Respiratory emergencies and management

Question 1

Respiratory Assessment?

Answer 1

FLAPS

Question 2

Airway?

Answer 2

Check patency - is the airway open and clear?
Look for any obstructions e.g. swelling foreign bodies, secretions.
Noisy breathing - stridor gurgling

Question 3

Breathing?

Answer 3

RR: 12-20 = normal
Oxygen saturations: normal is 94-98%
Chest expansion check for symmetry and reduced movement on one side.
Use of accessory muscles - intercostal retractions , nasal flaring

Question 4

Feel?

Answer 4

Palpate the chest wall for abnormalities such as tenderness or rib fractures.
Check for eqaul chest expansion

Question 5

Look?

Answer 5

Observe rise and fall assess for symmetry, accessory muscle use and any deformities e.g. barrel chest in COPD.
Look at the patients general appearance.
Cyanosis indicating hypoxia.
Nasal flaring intercostal and suprasternal retractions are signs of increased work of breathing
Tripod position

Question 6

Auscultate?

Answer 6

Wheezing - heard in asthma or COPD
Crackles - fluid in the airways indicating pulomonary oedema or pneumonia.
Reduced or absent breath sounds - possible pneumothorax, pleural effusion.

Question 7

Percuss?

Answer 7

Tap the chest wall and listen for sounds.
Hyper resonance - pneumothorax
Dullness seen in pleural effuison or pneumonia.

Question 8

Saturations and speech?

Answer 8

Speaking in short sentences can indicate difficulty in breathing.

Question 9

Circulation?

Answer 9

HR: Tachycardia - hypoxia or infection.
BP: Monitor for signs of shock or hypotension
CAP refill delayed can result in poor perfusion.

Question 10

Disability?

Answer 10

Level of consciousness: hypoxia or hypercapnia can cause confusion, drowsiness .
GCS assess patient if they are drowsy or unresponsive.

Question 11

Acute exacerbation of asthma?

Answer 11

Cannot complete sentences in one breath.
Resps above 25.
Expiratory wheeze.
PMH of asthma
Hyperinflated chest
Fatigue, anxiety
Non productive cough
Management: patient to use their own inhaler, nebulised salbutamol and ipatropium, ECG 12 lead, consider IV hydrocortisone

Question 12

Life threatening asthma? Management?

Answer 12

Silent chest, cyanosis, bradycardia, unable to talk, decreased LOC.
Oxygen, 1 in 1000 adrenaline ECG 12 lead, consider hydrocortisone, pre-alert to hospital: continuous salbutamol neb and ipratropium single dose.

Question 13

PEAK flow?

Answer 13

Measures the peak speed of expiration
Done before and after treatment.

Question 14

COPD?

Answer 14

Hypoxic drive

Question 15

Chronic Bronchitis?

Answer 15

Dyspnoea above and beyond norm levels
Low PO2 and PCO2 retention
Productive cough
Crackles and wheezes common.
Management: Provide high flow oxygen, monitor the patient carefully consider nebulisation.

Question 16

Emphysema?

Answer 16

Extreme dyspnoea on exertion
Signs of respiratory distress.
Breathing with pursed lips on expiration
Barrel chest.
Same management

Question 17

PE?

Answer 17

Blood clot impair the blood supply to the lungs. Caused by a DVT.
Chest pain, breathlessness, abnormal heart trace, coughing, feeling dizzy, altered level of consciousness.
High flow oxygen, IV cannulation, monitor patient carefully.

Question 18

Pneumonia?

Answer 18

Develops over several days with cough and sputum production, dyspnoea, pleuritic chest pain, weakness, malaise and often myalgia.
Often follows flu viral infection, smoking, alcohol excess, immunosuppression, aspiration.

Question 19

Productive cough (sputum)

Answer 19

Frothy white/pink sputum - acute LVF
Productive yellow/green/red - infection.
Haemopysis - PE, Chest infection, CA lung.

Question 20

Abnormal sounds?

Answer 20

Adventitious - fluid in the airway.
Crackles - implies fluid or exudate
Wheeze - implies a decreased airway lumen.
Stridor - implies upper airway obstruction.