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Can I get your autograph now ... in invisible ink ? But you know you now WILL be forced to change your avatar picture so I located one for yall.

I created a post earlier, that might have actually had something interesting in it (Yeah, probably not) but nuked it somehow before I got it posted. I don't have time to recreate it now, but I wanted to say a couple of things.... First. I'm not of the crowd that believes there's no such thing as a stupid question. I've heard millions of them. (Why do I have to stay awake during clinicals even when we don't have a pt? As he uses his book for a pillow) But not only is your question not stupid, it is not even close to being silly. I'll tell you why. I have never known anyone to the best of my knowledge that was good at hands off resp rates on those patients that aren't at least slightly obvious. It's hard. Sometimes you simply have to put your hands on the patients to get it. I wish I had a tricky, reliable, tried and true answer, but I've never heard of one. Sometimes it's easier to watch the stomach, sometimes easier and more pleasant to watch the high point of the breasts, sometimes you can see them breathing through their pursed lips, but not always. The other thing I love about this question is that 99% of basics have this question coming out of school yet only about 5% (These numbers come from a very famous study that involved a gazillion subjects, so I'm confident that they're accurate. And no, I can't remember the name of the study. It was really famous though. The doc in the ER even told me about it. So famous so that if I need to cite it for you...well, just forget it then.) will ask the question. The vast majority of those that choose not to ask are simply going to put 12 for all of their 'well' patients, and 18-20 for all of their 'sick' patients. They are going to lie, because they don't have the balls to learn. It takes guts to ask a question that you think people are going to think is stupid on a subject that seems as if it should be so friggin' easy! But it's not. But how can that be?? Everyone else can do it, right? Yeah, not so much. Most everyone else pretends to do it...and that should be unacceptable. You're off to a good start brother....Welcome to the family! Dwayne

Placing your hand on a chest is indeed one way of checking respirations. Check the abdomen- sometimes it's easier to see it rise and fall vs the chest. Depends also on the depth of their respirations, if they are a mouth breather- like a baby, COPD'er, or someone who is dyspneic. Keep at it- you'll get it. Just like anything else, it takes practice. Listen to as many chests as you can. As an aside- one of the hardest things to learn are breath sounds, and until you know all the variations of "normal", it will be hard to tell what an abnormal sound really is. One suggestion, try looking at as many folks as you can and see if you can count their respiratory rate. Listening to lung sounds you can also get their respiratory rate AND their heart rate. Your instructor is correct BTW- if people know you are watching them, they will alter their breathing patterns. Depending on the situation, I try to gauge the person's breathing as one of the first things I do. Walk into a room, look at the person- especially if they do not see you yet- and you can get a pretty good quick baseline reading. As soon as you start interacting with them, their anxiety causes them to speed up.

TES! YES! Yes! Learn the meds, and patient conditions. Anyone can learn the mechanics of the job, but not everyone understands what is happening with the patients, Know the 'normal' A&P and you will pick the abnormal a lot easier.I suggest you always take manual pulses, so once you have counted 100 'normal and regular' pulses you will quickly pick the very fast, very slow and irregular pulses. Also listen to as many 'normal' chests as you can. so you will easily pick the abnormal sounds. You may not know for a while what the abnormal sound is, but knowing it is not 'normal' is the first thing to know. Learn the 'normals',make all your baselines manual recordings, and you will learn to treat the patient not the machine. Happy studys

"Are you bleeding?" DO I see massive blood loss? Is a baby popping out? If I don't i'm not going in I'm not looking unless both of those questions are 100% affirmative. Who wants to be up in someones nasty junk? Hahaha