Types of breathing, frequency and depth, nature of breathing movements. Determination of basic respiratory indicators Normal respiratory rate and age

Breathing (respiration) is a set of processes that ensure the entry of atmospheric oxygen into the body, its use in biological oxidation reactions, and the removal from the body of carbon dioxide formed during metabolism. Reflex irritation of the respiratory center occurs when the level of carbon dioxide in the blood increases.

There are several stages of respiration: 1. External respiration - exchange of gases between the atmosphere and alveoli. 2. Exchange of gases between the alveoli and the blood of the pulmonary capillaries. 3. Transport of gases by blood - the process of transferring O2 from the lungs to the tissues and CO2 from the tissues to the lungs. 4. Exchange of O2 and CO2 between capillary blood and body tissue cells. 5. Internal, or tissue, respiration - biological oxidation in the mitochondria of the cell. There are several stages of respiration: 1. External respiration - exchange of gases between the atmosphere and alveoli. 2. Exchange of gases between the alveoli and the blood of the pulmonary capillaries. 3. Transport of gases by blood - the process of transferring O2 from the lungs to the tissues and CO2 from the tissues to the lungs. 4. Exchange of O2 and CO2 between capillary blood and body tissue cells. 5. Internal, or tissue, respiration - biological oxidation in the mitochondria of the cell.

In a healthy adult, the normal respiratory rate at rest is 1620 per minute. RR (Respiratory rate) depends: 1. On gender: Women have 2-4 breaths more than men; 2. From body position; 3. From the state of the nervous system; 4. From age; 5. From body temperature; When body temperature increases by 1 °C, breathing becomes more frequent by an average of 4 respiratory movements. 1. From the floor: Women have 2-4 more breaths than men; 2. From body position; 3. From the state of the nervous system; 4. From age; 5. From body temperature; When body temperature increases by 1 °C, breathing becomes more frequent by an average of 4 respiratory movements. Observation of breathing must be carried out unnoticed by the patient, since he can involuntarily change the respiratory rate, rhythm, and depth of breathing. ATTENTION!

There is a distinction between shallow and deep breathing. Shallow breathing may be inaudible at a distance or slightly audible. It is often combined with a pathological increase in breathing. Deep breathing, audible from a distance, is most often associated with a pathological decrease in breathing.

Physiological types of breathing include thoracic, abdominal and mixed type. In women, thoracic breathing is more common, while in men, abdominal breathing is more common. With a mixed type of breathing, a uniform expansion of the chest and all parts of the lung occurs in all directions.

It is advisable that the ward before the test should not be agitated by anything, should not eat, or be exposed to physical activity. Inhalation and exhalation are considered “one breath”. The calculation is carried out without informing the patient about the respiratory rate study in order to prevent voluntary changes in breathing. It is advisable that the ward before the test should not be agitated by anything, should not eat, or be exposed to physical activity. Inhalation and exhalation are considered “one breath”. The calculation is carried out without informing the patient about the respiratory rate study in order to prevent voluntary changes in breathing. It is convenient to calculate the respiratory rate when the patient lies on his back and the upper part of his chest or epigastric region is visible (with abdominal breathing) Take the patient’s hand as for examining the pulse, count the number of breaths per minute, using a stopwatch, simulating pulse examinations Estimate the frequency of the patient’s respiratory movements . Watch the movements (rising and lowering) of the chest or abdominal wall: how high the chest rises, whether the inhalations and exhalations are equal, whether the pauses between them are equal. At the end of the procedure, record data to ensure continuity of work and control over the NPV. It is convenient to calculate the respiratory rate when the patient lies on his back and the upper part of his chest or epigastric region is visible (with abdominal breathing) Take the patient’s hand as for examining the pulse, count the number of breaths per minute, using a stopwatch, simulating pulse examinations Estimate the frequency of the patient’s respiratory movements . Watch the movements (rising and lowering) of the chest or abdominal wall: how high the chest rises, whether the inhalations and exhalations are equal, whether the pauses between them are equal. At the end of the procedure, record data to ensure continuity of work and control over the NPV.

