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Respiratory OSCE Year 2 > respiratory > Flashcards

respiratory Flashcards

1
Q

During ABCDE - What do we look for in the airway?

A

is the airway
patient
blocked ?
can they speak? is there voice wet ?
is there cynosis ?

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2
Q

During ABCDE assessement what do we look for in breathing ?

A

Are they self ventilating? are they on 02? RR are they brady or tachy? is the pattern atipical ? is there symmetry, increased WOB? accessory muscle use? ausculation - check each lobe, percussion - dull - resonant ? do they have a cough?

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3
Q

ABCDE assesment what do we look for in circulation ?

A

HR, BP, capillary refill, temperature, colour (pale, flushed), fever or hypothermic, renal output? urine normal 0.5mls? check the fluid balance chart, any dialysis machnines ?

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4
Q

ABCDE - what does Disability mean?

A

GCS score, pupils, seizures, sedation, muscle tone, pain, posture, positioning.

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5
Q

ABCDE what does EXPOSURE/Everything else mean?

A

dignity and respect, trauma, bruising, bleeding, swellin, odema, antibiotics, chest strain, feeding tube etc.

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6
Q

normal Blood PH?

A

7.35 - 7.45

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7
Q

normal value of PaCO2

A

4.7 - 6.0 kPa

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8
Q

normal PaO2 (arterial partial pressure of oxyge)

A

11 - 14 kPa

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9
Q

Normal SpO2 (02 saturation)

A

95-98% pulse oximetry

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10
Q

BE normal range

A

-2 -+2

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11
Q

What does an objective assement look like?
CNS, Cardiovasuclar and Respiratory

A

AVPU, GCS, awake reposnding, do they know the date, prime minister ? (CNS), Temp, BP, HR, odema ?(cardiovascular system), and 02 sats, ascultation, blood gasses, cynosis.

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12
Q

What to look for during Breathing assessment

A

Breathing: Spontaneous breaths? Ventilation settings / mode? Breathing pattern & depth?, Respiratory rate (RR), Cyanosis / low SpO2? Expansion / symmetry / fremitus / resonance? Accessory muscles use? Auscultation? What about cough & sputum?​
Circulation: patient’s colour, HR, BP, raised JVP, fluid charts​
Disabilities: level of consciousness ​
Exposure: other considerations – trauma / fracture / fall risk – mobility

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13
Q

signs of respiratory distress?

A

Central cyanosis​
Reduced SpO2 / ABGs (more about ABGs next session)​
Sweating ​
Use of accessory muscle of respiration / abdominal breathing​
Increased RR / SOB​
Wheezing ​
Rattling noises

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14
Q

Hypoxemia is ……….?

A

Hypoxemia is a below-normal level of oxygen in your blood, specifically in the arteries

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15
Q

hypoxia is?

A

Hypoxia is a state in which oxygen is not available in sufficient amounts at the tissue level to maintain adequate homeostasis; this can result from inadequate oxygen delivery to the tissues either due to low blood supply or low oxygen content in the blood

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16
Q

when is oxygen used ?

A

A drug used to treat hypoxemia NOT for breathlessness

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17
Q

What is the indication for hypoxemia ?

A

Pa02 is less than 8Kpa or
Sp02 is less than 94% in acute ill adults and 88-92% is a risk of hypercapnea in COPD patients

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18
Q

casues of hypoxemia ?

A

exercise induced
post tracheal suction,
post operative
nocturnal hypoxemia

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19
Q

considerations for an 02 delivery system ?

A

duration of treatment, type of illness, C02 retention, age, tolerance, mouth breather, humidification, RR?

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20
Q

how many litres does a nasal cannulae provide ?

A

up to 5l

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21
Q

how many litres does a simple face mask provide ?

A

5-10l

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22
Q

How many litres does a high concentration (non-rebreath) mask hold?

A

10-15l

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23
Q

How to assess efficay of treatment ?

