Determination of pulse and respiration, their assessment

FUNDAMENTALS OF FIRST AID
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Determination of pulse and respiration, their assessment

Fundamentals of First Aid (OPMP)

Pulse - These are periodic jerky oscillations of the walls of the arteries, caused by the movement of blood entering the vessels during the contraction of the heart. It is characterized by frequency, rhythm, filling, tension and is determined by touch (palpation).

The pulse rate under physiological conditions depends on many factors: on age (newborns have 130-140 contractions, at 3-5 years old - 95-100, at 7-10 years old - 85-90, in adults - 60-80); from gender (in women, there are 6-10 contractions more than in men);

from the time of day (during sleep, the pulse becomes less frequent); from muscular work, from the position of the body, from the state of the neuropsychic sphere (with fear, pain, the pulse quickens), etc.

An increase in heart rate (greater than 80 beats per minute) is called tachycardia, and decrease (less than 60) - bradycardia.

Distinguish rhythmic pulse и arrhythmic. With a rhythmic pulse, pulse waves follow one after another at regular intervals and with the same strength. With an arrhythmic pulse, the intervals between the pulse waves and their strength are different. The most common types of arrhythmias are extrasystole и flickering arrhythmia.

Extrasystole palpation of the pulse is defined as an extraordinary premature pulse wave of lesser strength.

Atrial fibrillation characterized by the absence of any order in the rhythm of the pulse: pulse waves are determined by different sizes, follow one after another at different intervals. At the same time, some systoles are so weak, and the pulse wave is so small that it does not reach the periphery and, accordingly, is not palpable. There is a difference between the number of systoles when listening to the heart and the number of pulse waves - the so-called pulse deficit. Atrial fibrillation occurs with heart defects.

Filling the pulse depends on the systolic volume of blood (60-80 ml) ejected by the heart into the systemic circulation (into the aorta), as well as on the strength of heart contractions, vascular tone, the total amount of blood in the system and its distribution. By filling the pulse, the strength of heart contractions is judged. With blood loss, the filling of the pulse decreases.

Pulse voltage is determined by the force that must be applied to the examining finger to completely stop the blood flow in the palpable artery, and the resistance of the artery wall when it is compressed. The tension of the pulse depends on the height of the arterial pressure: the higher it is, the more intense the pulse. The voltage of the pulse increases with sclerosis of the vascular wall. With a significant weakening of the activity of the heart and a decrease in the mass of circulating blood, the pulse becomes weak and barely palpable (filamentous pulse).

The pulse is examined in those places where the arteries are located superficially, close to the bone and accessible to direct palpation. Most often, the pulse is determined at the peripheral end of the radial artery: this is convenient for assessing the pulse because the radial artery at the wrist joint is located superficially and lies on the radius.

The subject's hand should be in a comfortable half-bent position, excluding muscle tension. The examiner puts the 2nd, 3rd, 4th fingers on the inner surface of the lower part of the forearm in the region of the radius, placing the thumb on the outer surface of the hand; finding the pulse, determines its frequency, rhythm, filling and tension.

If the pulse on the radial artery cannot be examined (with injuries, burns), then it is determined on the carotid, femoral, temporal arteries.

Breath

The frequency of respiratory movements in an adult ranges from 16 to 20 per minute, in women it is 2-4 breaths per minute more, in newborns it is 40-60 per minute. In trained athletes, the respiratory rate can be 6-8 per minute.

The counting of respiratory movements is carried out as follows: the examiner puts his hand on the patient's chest or on the upper abdomen and counts the number of breaths for a minute. It is most convenient to count the breath visually, observing the movements of the chest and abdominal wall. Counting is done unnoticed by the patient, best of all during palpation of the pulse, since the patient can arbitrarily hold or speed up breathing. The number of respiratory movements per minute correlates with the heart rate as 1: 4. Violation of the frequency, depth and rhythm of breathing is called shortness of breath. Shortness of breath can be associated with impaired inhalation and exhalation, with the former called inspiratory (breathing), second-expiratory (expiratory).

To facilitate breathing during shortness of breath, the chest should be freed from restrictive clothing, take a semi-sitting position, increase access to fresh air, and also give the patient oxygen.

In some cases, and at home, there is a need for digital and graphic registration of body temperature, pulse and number of breaths on the temperature sheet. The temperature sheet is an important document that includes the leading indicators of the patient's condition and their dynamics. Chronological indicators (days of illness and temperature) are noted on the sheet. Each day (on the sheet - a square) has two halves to mark the morning and evening temperature. Horizontally from the left edge of the sheet there are graphs for indicators of pulse rate (P), respiration (D) and temperature altitude (T).

The data obtained is drawn with colored pencils or felt-tip pens in the form of curves.

Table 7 shows the average data on changes in the considered indicators during life.

Table 7. Indicators of pulse, pressure, respiration in different age periods

Age	Systolic BP	Diastolic BP	Pulse	Breath
Newborns	59-71	30-40	90-100	45-60
1 month - 1 year	85-100	35-45	120-140	35-45
3-7 years	86-110	55-63	120-140	20-25
8-16 years	93-117	59-75	78-84	18-25
17-20 years	100-120	70-80	60-80	16-18
21-60 years	to 140	to 90	60-80	14-18
Older than 60 years	to 150	to 90	60-80	14-18

Authors: Aizman R.I., Krivoshchekov S.G.

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