Respirations

Respiration (breathing) provides a way for the body to exchange of oxygen and carbon dioxide.

Respiration is automatically controlled by the brain. A variety of factors can influence respirations, such as:

• Head injury (Depressed with elevation of intracranial pressure)
• Bleeding (Increased respirations with significant blood loss)
• Stress (Rapid rate and increased depth)
• Fever (Increased rate)
• Hypothermia (Slower rate and shallow breaths)
• Medications (Narcotics in large doses can depress both rate and depth)
• Voluntary control can also influence breathing, up to a point.

To avoid voluntary changes in rate or depth, it is best to count the respirations in such a way that the patient is not aware they are being counted. 

Start by taking the pulse of the patient:

• While you are holding the patient's wrist and looking at your watch, use your peripheral vision to observe the chest rise and fall. 
• Many experienced examiners will actually take the respiratory rate first (even though they are holding the wrist and appearing to take the pulse).

Ideally, the respirations are observed for a full minute and reported as "RR=16" (meaning respiratory rate equals 16 respirations per minute). Often, respirations are observed for only 30 seconds (and the results doubled to give the respiratory rate per minute). If pressed for time, respirations can be observed over 15 seconds and quadrupled to give the RR.

The normal respiratory rate in adults is 12-20 respirations per minute. If the patient's rate is outside those limits, it may indicate a significant pathologic process.

Normal respirations are deep and even. The rib cage expands fully and the abdomen rises and falls. Abnormal breathing includes deep breathing, shallow breathing, and rapid breathing.

Abnormal respirations may be irregular, due to illness or injury. If the patient experiences difficulty in breathing, there may be associated noises, such as wheezing, rattling, or bubbling. The patient may be more comfortable sitting up or leaning forward. They may appear restless and anxious. Their skin can be pale, ashen or cyanotic.

Measure respiratory rate while you are appearing to take the patient's pulse.

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*This web version is provided by The Brookside Associates, LLC.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. The medical information presented was reviewed and felt to be accurate in 2001. Medical knowledge and practice methods may have changed since that time. Some links may no longer be active. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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