34. Clinical signs and approach to respiratory compromised patients

Question 1

34. Clinical signs and approach to respiratory compromised patients

Answer 1

Clinical signs of respiratory compromise
-increased respiratory rate and effort(also sounds)
-restlessness
-extended head and neck
-abducted elbows
-paradoxic movement of the chest and abdominal walls
>unwillingness to lie down/on one side

Characterize lung sounds as increased and decreased
-decreased lung sounds(suspect pleural space injury)->characterize location of decreased sounds:
>decreased sounds dorsal to diffuse
*R/o pneumothorax
1.provide oxygen support
2.perform thoracocentesis 9th-11th rib space bilaterally in dorsal 3rd of chest
3.perform 3-view thoracic radiography when medically stable
>decreased sounds ventral to diffuse with concurrent signs of hypovolemia
*R/o hemothorax
1.provide oxygen support
2.perform thoracocentesis 5th-7th rib space bilaterally in ventral 3rd of chest
3.perform 3-view thoracic radiography when medically stable
4.consider tube thoracostomy
>decreased sounds ventral to diffuse +/- borborygmi
*R/o diaphragmatic hernia
1.provide oxygen support
2.stabilize medically
3.perform 3-view thoracic radiography when stable
-increased lung sounds(suspect pulmonary injury)->evaluate for referred upper airway sounds
>increased lung sounds originate from lungs and lower airways
*R/o pulmonary contusion
1.provide oxygen support
2.confirm pulmonary contusion through 3-view thoracic radiography when medically stable
-normal auscultation with severe increases in respiratory rate and effort
>R/o concurrent pneumothorax and pulmonary contusion
1.provide oxygen support
2.perform thoracocentesis 9th-11th rib space bilaterally in dorsal 3rd of chest
3.confirm pulmonary contusion through 3-view thoracic radiography when medically stable