Pathological types of breathing. For a patient with a heart or pulmonary disease, a sharp increase in breathing is a sign of a complication or worsening of the condition. Rare breathing (less than 12 breath per minute) is a sign of a threat to life. If shallow and excessively frequent breathing occurs with noise, sometimes bubbling, this indicates improper gas exchange in the lungs. With asthma, breathing is wheezing, with bronchitis with wheezing. For a patient with a heart or pulmonary disease, a sharp increase in breathing is a sign of a complication or worsening of the condition. Rare breathing (less than 12 breath per minute) is a sign of a threat to life. If shallow and excessively frequent breathing occurs with noise, sometimes bubbling, this indicates improper gas exchange in the lungs. With asthma, breathing is wheezing, with bronchitis with wheezing.

Big Kussmaul breathing is rare, deep breathing with a loud noise, observed in deep coma (prolonged loss of consciousness); Biotte breathing is periodic breathing, in which there is a correct alternation of periods of shallow respiratory movements and pauses of equal duration (from several seconds to a minute);

Cheyne-Stokes breathing is characterized by a period of increasing frequency and depth of breathing, which reaches a maximum at the 57th breath, followed by a period of decreasing frequency and depth of breathing and another long pause of equal duration (from several seconds to 1 minute). During the pause, patients are poorly oriented in the environment or lose consciousness, which is restored when breathing movements are resumed (in case of severe damage to the brain, kidneys, and heart vessels).

“The art of medicine consists of the amount of knowledge necessary to understand the causes and pathophysiological mechanisms of diseases, from clinical experience, intuition and a set of qualities, which together constitute the so-called “clinical thinking.”

Ellipses

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To build an elliptical arc you need to select the option Arc(Arc).

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The heart is a hollow muscular organ, the “pump” of our body, which pumps blood through blood vessels: arteries and veins.

Through arteries, blood flows from the heart to organs and tissues, while it is rich in oxygen and is called arterial. Blood flows through the veins to the heart, while it has already given oxygen to each cell of the body and taken carbon dioxide from the cells, therefore this blood is darker and is called venous.

Arterial called pressure, which is formed in the arterial system of the body during contractions of the heart and depends on complex neurohumoral regulation, the magnitude and speed of cardiac output, the frequency and rhythm of heart contractions and vascular tone.

There are systolic (SD) and diastolic pressure (DD). Blood pressure is recorded in millimeters of mercury (mmHg). Systolic is the pressure that occurs in the arteries at the moment of maximum rise of the pulse wave after ventricular systole. Normally, in a healthy adult, DM is 100–140 mm Hg. Art. The pressure maintained in the arterial vessels during ventricular diastole is called diastolic; normally in a healthy adult it is 60–90 mmHg. Art. Thus, human blood pressure consists of two values - systolic and diastolic. SD (larger indicator) is written first, DD (smaller indicator) is written second, separated by a fraction. An increase in blood pressure above normal is called hypertension or hypertension. The difference between DM and PP is called pulse pressure (PP), which is normally 40 - 50 mmHg. Blood pressure below normal is called hypotension or hypotension.

In the morning, blood pressure is lower by 5-10 mmHg than in the evening. Art.. A sharp drop in blood pressure is life-threatening! It is accompanied by pallor, severe weakness, and loss of consciousness. Low blood pressure disrupts the normal course of many vital processes. So, when systolic pressure drops below 50 mmHg. Art. urine production ceases and renal failure develops.

Blood pressure is measured using the indirect sound method, proposed in 1905 by the Russian surgeon N.S. Korotkov. Devices for measuring pressure have the following names: Riva-Rocci apparatus, or tonometer, or sphygmomanometer.

Currently, electronic devices are also used that make it possible to determine blood pressure using a non-sound method.

To study blood pressure, it is important to consider the following factors: the size of the cuff, the condition of the membrane and tubes of the phonendoscope, which may be damaged.

Pulse- these are rhythmic vibrations of the artery wall caused by the release of blood into the arterial system during one heartbeat. There are central (on the aorta, carotid arteries) and peripheral (on the radial, dorsal artery of the foot and some other arteries) pulse.

For diagnostic purposes, the pulse is determined in the temporal, femoral, brachial, popliteal, posterior tibial and other arteries.

More often, the pulse is examined in adults on the radial artery, which is located superficially between the styloid process of the radius and the tendon of the internal radial muscle.

