The name of the vital sign proposed by Edward Seguin in 1866 was “respirations”. Over the years the name changed to “respiratory rate” (RR), the original emphasis of the sign. Today in many charts it is back to “respiration(s)”, indicating a more thorough evaluation.
Respiration is the more critical of the vital signs, since the heart and brain require a definite amount of oxygen in order to function. In emergencies, the airway is first addressed, then breathing, then circulation—the ABCs of resuscitation.
Apnea for more than 7-10 minutes usually means irreversible brain damage. Exceptions exist, including infants, and isolated cases of hypothermia and drowning.
A protocol was developed a few years ago for the Advanced Trauma Life Support (ATLS) course also, relevant to the non trauma patient: Primary Survey
(ABCDs), Resuscitative Measures and Secondary Survey
(history and physical exam).
is opened with jaw thrust or chin lift, oxygen is administered, pulse oximetry is monitored, the airway is secured by intubation or cricothyrotomy and the cervical spine is cleared. Breathing
is assisted with bag-valve-mask or ventilator, tension pneumothorax is decompressed by needle, a chest tube is placed for pneumothorax or hemothorax and pulmonary edema is treated. Circulation
: IV access is obtained, a cardiac monitor is placed, dysrhythmias and shock are treated, and Disability:
a brief neurological exam is assessed. If decreased level of consciousness is present, a chemstrip glucose is obtained (or if unavailable glucose is given) and thiamine and naloxone are administered.