An adult has a respiratory rate of 50, what should I do? Breathing in the elderly. Abdominal breathing

The ratio of respiratory rate and heart rate in healthy children in the first year of life it is 3-3.5, i.e. One respiratory movement accounts for 3-3.5 heartbeats, in older children – 5 heartbeats.

Palpation.

For palpation chest both palms are applied symmetrically to the areas being examined. By squeezing the chest from front to back and from the sides, its resistance is determined. The younger the child is, the more pliable the chest is. Increased resistance of the chest is called rigidity.

Voice tremors– resonant vibration of the patient’s chest wall when he pronounces sounds (preferably low-frequency), felt by the hand during palpation. To assess vocal tremor, the palms are also placed symmetrically. Then the child is asked to pronounce words that cause maximum vibration of the vocal cords and resonating structures (for example, “thirty-three,” “forty-four,” etc.). In children early age vocal tremor can be examined during screaming or crying.

Percussion.

When percussing the lungs, it is important that the child’s position is correct, ensuring the symmetry of the location of both halves of the chest. If the position is incorrect, the percussion sound in symmetrical areas will be unequal, which may give rise to an erroneous assessment of the data obtained. When percussing the back, it is advisable to invite the child to cross his arms over his chest and at the same time bend slightly forward; when percussing the anterior surface of the chest, the child lowers his arms along the body. It is more convenient to percuss the anterior surface of the chest in young children when the child lies on his back. For percussion of the child's back, the child is seated, and small children must be supported by someone. If the child does not yet know how to hold his head up, he can be percussed by placing his stomach on a horizontal surface or his left hand.

There are direct and indirect percussion.

Direct percussion – percussion with tapping with a bent finger (usually the middle or index finger) directly on the surface of the patient’s body. Direct percussion is more often used when examining young children.

Indirect percussion - percussion with a finger on the finger of the other hand (usually along the phalanx of the middle finger of the left hand), tightly applied with the palmar surface to the area of ​​the patient’s body surface being examined. Traditionally, percussion is done with the middle finger of the right hand.

Percussion in young children should be carried out with weak blows, since due to the elasticity of the chest and its small size, percussion shocks are too easily transmitted to distant areas.

Since the intercostal spaces in children are narrow (compared to adults), the pessimeter finger should be positioned perpendicular to the ribs.

When percussing healthy lungs, a clear pulmonary sound is obtained. At the height of inhalation, this sound becomes even clearer; at the peak of exhalation, it shortens somewhat. The percussion sound is not the same in different areas. On the right in the lower sections, due to the proximity of the liver, the sound is shortened; on the left, due to the proximity of the stomach, it takes on a tympanic hue (the so-called Traube’s space).

Auscultation.

During auscultation, the position of the child is the same as during percussion. Listen to symmetrical areas of both lungs. Normally, in children under 6 months of age, they listen weakened vesicular breathing, from 6 months to 6 years – puerile(breath sounds are louder and longer during both phases of breathing).

The structural features of the respiratory organs in children that determine the presence of puerile breathing are listed below.

Greater elasticity and thin thickness of the chest wall, increasing its vibration.

Significant development of interstitial tissue, reducing the airiness of lung tissue.

After 6 years of age, breathing in children gradually acquires the character of a vesicular, adult type.

Bronchophony – conduction of a sound wave from the bronchi to the chest, determined by auscultation. The patient whispers the pronunciation of words containing the sounds “sh” and “ch” (for example, “cup of tea”). Bronchophony must be examined over symmetrical areas of the lungs.

Instrumental and laboratory studies.

Clinical blood test allows you to clarify the degree of activity of inflammation, anemia, the level of eosinophilia (an indirect sign allergic inflammation).

Sputum culture from tracheal aspirate, bronchial lavage waters (throat smears reflect the microflora of the upper respiratory tract only) allows identifying the pathogen respiratory disease(diagnostic titer with a semi-quantitative research method - 10 5 - 10 6), determine sensitivity to antibiotics.

