Interpretation of the Respiratory Rate (Strong Exam)
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- Опубліковано 28 лис 2023
- A discussion of the normal respiratory rate, and the interpretation of unusually fast or slow rates.
References for Normal RR:
Hooker EA, O'Brien DJ, Danzl DF, et al. Respiratory rates in emergency department patients. J Emerg Med. 1989; 7:129-32.
Rodriguez-Molinero A, Narvaiza L, Ruiz J, et al. Normal respiratory rate and peripheral blood oxygen saturation in the elderly population. J Am Geriatr Soc. 2013; 61:2238-40.
Takayama A, Nagamine T, Kotani K. Aging is independently associated with an increasing normal respiratory rate among an older adult population in a clinical setting: A cross-sectional study. Geriatr Gerontol Int. 2019; 19:1179-83.
Hutchinson J. Thorax. In: Todd RB. Cyclopaedia of anatomy and physiology. London: Longman, Brown, Green, Congmans, & Roberts; 1849: 1079-87.
*Minor erratum: In the video, I state that the 19th century textbook containing the normal RR table was from 1846. The book that the screenshot was taken from was actually published in 1849, but the included table is a revision from one the same author originally published in 1846.
#physicalexam
This issue is alluded to in the video on heart rate, but in retrospect, I should have included it here too:
There probably should be a distinction between what is a "normal" respiratory rate from the perspective of what is typical within the general population (i.e. 2.5th percentile to 97.5th percentile), and what thresholds we should use for identify possible pathology in certain situations. So for example, a RR of 24 might not be truly "abnormal" in an asymptomatic adult at rest in primary care clinic, but if the patient presented to the ED with fever and cough, it would increase my suspicion of pneumonia compared to an otherwise identical patient with a RR of 16. Likewise, a documented RR of 10 in an inpatient receiving IV opiates might trigger me to check to ensure they are not over-sedated, even if 10 is technically "normal".
I am so watching this
Such a good series!!!!!!!!!!!!!!!!!
Thank you very much , I learn something new from you , embarrassing , someone should tell me this long time ago. Thanks Dr Strong.
Thank you sir 🙏😊
Thank you
Love this new series and your channel in general! Always wondered how these seemingly abstract cutoffs were determined when learning about it in med school. Makes me wonder if the changes we’re seeing with evidence-based medicine will lead to any dramatic changes in these longstanding and seemingly abstract cutoffs that we learned as dogma (or if it’s negligible would it even be worth the hassle with adopting these new cutoffs from a provider practicality standpoint?). Is 38°C a very good cutoff (should there be a sex modifier as women tend to have higher core baselines)? Or how about a HR of >100? Looks like we need to do a systemic eval with the help of AI and machine learning to see if these cutoffs have any meaningful sensitivity/specificity. Oh well, guess that’s why we have to look at the patient as a whole to get a sense of their entire clinical picture :)
I don't think we can rely on evidence-based medicine to fix this problem. Unlike RR, normal ranges for HR and temperature are better studied, and all that data is totally ignored by textbooks, websites for laypersons, and the medical faculty who train the next generation of clinicians. Sorry, but you'll need to wait until those videos drop next week to hear what evidence says those ranges should be... ;)
I was surprised by this fact 🤯 🤯
Is the tachypnoea we see in sepsis secondary to hyperthermia or the acidosis?
Doctor, can you clarify the distinction between tachypnea and dyspnea?
And when does each one present without the other?
Tachypnea is an elevated respiratory rate. It is objectively measured as part of the physical exam.
Dyspnea is the medical term for the symptom of shortness of breath. It is subjective (i.e. based solely on how the patient feels), and is elicited during the history.
The two almost always go together (i.e. the conditions that cause one, cause the other), but one classic exception is that *occasionally* patients with diabetic ketoacidosis will feel dyspnea (due to chemoreceptors detecting low blood pH), but will have a normal respiratory rate because their body responds to the dyspnea by breathing unusually deeply rather than unusually quickly. As far as I know, why this can happen in ketoacidosis is not known.
I suggest Stanford uni do a research on the normal respiratory rate 😊
I wish I had the time to tackle this!
Thanks for the great video, may I ask is fever a cause of tachypnea?
I feel like I've probably heard someone attribute tachypnea to a fever once or twice, but I personally would not.
Many thanks for the reply! @@StrongMed
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What if keep counting untill 60 seconds
No audio in this video
Can you clarify? Audio seems to be working for others.
Charge your headphones, brother
Another mic drop! Obscene how many ground truths in medicine are completely made up or have very poor quality evidence (was watching the OMI vs NOMI webinar yesterday where the evidence for using ST elevation to decide on intervention is also poor)
The (STEMI vs. NSTEMI) vs (OMI vs. NOMI) paradigm battle is an interesting one which I've been surprised has not been discussed more. I've avoiding discussing ACS on the channel in general because I rarely treat it, but the OMI vs. NOMI paradigm is on my list of topics to cover for my ECG series...someday.
thats why i hate our job it is absurd indeed
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😁😁😁😁