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Respiratory Emergencies > Respiratory Assessment And History Taking > Flashcards

Respiratory Assessment And History Taking Flashcards

1
Q

Airway assessment

A

Determine if the airway is open and clear, if not, consider the need for interventions

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2
Q

Airway intervention considerations

A

Manual airways adjustment maneuvers, BLS airway adjunct (OPA/NPA), secretion management (recovery position, suctioning), foreign body airway obstruction management, stridor

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3
Q

Breathing assessment

A

Rate, depth, quality. Consider the need for interventions

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4
Q

Breathing intervention considerations

A

Nasal cannula (1-4L/min with 100% O2) chest pain or CVA symptoms, NRB (15L/min with 100% O2) signs of obvious respiratory distress with an elevated respiratory rate, BVM (15L/min or >30 breaths/min) signs of obvious ineffective ventilations

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5
Q

Circulation assessment

A

Radial/carotid rate, rhythm and quality. Consider interventions

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6
Q

Circulation intervention considerations

A

Pulse less than 50 / greater than 150 (apply AED pads, consider ALS intercept), no pulse (CPR, AED pads)

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7
Q

Head to toe assessment

A

Whole body, head, neck, chest

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8
Q

Whole body evaluation

A

Any rash/hives/swelling, any medic alerts

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9
Q

Head evaluation

A

Pain/discomfort (OPQRST), lightheaded/dizzy/syncopal, visual disturbances, ringing or rushing in the ears, facial droop present, speech deficits

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10
Q

Neck evaluation

A

Pain or discomfort (OPQRST), any JVD/ trachea midline, any subcutaneous emphysema

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11
Q

Chest evaluation

A

Any pain or discomfort (OPQRST), any SOB/difficulties breathing, any increased WOB, speech pattern, medication patches/surgical scars, auscultate lungs/heart tones

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12
Q

IPPA

A

Inspection, palpation, percussion, auscultation

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13
Q

IPPA purpose

A

To define pathology in order to treat effectively and efficiently

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14
Q

IPPA interpretation

A

Findings may indicate certain disease processes

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15
Q

IPPA limitations for palpation

A

has to be done with respect to the patient and in reflection of patients pain level and thoracic expansion is not clinically diagnostic

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16
Q

IPPA limitations for percussion

A

Cannot be done on elderly or very young patients and diaphragmatic excursion is not clinically diagnostic

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17
Q

IPPA - inspection

A

Appearance, LOC, WOB, patient condition (history), emergent reason, environment, surroundings, support, vitals

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18
Q

IPPA - inspection; general appearance

A

Colour (cyanotic, pale), peripheral cyanosis, central cyanosis, pallor, looks ill, scars, bruising, deformities

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19
Q

IPPA - inspection; WOB

A

Normal, increased (accessory muscle use - retractions, tracheal tug, nasal flaring, pursed lip breathing, stridor, tripod position)

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20
Q

IPPA - inspection; vital signs

A

BP, HR, RR (rate, rhythm, quality), SpO2, extremities, clubbing, capillary refill, peripheral edema, JVD

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21
Q

IPPA - palpation

A

Act of touching the patients chest wall to evaluate underlying structure and anatomy
Used to assess pain, fremitus, thoracic expansion, tracheal position, and subcutaneous emphysema

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22
Q

IPPA - palpation; pain

A

Gently palpating the patients skin can reveal areas of pain

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23
Q

IPPA - palpation; tracheal position

A

Normal is midline, shifts from the midline are indicative of disease (unilateral pneumonia, pneumothorax, pleural effusion, tumours

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24
Q

What way does the trachea shift for certain diseases?