Cytomorphological examination of sputum , obtained by collecting a tracheal aspirate or during bronchoalveolar lavage allows one to clarify the nature of inflammation (infectious, allergic), the degree of activity of the inflammatory process, and conduct a microbiological, biochemical and immunological study of the obtained material.

Puncture of the pleural cavity carried out at exudative pleurisy and other significant accumulations of fluid in the pleural cavity; allows for biochemical, bacteriological and serological examination of the material obtained during puncture.

X-ray method:

Radiography is the main method of x-ray diagnostics in pediatrics; a photograph is taken in a direct projection while inhaling; according to indications, a photograph is taken in a lateral projection;

Fluoroscopy - gives a large radiation dose and therefore should be carried out only according to strict indications: determining the mobility of the mediastinum during breathing (suspicion of a foreign body), assessing the movement of the domes of the diaphragm (paresis, diaphragmatic hernia) and for a number of other conditions and diseases;

Tomography – allows you to see small or merging details of lung lesions and lymph nodes; with a higher radiation dose, it is inferior in resolution to computed tomography;

Computed tomography (mainly cross-sections are used) provides rich information and is now increasingly replacing tomography and bronchography.

Bronchoscopy - a method of visual assessment of the inner surface of the trachea and bronchi, carried out with a rigid bronchoscope (under anesthesia) and a fiber optic bronchoscope (under local anesthesia).

Bronchoscopy is an invasive method and should be performed only if there is an undeniable indication .

- SHOWINGS for diagnostic bronchoscopy are:

Suspicion of congenital defects;

Aspiration of a foreign body or suspicion of it;

Suspicion of chronic aspiration of food (lavage to determine the presence of fat in alveolar macrophages);

The need to visualize the nature of endobronchial changes in chronic diseases of the bronchi and lungs;

Carrying out a biopsy of the bronchial mucosa or transbronchial lung biopsy.

In addition to diagnostic, bronchoscopy, according to indications, is used with therapeutic purpose: sanitation of the bronchi with the introduction of antibiotics and mucolytics, drainage of the abscess.

During bronchoscopy, it is possible to perform bronchoal volar lavage (BAL) - flushing the peripheral parts of the bronchi with a large volume isotonic solution sodium chloride, which gives important information if alveolitis, sarcoidosis, pulmonary hemosiderosis and some other rare lung diseases are suspected.

Bronchography - contrasting the bronchi to determine their structure and contours. Bronchography is not a primary diagnostic test. Currently, it is used mainly to assess the extent of bronchial lesions and the possibility of surgical treatment, to clarify the form and localization of the congenital defect.

Pneumoscintigraphy - used to assess capillary blood flow in the pulmonary circulation.

Study of respiratory organ functions. IN clinical practice The ventilation function of the lungs is most widely used, which is methodologically more accessible. Violation ventilation function lungs can be obstructive (impaired passage of air through the bronchial tree), restrictive (reduced gas exchange area, decreased extensibility of lung tissue ) and combined type. Functional research allows differentiating types of insufficiency external respiration, forms of ventilation failure; detect disorders not detected clinically; evaluate the effectiveness of the treatment.

To study the ventilation function of the lungs, spirography and pneumotachometry are used.

Spirography gives an idea of ​​ventilation disturbances, the degree and form of these disturbances.

Pneumochymetry gives an FVC exhalation curve, from which about 20 parameters are calculated both in absolute values ​​and as a percentage of the required values.

Functional tests for bronchial reactivity. Inhalation pharmacological tests are carried out with β 2 -adrenergic agonists to determine latent bronchospasm or select adequate antispasmodic therapy. FVD study carried out before and 20 minutes after inhalation of 1 dose of the drug.

Allergy tests.

Skin (application, scarification), intradermal and provocative tests with allergens are used. The total IgE content and the presence of specific immunoglobulins to various allergens are determined.

Determination of blood gas composition.

