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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. RESPIRATION (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 www.emsresponder.com 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 “Pain 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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