"Breathing starts by inhaling air through the nose hopefully or the mouth down the trachea and into the lungs where oxygen is exchanged into the blood and carbon dioxide is exhaled up the trachea and out through the mouth or nose. The diaphragm is an important muscle that helps our breathing."

They all looked like they were listening and I hoped they were studying the picture of their text book while I talked. Several were taking breaths through their noses while others were trying to inhale via their mouths. I could see fingers tapping on desks as they attempted to count.

"How about we do this as a group? On the count of three, take a deep breath in through your nose, hold it while I count to five then exhale through your mouth. We will do this about five times."

I counted them through this exercise. Then I instructed them to repeat the steps only this time they were supposed to breath in using their mouths. There were about seven coughers.

I laughed as I explained that some people just could not tolerate mouth breathing. The seven blushed and hung their heads.

I went to one of the front corners of the room, a point where I knew everyone would be able to watch as I demonstrated both methods. I instructed them to concentrate on both my chest and abdomen and then proceeded.

When finished I asked for comments and every hand went up. I picked the middle row as a starting point.

"You seemed to take deeper breaths through your nose."

"It was noisier using your mouth."

"Both your chest and abdomen rose when breathing in."

"Your abdomen definitely deflated by breathing out, sorry but I was uncomfortable watching your chest."

The comments continued and then I asked if anyone had attempted to count each episode.
Daniel who preferred to be called 'DJ' was the only one to respond, "I watched as you breathed in and saw that your abdomen rose, so I looked at the clock over your head and counted the number of times I saw your abdomen rise for a minute. It was twelve."

"Your count was absolutely correct. And that is exactly one way you can count respirations. When you have a patient who is sitting up, it might be difficult to watch the tummy, so you might have to look either at the chest or even at their back. If the woman is pregnant you will definitely watch the chest or back. If you are lucky they will be a noisy breather and you can count the inhale noise."

"What about the patient talking? How can you get someone to be quiet when you are trying to count their respirations?"

"That is a great question. There are two tricks you can use. First, after you take the pulse, remember the number but continue to hold their wrist as you count their respirations, they will think you are still checking the pulse and will not interrupt you. Second, you can always check their temperature while watching respirations. They can not talk while holding a thermometer in their mouth."

DJ smiled, proud of himself for his question.

"Now I would like you to pair up your partners. Try both breathing techniques and get a count. For those who are portraying the patient you can hold your breath now and then if you want to."

They spent the rest of the class, practicing and learning