A

02 sats, ABG’s, cynosis, conscious level? increase in Pa02, improvement of RR, HR, WOB

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24
Q

cough assist contraindicatons

A

barotrauma, pnemothorax, bullous emphysema, Unstable CV system, uncontrolled asthma and bronchspasm, hypotension, heamoptosis,

25
Q

relative contraindications to cough assist

A

nausa,raised intercranial pressure, osophegeal surgery, tumors, PE, lung abscessess, pneumothorax

26
Q

reasons to stop the cough assist?

A

Patient request to do so​
Signs of increased WOB​
Signs of cyanosis​
Drop in SpO2​
Patient feels uncomfortable​
Secretions needs to be cleared​
Suspect patient is unstable

27
Q

cough assist settings

A

start low +15 to+40 insufflation
exsufflation -20 to -50 (4-6 reps). Always end on insufflation

28
Q

Why is manua hyperfinflation used?

A

Technique that uses a manual resuscitation circuit to provide a larger than baseline tidal volume to the lungs of a patient who is intubated

29
Q

indictions (reasons to use) to manual hyperinflation

A

Atelectasis​
To improve gas exchange​
Mobilisation of secretions​
To assess lung compliance​
Improve respiratory mechanics (increase compliance, reduced resistance)

30
Q

complications to manual hyperinflation

A

Haemodynamic instability​
Increased barotrauma risk​
Discomfort/anxiety​
Reduced sats​
Increase ICP

31
Q

Manual hyperinflation contraindications

A

Extra-alveolar air (undrained pneumothorax/bullae /surgical emphysema)​
Acute / Severe Bronchospasm​
Gross cardiovascular instability​
Acute head injury / Neurosurgery 0-72 hours ​
Increased levels of respiratory support (PEEP >10cmH20)

32
Q

precautions of manual hyperinflation

A

Emphysematous bullae ​
Renal dialysis ​
Recent lung surgery ​
Patients at risk of barotrauma ​
Rib fracture (especially in the presence of flail segments) ​
Hypoxic driven COPD/ Acute exacerbation of COPD​
Significant pain ​
Surgical emphysema/drained pneumothorax ​
Air leaks ​
ARDS ​
Haemoptysis ​
Broncho-pleural/broncho-oesophageal fistula

33
Q

patient selection for manual hyperinflation

A

No arrhythmias compromising cardiovascular function, ​
Stable ETT, Tracheostomy position ​
FiO2 <0.75 provided SaO2 >95% and PaO2 >9.0
no fitting in the last 72 hours
<2 sedation scale

34
Q

Manual Hyperinflation indications

A

Improve atelectasis
Increase lung volume and compliance
Mobilise secretions
Improve respiratory mechanics

35
Q

Precautions for manual hyperinflation

A

Drained pneumothorax
Increased intracranial pressure
Rib fracture
Renal dialysis
Barotrauma
Heamoptosis (blood)
ARDS

36
Q

Contraindications for manual hyperinflation

A

Untrained pnemonthorax
Unstable CV system
Severe broncospasm
Increased intracranial pressure

37
Q

Indications for suction

A

Patients don’t have an effective cough (to stimulate a cough). Access secretions that can’t by any other means

38
Q

Risks of suction?

A

Hypotension
Increased ICP
Reduce O2 sats
Bradycardia/hypoxia
Introduce infection
Trauma to the airway
Vomiting

39
Q

Contraindications of suction?

A

Severe bronchospasm
Surgery Gastro/throat
Stridor
Unexplained heamoptysis

40
Q

Precautions of suction

A

Recent acute head injury
Clotting abnormality
Anticoagulants
Unstable CV system

41
Q

Risks of suction

A

Increase intracranial pressure
Hypoxia
Vomiting
Hypotension
Bradycardia
Introduce infection
Vasovagel reflex

42
Q

What is sepsis?