Ra O and pa CO 2 are determined, as well as the pH of capillary blood. If long-term continuous monitoring of the blood gas composition is necessary, transcutaneous determination of blood oxygen saturation (S 2 O 2) is carried out in the dynamics of respiratory failure.

Software tests

One of the actions carried out during examination by a pediatrician is counting breathing movements. This seemingly simple indicator carries important information about the state of health in general and the functioning of the respiratory and of cardio-vascular system in particular.

How to correctly calculate the respiratory rate (RR) per minute? This is not particularly difficult. But certain difficulties arise with the interpretation of the data. This is more true for young parents, because, having received a result from a child that is several times higher than their own, they panic. Therefore, in this article we propose to figure out what the normal respiratory rate is for children. The table will help us with this.

Features of the child's respiratory system

The first thing you've been waiting for so long future mom- the baby's first cry. It is with this sound that his first breath occurs. By the time of birth, the organs that ensure the child’s breathing are not yet fully developed, and only with the growth of the body itself do they mature (both functionally and morphologically).

The nasal passages (which are the upper respiratory tract) in newborns have their own characteristics:
. They are quite narrow.
. Relatively short.
. Their inner surface is delicate, with a huge number of vessels (blood, lymphatic).

Therefore, even with minor symptoms, the child’s nasal mucosa quickly swells, the already small lumen decreases, and as a result, breathing becomes difficult and shortness of breath develops: small children cannot yet breathe through their mouths. How younger child, the more dangerous the consequences can be, and the faster it is necessary to eliminate the pathological condition.

Lung tissue in young children also has its own characteristics. They, unlike adults, have poorly developed lung tissue, and the lungs themselves have a small volume at a huge number blood vessels.

Rules for counting breathing rate

Measuring respiratory rate does not require any special skills or equipment. All you need is a stopwatch (or a watch with a second hand) and following simple rules.

The person should be calm and in a comfortable position. If we are talking about children, especially young children, then it is better to count respiratory movements during sleep. If this is not possible, the subject should be distracted from the manipulation as much as possible. To do this, just grab your wrist (where the pulse is usually detected) and meanwhile count your breathing rate. It should be noted that the pulse in children less than a year old(about 130-125 beats per minute) should not cause concern - this is the norm.

In infants, it is strongly recommended to count the respiratory rate during sleep, since crying can significantly affect the result and give deliberately false numbers. By placing your hand on the anterior abdominal wall (or just visually), you can easily carry out this study.

Considering that breathing has its own rhythmic cycle, it is necessary to observe the duration of its counting. Be sure to measure your respiratory rate over the course of a full minute, rather than multiplying the result obtained in just 15 seconds by four. It is recommended to carry out three counts and calculate the average.

Normal respiratory rate in children

The table shows the normal respiratory rate. Data are presented for children of different age groups.

As we can see from the table, the frequency of respiratory movements per minute is higher, the younger the child. Gradually, as they grow older, their number decreases, and by puberty, when the child turns 14-15 years old, the respiratory rate becomes equal to that of an adult healthy person. No differences by gender are observed.

Types of breathing

There are three main types of breathing in both adults and children: chest, abdominal and mixed.

The breast type is more typical for females. With it, inhalation/exhalation is ensured to a greater extent due to movements of the chest. The disadvantage of this type of breathing movement is poor ventilation. lower sections lung tissue. Whereas with the abdominal type, when the diaphragm is more involved (and the anterior one visually moves when breathing abdominal wall), the upper parts of the lungs experience a lack of ventilation. This type of breathing movement is more common for men.

But with a mixed type of breathing, a uniform (identical) expansion of the chest occurs with an increase in the volume of its cavity in all four directions (upper-lower, lateral). This is the most correct one, which ensures optimal ventilation of the entire lung tissue.

Normally, the respiratory rate in a healthy adult is 16-21 per minute, in newborns - up to 60 per minute. Above, the norm of respiratory rate in children is given in more detail (table with age norms).

Rapid breathing

The first sign of respiratory damage, especially when infectious diseases, is However, there will certainly be other signs colds(cough, runny nose, wheezing, etc.). Quite often, when body temperature rises, the respiratory rate increases and the pulse quickens in children.

