NEPT CPP 2023 Respiratory Status Assessment (RSA) Flashcards
There are 9 signs and symptoms that we observe when we carry out an RSA.
What are they?
- When we ask “how does the patient present?”,
these are the criteria we use in our description.
- General appearance,
- Speech,
- Breath sounds and auscultation,
- Respiratory rate,
- Respiratory rhythm,
- Work of breathing,
- Heart rate,
- Skin,
- Conscious state.
There are 5 levels of respiratory distress.
What are they?
- The level of respiratory distress will determine our management.
- No respiratory distress,
- Mild distress,
- Moderate distress,
- Severe distress,
- Critical.
Describe “General Appearance” as it pertains to each of the following:
- No respiratory distress,
- Mild distress,
- Moderate distress,
- Severe distress,
- Critical.
- Calm or quiet,
- MIldly anxious,
- Distressed or anxious,
- Distressed & anxious,
- Fighting to breathe, catatonic.
Catatonic - characterized by a marked lack of movement, activity, or expression.
Describe “Speech” as it pertains to each of the following:
- No respiratory distress,
- Mild distress,
- Moderate distress,
- Severe distress,
- Critical.
- Clear and steady sentences,
- Full sentences,
- Short phrases,
- Words only,
- Unable to speak or single word or grunting.
Describe “Breath sounds and auscultation” as it pertains to each of the following:
- No respiratory distress,
- Mild distress,
- Moderate distress,
- Severe distress,
- Critical.
- Bronchospasm: Usually quiet w no wheeze.
Oedema: No crackles or scattered fine crackles. - Able to cough.
Bronchospasm: Mild expiratory wheeze.
Oedema: Crackles at base of lungs. - Able to cough.
Bronchospasm: Expiratory wheeze +/- inspiratory wheeze.
Oedema: Crackles at base to mid-zone. - Unable to cough.
Bronchospasm: Expiratory & inspiratory wheeze.
Oedema: Crackles full field +/- possible wheeze. - Unable to cough.
Bronchospasm: Little to no air mvmt - “silent chest”.
Oedema: Full field crackles +/- possible wheeze OR little to no air mvmt.
Describe “Respiratory Rate” as it pertains to each of the following:
- No respiratory distress,
- Mild distress,
- Moderate distress,
- Severe distress,
- Critical.
- 12-16,
- 16-20,
- > 20,
- > 20,
- > 30 or <8.
Describe “Respiratory Rhythm” as it pertains to each of the following:
- No respiratory distress,
- Mild distress,
- Moderate distress,
- Severe distress,
- Critical.
- Regular even cycles,
- Slight increase in normal chest mvmt,
- Bronchospasm: prolonged expiratory phase.
Oedema: Short sharp breaths, - Bronchospasm: prolonged expiratory phase.
Oedema: Short sharp breaths, - Bronchospasm: prolonged expiratory phase.
Oedema: Short sharp breaths.
Describe “Work of breathing” as it pertains to each of the following:
- No respiratory distress,
- Mild distress,
- Moderate distress,
- Severe distress,
- Critical.
- Normal chest mvmt,
- Slight increase in normal effort,
- Marked chest mvmt +/- use of accessory muscles,
- Marked chest mvmt w accessory muscle use, intercostal retraction +/-,
- Marked chest mvmt w accessory muscle use, intercostal retraction +/-.
Describe “Heart rate” as it pertains to each of the following:
- No respiratory distress,
- Mild distress,
- Moderate distress,
- Severe distress,
- Critical.
- No resp distress = 60-100,
- MIld distress = 60-100,
- Moderate distress = 100-120,
- Severe distress = >120,
- Critical = >120 or bradycardic (late stage).
Describe “Skin” as it pertains to each of the following:
- No respiratory distress,
- Mild distress,
- Moderate distress,
- Severe distress,
- Critical.
- No resp distress = Normal,
- Mild distress = Normal,
- Moderate distress = Pale and sweaty,
- Severe distress = Pale and sweaty +/- cyanosis,
- Critical = Pale & sweaty, peripheral cyanosis may be central cyanosis (late sign).
Describe “Conscious state” as it pertains to each of the following:
- No respiratory distress,
- Mild distress,
- Moderate distress,
- Severe distress,
- Critical.
- Alert,
- Alert,
- May be altered,
- Altered,
- Altered or catatonic (no purposeful mvmts or interaction).
What is meant by “accessory muscle use”?
What is “intercostal retraction”?
Intercostal retractions happen when your airways are narrowed or blocked.
Your skin and muscles get sucked in around your ribs when you breathe in.
You might be able to see the outline of your ribs
Difference between central and peripheral cyanosis.
Central cyanosis refers to a bluish discoloration that is primarily observed in the central parts of the body, such as the lips, tongue, and trunk. It is caused by a decrease in the oxygen saturation of arterial blood, often due to respiratory or cardiovascular problems.
On the other hand, peripheral cyanosis is characterized by a bluish discoloration that is primarily observed in the extremities, such as the fingers, toes, and nail beds. It is caused by a decrease in blood flow to the peripheral tissues, leading to reduced oxygen delivery.
Management of asthma
What is the first step that informs your mgmt?
Establish asthma presentation and determine severity based on respiratory status assessment (RSA).
ie.
Nil distress,
Mild,
Moderate,
Severe,
Critical.
Management of asthma
What is the second step of your asthma mgmt?
Escalate care per CPP006 Clinical escalation:
- Medium acuity may consider delaying escalation if pt mgmt is routine for mild exacerbation (limited to PMDI salbutamol) (pMDI - Pressurised Metered Dose Inhaler).
- Where applicable consult and follow pt’s own asthma plan.
Management of asthma
Explain your mgmt of MILD asthma.
Salbutamol pMDI and spacer
- 4-12 doses,
- Pt to take 4 breaths b/w doses,
- Repeat at 20min intervals until resolution of symptoms.
If complete resolution of symptoms, medium-high acuity may continue with transport.
Management of asthma
Explain your mgmt of MODERATE asthma.
Salbutamol pMDI and spacer
- 4-12 doses,
- Pt to take 4 breaths b/w doses,
- Repeat at 20min intervals until resolution of symptoms.
If unsuccessful, manage as per severe asthma.
Management of asthma
Explain your mgmt of SEVERE asthma.
Salbutamol and Ipratropium Bromide (Atrovent) nebulised
- Salbutamol 10mg,
- Atrovent 0.50mg,
- Nebulised via mask wit 8L of oxygen,
- Repeat Salbutamol at 5min as required.
If unsuccessful, manage as per CRITICAL asthma.
Management of asthma
Explain your mgmt of CRITICAL asthma.
Salbutamol and Ipratropium Bromide (Atrovent) nebulised as per SEVERE with addition of IM adrenaline.
- 0.5mg (1:1000) adrenaline IM,
- Repeat at 5min intervals PRN,
- Max dose 1.5mg (3 doses).
(PRN - Pro Re Nata or “As needed”).