When examining the pulse, it is important to determine its frequency, rhythm, filling, tension and other characteristics. The nature of the pulse also depends on the elasticity of the artery wall.

Frequency is the number of pulse waves per minute. Normally, a healthy adult has a pulse of 60-80 beats per minute. An increased heart rate of more than 85-90 beats per minute is called tachycardia. A heart rate rate of less than 60 beats per minute is called bradycardia. The absence of a pulse is called asystole. With an increase in body temperature at HS, the pulse increases in adults by 8-10 beats per minute.

The pulse rhythm is determined by the intervals between pulse waves. If they are the same, the pulse is rhythmic (correct); if they are different, the pulse is arrhythmic (incorrect). In a healthy person, the contraction of the heart and the pulse wave follow each other at regular intervals.

Pulse filling is determined by the height of the pulse wave and depends on the systolic volume of the heart. If the height is normal or increased, then a normal pulse (full) is felt; if not, then the pulse is empty. Pulse voltage depends on blood pressure and is determined by the force that must be applied until the pulse disappears. At normal pressure, the artery is compressed with moderate force, so the normal pulse is of moderate (satisfactory) tension. With high pressure, the artery is compressed by strong pressure - this pulse is called tense. It is important not to make a mistake, since the artery itself can be sclerotic. In this case, it is necessary to measure the pressure and verify the assumption that has arisen.

With low blood pressure, the artery is easily compressed, and the tension of the pulse is called soft (relaxed).

An empty, relaxed pulse is called a small filamentous pulse.

Pulse study data is recorded in two ways: digitally - in medical documentation, journals, and graphically - in the temperature sheet with a red pencil in the column “P” (pulse). It is important to determine the division value on the temperature sheet.

The respiratory system provides the gas exchange necessary to maintain life and also functions as a vocal apparatus. The function of the respiratory system is simply to supply the blood with sufficient oxygen and remove carbon dioxide from it. Life without oxygen is not possible for humans. The exchange of oxygen and carbon dioxide between the body and the environment is called respiration.

Breathing is a single process consisting of 3 parts:

1. External respiration - gas exchange between the external environment and the blood of the pulmonary capillaries.

2. Transfer of gases (using blood hemoglobin).

3. Internal tissue respiration - gas exchange between blood and cells, as a result of which the cells consume oxygen and release carbon dioxide. Watching breathing, special attention should be paid to changes in skin color, determining the frequency, rhythm, depth of respiratory movements and assessing the type of breathing.

The respiratory movement is carried out by alternating inhalation and exhalation. The number of breaths in 1 minute is called the respiratory rate (RR).

In a healthy adult, the rate of respiratory movements at rest is 16-20 per minute; in women it is 2-4 breaths more than in men. NPV depends not only on gender, but also on body position, state of the nervous system, age, body temperature, etc.

Observation of breathing should be carried out unnoticed by the patient, since he can arbitrarily change the frequency, rhythm, and depth of breathing. NPV is related to heart rate on average as 1:4. When body temperature increases by 1°C, breathing becomes more frequent by an average of 4 respiratory movements.

Possible changes in breathing patterns

There is a distinction between shallow and deep breathing. Shallow breathing may not be audible from a distance. Deep breathing, audible from a distance, is most often associated with a pathological decrease in breathing.

Physiological types of breathing include thoracic, abdominal and mixed type. In women, thoracic breathing is more common; in men, abdominal breathing is more common. With a mixed type of breathing, a uniform expansion of the chest of all parts of the lung occurs in all directions. Types of breathing are developed depending on the influence of both the external and internal environment of the body. When the rhythm and depth of breathing is disturbed, shortness of breath occurs. There is inspiratory dyspnea - this is breathing with difficulty inhaling; expiratory - breathing with difficulty exhaling; and mixed - breathing with difficulty inhaling and exhaling. Rapidly developing severe shortness of breath is called suffocation.

2. Mechanisms of heat generation and heat transfer pathways

In an adult healthy person, body temperature is constant and when measured in the armpit, it ranges from 36.4-36.9°.

Heat is generated in all cells and tissues of the body as a result of the metabolism occurring in them, i.e. oxidative processes, breakdown of nutrients, mainly carbohydrates and fats. The constancy of body temperature is regulated by the relationship between the formation of heat and its release: the more heat is generated in the body, the more it is released. If during muscular work the amount of heat in the body increases significantly, then its excess is released into the environment.

