Normal Respiratory Rate

Prove it: Trauma patients need two IV lines

The restrained and non-ejected front seat passenger is conscious and alert and complaining of pain in the right lower leg. A quick visual exam reveals an obvious midshaft closed lower leg fracture that did not produce a disruption in distal blood flow. The remainder of the patient's physical exam is unremarkable for trauma. The patient's blood pressure is 128/86 mmHg, the heart rate is 96 bpm, the respiratory rate is 16 bpm, the room-air pulse oximetry reading is 96%, and the Glasgow Coma Scale (GCS) score is 13.

After taking spinal stabilization procedures, Medic 16 begins transport to the hospital. Local protocol requires the medics to transport all survivors from a passenger compartment involving a death to a Level 1 trauma center. On the way, the medic places the patient on an electrocardiogram (ECG) monitor and establishes one large-bore intravenous (IV) line with normal saline at a to keep open (TKO) rate. The transport interval is uneventful.

The medics roll the cot into the emergency department passed the waiting trauma team. A nurse asks why there is only one IV and the medic responds that because of the patient's stable condition, the second line (also required by local protocol) was unnecessary. The nurse accepts the explanation but seems perturbed.

After completing the paperwork, the medic asks the nurse to sign the chart accepting care for the patient. As she signs her name, she adds that if patients are bad enough for trauma team activation, they should probably have two large-bore IV lines to guard against the possibility of deterioration before arrival at the hospital.

On the way back to the station, the medic thinks about what the nurse said. Do trauma patients, even critical ones, really need a second IV line?

Review Researchers at the Robert Wood Johnson Medical School in New Jersey evaluated whether a second IV line provided any benefit for trauma patients (Merlin et al., 2011). Specifically, the researchers wanted to know if the second IV line influenced the patient's heart rate, blood pressure, total amount of fluid infused in the prehospital environment, rehospitalization rate, or 30-day mortality.

Normal ranges of heart rate and respiratory rate in children from ...

We searched Medline, Embase, CINAHL, and reference lists for studies that reported heart rate or respiratory rate of healthy children between birth and 18 years of age. We used non-parametric kernel regression to create centile charts for heart rate and respiratory rate in relation to age. We compared existing reference ranges with those derived from our centile charts. We identified 69 studies with heart rate data for 143 346 children and respiratory rate data for 3881 children. Our centile charts show decline in respiratory rate from birth to early adolescence, with the steepest fall apparent in infants under 2 years of age; decreasing from a median of 44 breaths per min at birth to 26 breaths per min at 2 years. Heart rate shows a small peak at age 1 month. Median heart rate increases from 127 beats per min at birth to a maximum of 145 beats per min at about 1 month, before decreasing to 113 beats per min by 2 years of age. Comparison of our centile charts with existing published reference ranges for heart rate and respiratory rate show striking disagreement, with limits from published ranges frequently exceeding the 99th and 1st centiles, or crossing the median. Farshad Farzadfar,Mariel M Finucane,Goodarz Danaei,Pamela M Pelizzari,Melanie J Cowan,Christopher J Paciorek,Gitanjali M Singh,John K Lin,Gretchen A Stevens,Leanne M Riley,Majid Ezzati,on behalf of the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Cholesterol).

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