Physical Exam

Respiratory Rate

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Video coming September 2026

How to Perform

Without alerting the patient, count the breaths over a full 60 seconds by watching a location with obvious movement during respiration or feeling the chest or abdomen rise.

How to Interpret

Cardiopulmonary Arrest

Tachypnea (respiratory rate >27 breaths per minute) in a medical inpatient, predicting impending cardiopulmonary arrest

Rule in

Somewhat helpfulDerived CI

Rule out

Minimally helpfulDerived CI

Evidence:Limited

Pneumonia

Tachypnea (respiratory rate ≥20 breaths per minute)

Rule in

Somewhat helpful

Rule out

Not helpful

Evidence:Strong

Pulmonary Embolism

Tachypnea (respiratory rate >20 breaths per minute)

Rule in

Not helpful

Rule out

Minimally helpful

Evidence:Limited

Reduced Left Ventricular Ejection Fraction

Ejection Fraction Below 40%

Cheyne-Stokes respirations

Rule in

Helpful

Rule out

Not helpfulNo CI

Evidence:Limited

Cheyne-Stokes respirations in a patient over 80

Rule in

Somewhat helpfulDerived CI

Rule out

—

Evidence:Limited

References

Research in progress on one or more findings above; ratings may change.

Htun TP, Sun Y, Chua HL, Pang J. Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review. Sci Rep. 2019;9(1):7600. doi:10.1038/s41598-019-44145-y. PMID: 31110214. PMC: PMC6527561.
Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287. PMID: 26903338. PMC: PMC4968574. Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-774. doi:10.1001/jama.2016.0288. PMID: 26903335. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. ACCP/SCCM Consensus Conference Committee. Chest. 1992;101(6):1644-55. doi:10.1378/chest.101.6.1644. PMID: 1303622.
West J, Goodacre S. The value of clinical features in the diagnosis of acute pulmonary embolism: systematic review and meta-analysis. QJM. 2007;100(12):763-769. PMID: 18089542.
Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005;294(15):1944-1956. doi:10.1001/jama.294.15.1944. PMID: 16234501. Bickley LS. Bates' Guide to Physical Examination and History Taking. 13th ed. Wolters Kluwer; 2020. Sapira JD. The Art and Science of Bedside Diagnosis. 4th ed. (LeBlond/Brown/DeGowin eds.) Wolters Kluwer; 2014. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145(18):e895-e1032. PMID: 35363499.
Cushing H. Concerning a definite regulatory mechanism of the vasomotor centre which controls blood pressure during cerebral compression. Johns Hopkins Hosp Bull. 1901;12:290-292. Carney N, Totten AM, OReilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017;80(1):6-15. doi:10.1227/NEU.0000000000001432. PMID: 27654000. Wan WH, Ang BT, Wang E. The Cushing Response: a case for a review of its role as a physiological reflex. J Clin Neurosci. 2008;15(3):223-228. doi:10.1016/j.jocn.2007.05.025. PMID: 18182296. Plum F, Posner JB. The Diagnosis of Stupor and Coma. 4th ed. Oxford University Press; 2007.
Kussmaul A. Zur Lehre vom Diabetes mellitus. Über eine eigentümliche Todesart bei Diabetischen, über Acetonämie, Glycerin-Behandlung des Diabetes und Einspritzungen von Diastase ins Blut bei dieser Krankheit. Deutsches Archiv für Klinische Medizin. 1874;14:1-46. American Diabetes Association. Standards of Care in Diabetes — 2024. Diabetes Care. 2024;47(Suppl 1). Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335-43. doi:10.2337/dc09-9032. PMID: 19564476. PMC: PMC2699725. Bickley LS. Bates' Guide to Physical Examination and History Taking. 13th ed. Wolters Kluwer; 2020. Sapira JD. The Art and Science of Bedside Diagnosis. 4th ed. (LeBlond/Brown/DeGowin eds.) Wolters Kluwer; 2014.
American Heart Association. 2020 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 4. Boyer EW. Management of opioid analgesic overdose. N Engl J Med. 2012;367(2):146-55. doi:10.1056/NEJMra1202561. PMID: 22784117. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5-TR). 2022. Goldfrank's Toxicologic Emergencies. 11th ed. McGraw Hill; 2019. Wermeling DP. Review of naloxone safety for opioid overdose. Ther Adv Drug Saf. 2015;6(1):20-31. PMID: 25642320. PMC: PMC4308412.
Fontanarosa PB, Kaeberlein FJ, Gerson LW, Thomson RB. Difficulty in predicting bacteremia in elderly emergency patients. Ann Emerg Med. 1992;21(7):842-848. PMID: 1610043.
Duron VP, Rutigliano S, Machan JT, Dupuy DE, Mazzaglia PJ. Computed tomographic diagnosis of pneumatosis intestinalis: clinical measures predictive of the need for surgical intervention. Arch Surg. 2011;146(5):506-510. doi:10.1001/archsurg.2011.95. PMID: 21576602.
Tobin MJ, Perez W, Guenther SM, et al. The pattern of breathing during successful and unsuccessful trials of weaning from mechanical ventilation. Am Rev Respir Dis. 1986;134(6):1111-1118. PMID: 3789513.
Fieselmann JF, Hendryx MS, Helms CM, Wakefield DS. Respiratory rate predicts cardiopulmonary arrest for internal medicine inpatients. J Gen Intern Med. 1993;8(7):354-360. PMID: 8410395.
Strauss R, Ewig S, Richter K, Konig T, Heller G, Bauer TT. The prognostic significance of respiratory rate in patients with pneumonia: a retrospective analysis of data from 705,928 hospitalized patients in Germany from 2010-2012. Dtsch Arztebl Int. 2014;111(29-30):503-508. PMID: 25142073. doi:10.3238/arztebl.2014.0503
McGee SR. Cheyne-Stokes breathing and reduced ejection fraction. Am J Med. 2013;126(6):536-540. PMID: 23541375.
McGee SR. Cheyne-Stokes breathing and reduced ejection fraction. Am J Med. 2013;126(6):536-540. doi:10.1016/j.amjmed.2013.01.005. PMID: 23541375.
McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.