With increased heat production or increased heat transfer, skin capillaries expand and then sweating begins.

Due to the expansion of skin capillaries, a rush of blood occurs to the surface of the skin, it turns red, becomes warmer, “hotter”, and due to the increased temperature difference between the skin and the surrounding air, heat transfer increases. When sweating, heat transfer increases because a lot of heat is lost when sweat evaporates from the surface of the body. That is why, if a person works hard, especially at high air temperatures (in hot workshops, a bathhouse, under the scorching rays of the sun, etc.), he turns red, he becomes hot, and then he begins to sweat.

Heat transfer, although to a lesser extent, also occurs from the surface of the lungs - the pulmonary alveoli.

A person exhales warm air saturated with water vapor. When a person is hot, he breathes more deeply and frequently.

A small amount of heat is lost in urine and feces.

With increased heat generation and reduced heat transfer, body temperature rises, a person gets tired faster, his movements become slower, sluggish, which somewhat reduces heat generation.

A decrease in heat generation or a decrease in heat transfer, on the contrary, is characterized by a narrowing of the skin blood vessels, paleness and coldness of the skin, due to which heat transfer decreases. When a person is cold, he involuntarily begins to tremble, that is, his muscles begin to contract, both embedded in the thickness of the skin (“skin tremors”) and skeletal ones, as a result of which heat generation increases. For the same reason, he begins to make rapid movements and rub the skin to increase heat generation and cause hyperemia of the skin.

Heat generation and heat transfer are regulated by the central nervous system.

The centers that regulate heat exchange are located in the interstitial brain, in the subthalamic region under the controlling influence of the brain, from where the corresponding impulses spread to the periphery through the autonomic nervous system.

Physiological adaptability to changes in external temperature, like any reaction, can only occur to certain limits.

If the body overheats excessively, when the body temperature reaches 42-43°, a so-called heat stroke occurs, from which a person can die if appropriate measures are not taken.

With excessive and prolonged cooling of the body, the body temperature begins to gradually decrease and death from freezing may occur.

Body temperature is not a constant value. The temperature value depends on:

- time of day. The minimum temperature occurs in the morning (3-6 hours), the maximum in the afternoon (14-16 and 18-22 hours). Night workers may have the opposite relationship. The difference between morning and evening temperatures in healthy people does not exceed 1 0 C;

- motor activity. Rest and sleep help lower the temperature. Immediately after eating, there is also a slight increase in body temperature. Significant physical and emotional stress can cause a temperature increase of 1 degree;

Hormonal background. In women during pregnancy and the menstrual period, the body increases slightly.

Age. In children it is higher on average by 0.3-0.4°C than in adults; in old age it may be slightly lower.

It will be possible to determine the functional state of the respiratory and cardiovascular systems counting the number of breathing movements at the patient. Indications for calculating the frequency of respiratory movements are mainly diseases of the respiratory system and cardiovascular system. Before we consider the sequence of actions of this manipulation, let us remember what breathing is in general.

Breathing is a basic life process that ensures a continuous supply of oxygen to the body and the release of carbon dioxide and water vapor from the body. The following types of breathing in humans are distinguished depending on the involvement of parts of the chest in the process.

Chest type of breathing

With the chest type of breathing in a person, the chest expands mainly in the anteroposterior and lateral directions. This type of breathing is more common in women. In this case, the lower parts of the lungs may not be ventilated sufficiently.

Abdominal breathing

With the abdominal type of breathing in humans, the expansion of the chest cavity occurs mainly due to the diaphragm in the vertical direction. This type of breathing is more typical for men. In this case, the apexes of the lungs may become insufficiently ventilated.

Mixed breathing type

With a mixed type of breathing, a uniform expansion of the chest cavity occurs in all directions, which ensures sufficient ventilation of all parts of the lungs.

Fine respiratory rate (RR) in an adult it is 16-20 per minute. In newborns, the normal respiratory rate is 40-60 per minute, in children 1-2 years old - 30-40.

Counting the number of breathing movements

You will need a stopwatch to count. The patient should not be informed about the counting of his respiratory movements, since in this case the patient will begin to control his breathing, which will distort the true picture of the study.