Holding your breath during sleep

Quite often, young children (especially infants) experience short-term pauses in breathing during sleep. This physiological feature. But if you notice that such episodes become more frequent, their duration becomes longer, or other symptoms occur, such as blue lips or loss of consciousness, you should immediately call " Ambulance"to prevent irreversible consequences.

Conclusion

The respiratory organs have a number of features that contribute to their frequent defeat and rapid decompensation of the condition. This is primarily due to their immaturity at the time of birth, certain anatomical and physiological characteristics, incomplete differentiation of the structures of the central nervous systems s and their direct effect on the respiratory center and respiratory organs.
The younger the child, the less lung capacity he has, and therefore he will need to make a greater number of respiratory movements (inhalation/exhalation) to provide the body with the necessary volume of oxygen.

Summing up

It should be remembered that respiratory arrhythmia is quite common in children in the first months of life. Most often this is not pathological condition, but only indicates age-related characteristics.

So, now you know what the normal respiratory rate is for children. The table of averages should be taken into account, but small deviations should not panic. And be sure to consult your doctor before jumping to conclusions!

As the child grows older, the ratio of respiratory rate and heart rate should approach the norm of an adult. These indicators help to calculate the intensity of physical and moral stress on the child. For adults, standards also vary depending on the level physical activity. Athletes have a lower heart rate than people who are not involved in sports.

What are heart rate and respiratory rate?

Counting the number of beats the heart makes per minute. Respiratory rate is the number of inhalations and exhalations per minute. These indicators make it possible to determine how deep and rhythmic breathing is, as well as the ability to analyze the performance of the chest. Heartbeat characteristics differ during different periods of growth.

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Table by age for children: norms

Pulse studies have shown that in newborns it is 140 beats per minute. The pulse rate in children in the first 12 months of life decreases to 110-130, and over 12 years, the pulse rate reaches approximately the adult norm. The norm of respiratory rate in children is important for assessing the condition of the respiratory tract, heart, circulatory system and health in general. The ratio of respiratory rate to heart rate is the respiratory-pulse coefficient in infants 1:2.5, in children under 12 months - 1:3, older - 1:4. The following table presents the norms of respiratory rate and heart rate in children by age.

Measuring heart rate and respiratory rate

How to measure your pulse:

1. Grab your wrist in the pulse detection area.
2. Start the stopwatch.
3. Count the number of heartbeats per minute.

Technique for counting breathing in children (inhale-exhale):

1. Distract the child.
2. Place your hand on your stomach or take your hand.
3. Count the number of cycles in 1 minute.
4. Evaluate the result.

To calculate the heart rate, the baby must take a stationary position. Measurement cannot be carried out after various loads physical or emotional, because the pulse quickens. After this, it is worth determining whether the results correspond to the norm. Normally, the pulsation is rhythmic and clear. The counting technique is used for different ages. The breathing rate is measured over a minute. In children, it is better to count respiratory movements during sleep.

Deviations from the norm

Do not worry if the baby’s heart rate and respiratory rate differ slightly from the readings of an adult. And only if you receive data that differs significantly from the norm indicated in the table, should you be examined by a doctor to find out main reason deviations. Rapid shallow breathing is called tachypnea. An increase in heart rate is called tachycardia, a decrease is called bradycardia.

Rapid breathing

Frequent breathing is an increase in the repetition of respiratory movements, in which its rhythm does not change, and can develop due to gas exchange disorders with the accumulation of carbon dioxide in the blood and a decrease in the amount of oxygen. As a result, the range of movements during breathing becomes smaller. At times, rapid breathing worsens, which is mistaken for shortness of breath, in which the respiratory rate in children should be more than 60 inhalations and exhalations per minute.