A

Multi organ failure

43
Q

Signs of Sepsis

A

SPEECH
Extreme Pain
Passing no urine
Severe breathlessness
It feels like you’re dying
Skin discoloured

44
Q

Nice Guideline for REHAB after traumatic injury ?

A

[NG211] MDT social workers, specialist nurses, pain management, Education, Rehab passport. Early weight bearing, maintain Joint ROM, splinting and orthotics, cognitive rehab, pain management, positioning, special referral, bladder and bowel, SALT

45
Q

Oxygen therapy is used for?

A

Hypoxaemia not breathlessness

46
Q

Hypoxaemia clinically is <8KPa but what’re the signs?

A

Increased WOB, Tachycardia, peripheral vasoconstriction, cyanosis, Tachypnoea

47
Q

Signs of respiratory deterioration?

A

Increased HR, RR, drowsiness, headache, C02 retention, nasal flaring, accessory muscle use, stridor, sweating

48
Q

Benefits of early mobilisation? Short term goals?

A

CG83 - reduces LRTI (infection), DVT, PE, reduce immobility in delirium
Day 1: transfer to chair (optimise lung volume)
Day2: take a few steps
Day3: mobilise and work towards baseline

49
Q

Affects of General Anaesthetic?

A

Reduced tone in respiratory, lung volume, swelling, reduced tidal volume, reduced FRC, ATELECTASIS, RESPIRATORY DEPRESSION.

50
Q

Before mobilisation what should you check?

A

BP and BM (blood sugar) Lying and standing BP to reduce the risk of a fall, have thy had a blood transfusion?

51
Q

During C - what does finger clubbing indicate?

A

C02 retention - type 2 respiratory failure ?

52
Q

If people are in respiratory distress what education will help?

A

Positions of ease - accessory muscles in a contracted position to reduce use of 02.

53
Q

What to do if a patient has a bronchospasm?

A

Bronchodilators - open the airway - Beta 2 agonist - asthma and COPD
Corticosteroids - reduce inflammation

54
Q

Treatment of exacerbation of asthma ? Increase RR driving up C02 ?

A

Intervention: breathing control & hold and sniff (improve collateral ventilation).
Education around using the inhaler and position to ease work of breathing

55
Q

Head injury patients Treatment goals?

A

72 hours ? Wait until medically stable?
Maintain ROM - active/passive - splinting and casting
W/chair tilt in space chair
Positioning - spasticity management
SALT - Education - hobbies - job? Psychologist?

56
Q

Nice Guidelines Traumatic Injury NG211 - Limb, nerve, chest and spine

A

Discuss with MDT rehab Ax and rehab potential and REHAB PASSPORT, Social sort, Skin bladder and bowel, education, wheelchair, psychologist, social sort, funding, exercise, equipment, manual therapy, ROM, BP? (Vasovagal?), vocational support, work adjustment, strength & aerobic exercise, splints, Orthotics, gait re-education? Bed exercise?

57
Q

Head injury Short term goals?

A

CT scan, improve 02 sats, active/passive ROM, positioning V/Q & lung volume, splinting, casting, Neuro Ax, wean 02, sitting balance? Respiratory function management ? Postural drainage, collateral ventilation, maximise cough? Mobilise ASAP

58
Q

Evidence for early mobilisation ?

A

Tazeean et al., (2022) Early mobilisation on ITU - reduce surgery complications - SOEOB, sitting balance (be aware of BMs and postural drop), DAY 1: chair transfer, DAY 2: then mobilise a few steps. DAY 3: mobile to baseline then D/C (OT home Ax and Stair Ax too)

59
Q

Head injury Medium term goals ?

A

Neuro Assessment, Wien 02, REHAB passport, Early mobilisation, Gait retraining, ADLs, equipment, education, strength and aerobic training to reduce muscle atrophy, Transfer to Neuro rehab? Gait retraining, ADLs?, SALT, Skin management, bladder and bowel management, social sort.

Respiratory OSCE Year 2 (1 decks)

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