Sections to a history?
Presenting Complaint History of Presenting Complaint Relevant Systematic Enquiry ICE Past Medical History Drugs and Allergies Family History Social History Summary
Sections to a general exam?
Initial Assessment Introduction and Consent Hands Arms Face Lymph Nodes Anterior Chest Lower Limbs Closure
Sections to a respiratory exam?
Initial Assessment Introduction and Consent General Overview Hands Head Neck Front of Chest Back of Chest Closure
Sections to a cardiovascular exam?
Initial Assessment Introduction and Consent General Overview Peripheral examination - Hands - Arms - Head - Lung base - Lower limbs JVP Precordium Peripheral Pulses Closure Documentation
Process in CPR
Check danger Check for response Call for help Check airway Check breathing (10 seconds + pulse) Call ambulance Start CPR - 30 compressions - 2 breaths
What are the key points to be made in explaining how to use a peak flow meter?
Zero the device
Stand - where possible
Hold meter horizontally and ensure fingers are clear of slide
Take maximum inspiration
Form airtight seal with mouth around mouthpiece
Forcefully exhale as rapidly as possible into the meter
Record the number
Perform 3x in total and take the highest number
Demonstrate to patient and ask them to perform it
Mark in appropriate place in chart
Readings taken before and 15 minutes after inhaler use can be helpful
Compare to expected peak flow rate
Explain variance of 100 (male) and 85 (female) normal
What is technique in using a pressurised metered-dose inhaler
Sit up straight or stand Lift chin to open airways Shake the inhaler Remove cap Breathe out gently Place teeth and lips around mouthpiece Breath in slowly, then press canister (do not hold down) Breathe in to max inspiration and hold (10 seconds or as long as possible)
If second dose required, wait 30-60 seconds, shake again.
What is the technique for using a spacer with a pMDI?
Remove inhaler cap and shake
Insert inhaler into spacer device
Place mouth and teeth around spacer mouthpiece
‘Test’ valve by breathing (clicking noise)
Press canister and take a deep slow breathe (hold)
Wait 30-60 seconds between each dose (and shake again)
Don’t have to do one big breath, can take multiple smaller due to valve.
One dose at a time
- warm soapy water, air dry (no rinse)
- wipe mouthpiece
- check valve function
- replace every 12 months
What is the technique for using an accuhaler?
Check dose counter Stand/sit straight and lift chin Open inhaler Hold horizontal and slide trigger until click Breath out gently away from the mouthpiece Place mouth on inhaler Breath in steadily and deeply Hold breath for 10 seconds Breath out away from inhaler
Must use trigger again if multiple doses required.
What is the process for checking someones BP?
Prepare sphyg - dial level with patient’s heart
Ensure dial is zeroed
Patient seated and relaxed
Upper arm fully exposed
Apply cuff (correct side) with 1-finger space
Locate brachial pulse
Estimate systolic pressure by inflating cuff until pulse no longer palpable, note this pressure
- use radial if brachial can’t be found
Deflate cuff rapidly
Avoid stethoscope contact with cuff/tubing
Inflate cuff to estimated +30mmHg
Slowly open valve to deflate ~2mmHg/sec
When you hear repeated beats, note systolic pressure
When beats disappear, note diastolic pressure
Rapidly deflate cuff
Document results - nearest 2mmHg