Respiratory rate (RR) and vital capacity. Breathing at rest should be rhythmic and deep. The normal respiratory rate in an adult is 14-18 times per minute. Under load it increases 2-2.5 times. An important indicator The function of breathing is the vital capacity of the lungs (VC) - the volume of air obtained during the maximum exhalation made after the maximum inhalation. Normally in women it is 2.5-4 l, in men it is 3.5-5 l.

Blood pressure (BP). Systolic pressure (max) is the pressure during systole (contraction) of the heart, when it reaches its greatest value throughout the cardiac cycle. Diastolic pressure(min) - determined by the end of diastole (relaxation) of the heart, when it continues cardiac cycle reaches a minimum value.

Ideal blood pressure formula for each age:

Max. BP = 102+ (0.6 x number of years) min. BP = 63+ (0.5 x number of years)

The World Health Organization suggests that these should be considered normal numbers arterial pressure for systolic (max.) - 100 - 140 mm Hg; for diastolic 80-90 mm Hg.

58. Functional tests and tests

The level of the functional state of the body can be determined using functional tests and tests.

Orthostatic test. The pulse is calculated in a lying position after 5-10 minutes of rest, then you need to stand up and measure the pulse in a standing position. Based on the difference in heart rate while lying down and standing, one can judge functional state cardiovascular and nervous systems. The difference is up to 12 beats/min - good condition physical fitness, from 13 to 18 beats/min - satisfactory, 19-25 beats/min - unsatisfactory, i.e. lack of physical fitness, more than 25 beats/min - indicates overwork or illness.

Stange's test (holding your breath while inhaling). After 5 minutes of rest while sitting, do 2-3 deep breaths and exhalation, and then, having taken a full breath, hold their breath, the time is noted from the moment the breath is held until it stops.

The average indicator is the ability to hold your breath while inhaling for untrained people for 40-55 seconds, for trained people - for 60-90 seconds or more. With increasing training, the time you hold your breath increases; in case of illness or fatigue, this time decreases to 30-35 seconds.

This test characterizes the body's resistance to oxygen deficiency.

One-time test.

Before performing a single-stage test, rest while standing, without moving for 3 minutes. Then the heart rate is measured for one minute. Next, perform 20 deep squats in 30 seconds from the starting position with feet shoulder-width apart, arms along the body. When squatting, the arms are brought forward, and when straightening, they are returned to their original position. After performing squats, heart rate is calculated for one minute.

During the assessment, the magnitude of the increase in heart rate after exercise is determined as a percentage. A value of 20% means an excellent response of the cardiovascular system to stress, from 21 to 40% - good,

from 41 to 65% - satisfactory,

from 66 to 75% - bad,

from 76 and more - very bad.

Genchi test (holding your breath while exhaling). It is performed in the same way as the Stange test, only the breath is held after a complete exhalation. Here, the average indicator is the ability to hold your breath while exhaling for untrained people for 25-30 seconds, for trained people for 40-60 seconds. and more.

Ruffier's test. To assess the activity of the cardiovascular system, you can use the Ruffier test. 1 After a 5-minute calm state in a sitting position, count your pulse for 10 seconds (P1), then perform 30 squats within 45 seconds. Immediately after squats, count your heart rate for the first 10 seconds (P2) and a minute (P3) after the load. The results are assessed by an index, which is determined by the formula:

6 x (P1+ P2+ P3) - 200

Ruffier index =

Cardiac performance assessment:

Ruffier index

0 - athletic heart

0, 1 - 5 - "excellent" (very good heart)

5, 1 - 10 - “good” (good heart)

10, 1 - 15 - “satisfactory” (heart failure)

15 1 - 20 - “poor” (severe heart failure)

25 - 50% - good,

from 50 - 75% bad.

Test to check and evaluate general endurance.

It is carried out using control exercises of 2 types: overcoming a medium, long distance or overcoming the greatest possible distance in a certain time. Examples of these exercises are:

1) running and cross-country at 1000, 2000, 2500, 3000, 5000m;

swimming 200, 400, 500 m,

2) run 12 min.

The most substantiated assessments of general endurance are based on the K. Cooper test. This is a 12-minute run covering a maximum distance (km).