Reference — Fundamentals
Respiratory Assessment Quick Reference
A bedside lookup for respiratory assessment — normal vital sign and respiratory-rate ranges, percussion notes, tactile fremitus and tracheal-deviation patterns, the combined exam findings for common conditions, and the work-of-breathing red flags that signal deterioration.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Overview
A scannable companion to the bedside exam. Use it to confirm normal ranges, interpret a percussion note or fremitus finding, decide which way a deviated trachea points, and catch the work-of-breathing signs that mean a patient is tiring. Always combine findings into a pattern rather than acting on one in isolation, and compare left with right.
Normal Vital Signs (Adult)
| Parameter | Normal Range |
|---|---|
| Respiratory rate | 12 – 20 /min |
| Heart rate | 60 – 100 /min |
| SpO₂ | ≥ 95% (target 88 – 92% in chronic hypercapnia) |
| Tidal volume | about 6 – 8 mL/kg |
| EtCO₂ | 35 – 45 mmHg |
Respiratory Rate by Age
| Age Group | Normal Rate (/min) |
|---|---|
| Newborn | 30 – 60 |
| Infant | 25 – 40 |
| Toddler | 20 – 30 |
| Child | 18 – 25 |
| Adult | 12 – 20 |
Percussion Notes
| Note | Suggests |
|---|---|
| Resonant | Normal air-filled lung |
| Hyperresonant | Air trapping, pneumothorax, emphysema |
| Dull | Consolidation, atelectasis, or fluid (effusion) |
| Flat | Large pleural effusion |
Combined Exam Patterns
| Condition | Percussion | Tactile Fremitus | Breath Sounds | Trachea |
|---|---|---|---|---|
| Normal | Resonant | Normal | Vesicular | Midline |
| Consolidation / pneumonia | Dull | Increased | Bronchial, crackles | Midline |
| Pleural effusion | Dull to flat | Decreased | Decreased or absent | Midline (pushed away if large) |
| Pneumothorax (tension) | Hyperresonant | Decreased | Decreased or absent | Deviated AWAY |
| Atelectasis | Dull | Variable | Decreased | Deviated TOWARD |
| COPD / hyperinflation | Hyperresonant | Decreased | Decreased, prolonged expiration | Midline |
Work-of-Breathing Red Flags
Any of these means escalate. A single sign rarely tells the whole story, but each one below points to a patient who is decompensating — act on the trend.
- Accessory muscle use (sternocleidomastoid, scalenes), retractions, or nasal flaring.
- Paradoxical or abdominal breathing (a sign of diaphragmatic fatigue).
- Tripod positioning or pursed-lip breathing at rest.
- Single-word dyspnea (cannot complete a sentence).
- Respiratory rate over 30 or under 8 per minute.
- SpO₂ falling despite supplemental oxygen.
- A declining level of consciousness.
- A silent chest in a known asthmatic.
Clinical Notes
- Fremitus follows the medium. Tactile fremitus increases over consolidation and decreases over an effusion, a pneumothorax, or a hyperinflated chest.
- Trachea points to the problem. It deviates AWAY from a tension pneumothorax or a large effusion, and TOWARD atelectasis, fibrosis, or a pneumonectomy.
- SpO₂ is a late sign. Trend work of breathing and the whole picture, not a single saturation.
Related Resources
Sources
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021. Bedside assessment of the patient chapter.
- National Board for Respiratory Care. Therapist Multiple-Choice Examination (TMC) Detailed Content Outline. Patient Data Evaluation section.