Respiratory assessment

Question 1

What binds better to haemoglobin, O2 or CO and why is this relevant to assessment?

Answer 1

Carbon monoxide binds to haemoglobin about 200x more readily, the saturation probe cannot differentiate between blood saturated with oxygen or carbon monoxide

Question 2

What percentage of best predicted PEF indicates life threatening bronchoconstriction?

Answer 2

<33%

Question 3

What percentage of best predicted PEF indicates acute severe asthma?

Answer 3

<50%

Question 4

How does hyperventilation present on capnography and capnometry?

Answer 4

Crisp wave form and low ETCO2

Question 5

How does bronchospasm present on capnography and capnometry?

Answer 5

Due to trapped air in the alveoli being released inconsistently the capnography will follow a ‘shark fin’ curved shape and higher ETCO2

Question 6

When auscultating a chest what can stridor signify?

Answer 6

Upper airway obstruction

Question 7

When auscultating a chest what can wheeze signify?

Answer 7

Bronchoconstriction
-Asthma
-COPD
-Anaphylaxis

Question 8

When auscultating a chest what can course crackles signify?

Answer 8

Excessive fluid in the lungs
-Aspiration
-Pulmonary oedema
-Chronic bronchitis
-Pneumonia

Question 9

When auscultating a chest what can fine crackles signify?

Answer 9

Pulmonary fibrosis

Question 10

When auscultating a chest what can increased vocal resonance signify?

Answer 10

Consolidation
Lobar collapse
Tumor

Question 11

When auscultating a chest what can decreased vocal resonance signify?

Answer 11

Pleural effusion

Question 12

What is the V/Q ratio?

Answer 12

The ratio between ventilation and perfusion, ideally = 1.

The ventilation rate (V) refers to the volume of gas inhaled and exhaled from the lungs in a given time period, usually a minute.

The perfusion (Q) of the lungs refers to the total volume of blood reaching the pulmonary capillaries in a given time period.

Question 13

What is the average overall lung V/Q ratio?

Answer 13

0.8

Question 14

What is the body’s response to a reduced V/Q ratio and how does this affect the CO2 levels?

Answer 14

Hypoxic vasoconstriction causes diversion of blood to better ventilated parts of the lung. However, in most physiological states the haemoglobin in these well ventilated alveolar capillaries will already be saturated. This means that red blood cells will be unable to bind additional oxygen to increase the pO2. As a result, pO2 level of the blood remains low, which acts as a stimulus to cause hyperventilation and bronchoconstriction, resulting in either normal or low CO2 levels

Question 15

How can a PE cause haemoptesis?

Answer 15

Reduced blood flow from the right ventricle can cause an increase in pulmonary capillary wedge pressure causing capillary rupture

Question 16

What is epiglottitis?

Answer 16

Inflammation and swelling of the epiglottis.

Question 17

What is COPD?

Answer 17

Chronic Obstructive Pulmonary Disease is a group of lung conditions that cause breathing difficulties including:

Emphysema - damage to the air sacks in the lungs

Chronic bronchitis - long term inflammation of the airways

Question 18

What are the most common airway obstructions in paeds and adults?

Answer 18

Paeds: Round foods

Adults: Meat

Question 19

What is stridor?

Answer 19

Narrowing of the airway lumen causing the turbulence flow if air. Late sign means AW diameter is <50%

Question 20

What is a FBAO?

Answer 20

Foreign Body Airway Obstruction

Question 21

What are the general differences in uses between Macintosh and Miller laryngoscope blades?

Answer 21

Macintosh - Curved, provide better intubation conditions

Miller - Straight, usually used for intubating neonates and infants, literature suggests gives a better laryngoscopic view

Question 22

What is the definition of hypoxia?

Answer 22

Low levels of oxygen in the body’s tissues and cells

Question 23

What is apnoea?

Answer 23

Slowed or stopped breathing

Question 24

What are normal sats levels for patients with COPD?

Answer 24

88-92%

Question 25

What is the definition of hypoxaemia?

Answer 25

Low oxygen levels in the blood. (Sp02<92%)

Question 26

What is the definition of hypercapnia?

Answer 26

Too much CO2 in the blood. (>45mmHg)

Question 27

What is the difference between stridor and wheeze?

Answer 27

Wheezing is an obstruction of the lower airway heard more on expiration

Stridor is a higher pitch noise heard more on inspiration

Question 28

What can you use to evaluate the risk of a PE?

Answer 28

Well’s score including risk of prev. DVT