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Flashcards in Resp history and exam Deck (23)
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1

What questions to ask in a resp exam?

Sob - MCR scale, triggers
History of sudden wheeze/sob - triggers
Cough - dry/productive, sputum colour
Haemoptysis - chest pain
PND - orthopnea, SOA
Courses of abx and oral CS in 12/12
GORD - hayfever and eczema
Admissions to ED/hospital/IDU

2

What is the MRC breathlessness scale?

1 = no breathlessness except on exercise
2 = SOB when hurrying
3 = Walks slower than most people
4 = Stops for breath after 100yrs
5 = too breathless to leave house

3

What drug history to ask?

Allergies inc aspirin sensitivity
Inhalers
Anticoagulants
Oxygen use
Nebulisers
Confirm med histories

4

Social history?

Occupation
Smoking Hx
Alcohol consumption
Pets/birds
Asbestos

5

How to take their med history linking to resp conditions?

Asthma - sob/wheeze/cough - triggers, affects young and middle aged
COPD - sob/wheeze on exertion/cough, >35yrs;smokers
Bronchiectasis - chronic sputum production
PE - sob/pleuritic pain/may be on warfarin
IDL (lung disease) - occasional dry cough/may be on steroids/immunosuppressants

6

Symptoms of OSA?

Daytime somnolence
Own CPAP machine; supplemental O2
Resp muscle weakness

7

Lung cancer symptoms?

Weight loss
SOB
Cough +/- haemoptysis
Chest pain
Extra-pulmonary symptoms
If post chemoRx

8

How to take a drug history?

Inhalers for asthma and COPD only
SABA nebules for severe asthma
Oral steroids for immunosuppression in severe asthma and ILD processes
Amiodarone and methotrexate
Warfarin and rivaroxaban/apixaban
Aspirin/NSAID hypersensitivity

9

What questions to ask the pt?

Exacerbation of chronic lung disease
Increased breathlessness
Worsening cough
More sputum production
Change in sputum colour

10

How to do a general inspection for a resp exam?

At end of the chair:
Is the patient comfortable?
What is the respiratory rate? 14-16/min
Is there cyansosis?
Peripheral +/- central?
Accessory muscles being used?

11

What is cyanosis?

Blue discolouration of peripheries +/- tongue

Tongue reflects deoxygenated blood
SpO2 <90% with obvious cyanosis (with normal Hb)

12

What muscles to examine during a resp exam?

Accessory muscles
Sternomastoids
Platysma
Strap muscles

13

What does an audible wheeze indicate?

Asthma/COPD/Vocal cord dysfunction

14

What does stridor indicate?

Upper airway obstruction emergency

15

What does hoarseness indicate?

Recurrent laryngeal nerve injury and cancer

16

What pulse should be checked?

Radial pulse
>100bpm = underlying disease relating to anxiety

17

What to inspect regarding hands?

Clubbing - cancer, bronchiectasis/fibrosis
Flapping tremor - severe CO2 retention
Wasting of muscles of hands
(Bilateral - cachexia associated with COPD, cancer, motor neurone disease
Unilateral - compression of lower brachial plexus

18

How to examine the face?

Pallor - check conjunctiva for anaemia
Tongue colour
Lung abscess or pneumonia due to carious tooth
Obese = risk of ventilatory failure
Moon face - chronic oral steroid use

19

How to identify the unwell pt?

Is the Airway patent?
How is the Breathing? RR/SpO2/Chest mvmt/cyanosis/
How is the circulation? Pulse/BP/peripheral circulation
How is the neurological status? (Disability/GCS

20

Signs of an unwell pt?

Respiratory rate>20/min
Difficulty completing sentences
Using accessory muscles
Cyanosis
Audible Wheeze

21

How to treat asthma?

If PEF<75% give Short Acting Brochodilator
Give 4 puffs (inhaler) via spacer
Give 2 puffs/2mins & assess response up to 10puffs
or
Salbutamol 5mg nebuliser (ideally by 6l/min O2)

Consider oral steroids
Consider immediate referral to GP/walk-in centre/999

22

How to treat COPD?

If sob/wheezy
Give (salbutamol) ventolin 5mg dose & (ipratropium bromide) 500mcg via nebuliser driven (not via oxygen)
If nebuliser not to hand – administer 4 puffs of short acting beta agonist via spacer
Less likely COPD patients to develop acute bronchospasm post dental intervention compared to asthma patients
Consider referring immediately to GP/walk-in centre/999

If infective exacerbation (LRTI)
Aminopenicillin
Tetracycline
Macrolide

Oral course of prednisolone (if dyspnea impact on daily life)

GP review/refer to A&E/walk-in centre

23

How to give oxygen?

Initial = nasal cannulae 2-6 l/min or simple face mask 5-10l/min
Pt not at risk of hypercapnic resp failure who have saturation <85% = reservoir mask at 10-15l/min
Recommended initial O2 saturation rate = 94-98%