Sequence of actions of the nurse

With the patient lying down, we take his hand as if to count the pulse and, together with our hand, place it on the front surface of the patient’s chest.
Using excursions of the chest or abdominal wall, we count the number of respiratory movements in 1 minute, while counting either inhalations or exhalations.
We record the result in the patient’s temperature sheet, keeping a graphical record of the results and displaying a breathing curve. The curve is obtained by connecting the points, with the date or time marked horizontally and the NPV vertically.

Counting the number of breathing movements plays a significant role in assessing the patient’s condition (improvement or deterioration, or lack of dynamics).

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

Palpation.

To palpate the 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 young children, vocal tremors 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 healthy lungs are percussed, a clear lung 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, and the level of eosinophilia (an indirect sign of allergic inflammation).

Sputum culture from tracheal aspirate, bronchial washings (smears from the throat reflect the microflora of only the upper respiratory tract) allows you to identify the causative agent of a 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 for 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 for therapeutic purposes: sanitation of the bronchi with the administration of antibiotics and mucolytics, drainage of an abscess.

During bronchoscopy, it is possible to perform bronchoal volar lavage (BAL) - washing the peripheral parts of the bronchi with a large volume of isotonic sodium chloride solution, which provides important information in case of suspicion for alveolitis, sarcoidosis, pulmonary hemosiderosis and some other rare lung diseases.

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 of the ventilation function of the 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 us to differentiate types of external respiration failure, 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. The FVD study is 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

The heart is a hollow muscular organ, the “pump” of our body, which pumps blood through blood vessels: arteries and veins.

Currently, electronic devices are also used that make it possible to determine blood pressure using a non-sound method.

To study blood pressure, it is important to consider the following factors: the size of the cuff, the condition of the membrane and tubes of the phonendoscope, which may be damaged.

For diagnostic purposes, the pulse is determined in the temporal, femoral, brachial, popliteal, posterior tibial and other arteries.

More often, the pulse is examined in adults on the radial artery, which is located superficially between the styloid process of the radius and the tendon of the internal radial muscle.

When examining the pulse, it is important to determine its frequency, rhythm, filling, tension and other characteristics. The nature of the pulse also depends on the elasticity of the artery wall.

Frequency- this is the number of pulse waves in 1 minute. Normally, a healthy adult has a pulse of 60-80 beats per minute. An increased heart rate of more than 85-90 beats per minute is called tachycardia. A heart rate rate of less than 60 beats per minute is called bradycardia. The absence of a pulse is called asystole. With an increase in body temperature at HS, the pulse increases in adults by 8-10 beats per minute.

Rhythm pulse is determined by the intervals between pulse waves. If they are the same, the pulse is rhythmic (correct); if they are different, the pulse is arrhythmic (incorrect). In a healthy person, the contraction of the heart and the pulse wave follow each other at regular intervals.

Filling pulse is determined by the height of the pulse wave and depends on the systolic volume of the heart. If the height is normal or increased, then a normal pulse (full) is felt; if not, then the pulse is empty. Voltage pulse depends on blood pressure and is determined by the force that must be applied until the pulse disappears. At normal pressure, the artery is compressed with moderate force, so the normal pulse is of moderate (satisfactory) tension. With high pressure, the artery is compressed by strong pressure - this pulse is called tense. It is important not to make a mistake, since the artery itself can be sclerotic. In this case, it is necessary to measure the pressure and verify the assumption that has arisen.

With low blood pressure, the artery is easily compressed, and the tension of the pulse is called soft (relaxed).

An empty, relaxed pulse is called a small filamentous pulse.

Respiratory system provides the gas exchange necessary to maintain life, and also functions as a vocal apparatus. The function of the respiratory system is simply to supply the blood with sufficient oxygen and remove carbon dioxide from it. Life without oxygen is not possible for humans. The exchange of oxygen and carbon dioxide between the body and the environment is called respiration.

Breath– this consists of 3 links:

1. External respiration - gas exchange between the external environment and the blood of the pulmonary capillaries.

2. Transfer of gases (using blood hemoglobin).

The respiratory movement is carried out by alternating inhalation and exhalation. The number of breaths in 1 minute is called the respiratory rate (RR).