ability of mothers   analgesic interventions compared with
  from the patient’s bedside by observa-       and medical students to detect fever in     adults. Inability to assess pain may be
  tion only. The authors theorized that        children using only touch. Both groups      an important barrier to providing anal-
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