A

Towards atelectasis
Away from pneumothorax, pleural effusion, large tumour

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25
Q

IPPA - palpation; vocal fremitus

A

Vibrations created by the vocal cords during phonation which are transmitted through the parenchyma to the chest wall

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26
Q

IPPA - palpation; tactile fremitus

A

When these vibrations are felt on the chest wall by a practitioner; having a patient say 99 while repeatedly bilaterally placing hands on patients chest

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27
Q

IPPA - palpation; subcutaneous emphysema

A

Chest wall skin can be palpated for the condition and temperature (perfusion), palpated for air leaks that move from lungs to skin, fine beads of air in skin produce a crackle sound

28
Q

IPPA - percussion

A

Tapping on the chest wall to evaluate underlying structures and pathology, produces a vibration that evaluates the lung to a depth of 5-7cm below chest wall

29
Q

IPPA - auscultation

A

Process of listening to sounds produced by the body, done via stethoscope, patient should be sitting up ideally

30
Q

Abnormal breath sounds

A

Considered Adventia; continuous - longer than 25ms (wheezes, rhonchi, stridor)
Discontinuous - intermittent, short duration less than 20ms (crackles, rubs)

31
Q

Bronchial breath sounds

A

Are considered abnormal when they replace vesicular breath sounds with an increase in lung tissue density due to disease

32
Q

Diminished breath sounds

A

Shallow breathing, obese patients, COPD and emphysema (significant hyperinflation)

33
Q

Adventitia

A

Stridor, wheezes, crackles, rubs

34
Q

Stridor

A

Continuous sound heard on inhalation, occurs during upper airway obstruction, loud and high pitched, crowing, can be heard without a scope

35
Q

Wheezes

A

Generated by bronchospasms that do not clear with cough, narrowed airway as air passes through at high velocity (higher pitch=narrower airway)

36
Q

Wheezes - polyphonic

A

Several musical notes, usually E, indicative of multiple airway involvement

37
Q

Wheezes - monophonic

A

Single musical note, indicates singular obstruction of a bronchus

38
Q

Wheezes - rhonchi

A

Low pitched continuous sounds that can be caused by excessive secretions and may clear with a cough (wet wheezes)

39
Q

What causes crackles?

A

Movement of excessive secretions/fluid in the airway as air passes through/collapsed airways popping open on I

40
Q

Crackles

A

Clear with a cough, coarse, heard in I and E, associated with rhoncial fremitus

41
Q

Early inspirations crackles

A

Sudden opening of large, proximal airways which closed during E due to high compliance or decreased elasticity, scanty (do not clear with cough), COPD, CB, Asthma

42
Q

Late inspiratory crackles

A

Sudden opening of collapsed peripheral airways and alveoli on I, collapse due to increased P.
More common in the dependant lung regions where gravity predisposes the airway/alveoli to collapse E

43
Q

When do crackles occur?

A

Restrictive defence; atelectasis, pneumonia, pulmonary edema, fibrotic disease

44
Q

Pleural friction rub

A

Creaking or grinding sounds, creaky leather, gets louder with deep breathing, very painful

45
Q

When does pleural friction rub occur and what is it associated with?

A

Occurs when irritated inflamed pleural surfaces rub together on I or E
Associated with pneumonia, TB, pleurisy, pleural effusions

46
Q

Respiratory patterns

A

Cheyne-Stokes respiration, hyperventilation, apneustic, cluster breathing, ataxic breathing

47
Q

Cheyne-Stokes respiration

A

Denotes a cyclic pattern of alternating hyperpnea and apnea.
A bilateral hemispheric or diencephalic insult.
May indicate incipient transtentorial herniation.
CHF, COPD, OSA, Uremia

48
Q

Hyperventilation

A

Injury in the pontine or midbrain tegmentum.
Respiratory failure, hemodynamics shock, fever, sepsis, metabolic disarray, and psychiatric disease

49
Q

Apneustic breathing

A

Prolonged pause at the end of respiration, lateral tegmentum of the lower half of the pons

50
Q

Cluster breathing

A

Periodic respirations that are irregular in frequency and amplitude with variable pauses between clusters of breaths, lower pontine tegmental lesion.

51
Q

Ataxic breathing

A

Is irregular in both rate and tidal volume, suggests damage to medulla

52
Q

Eupnea

A

Normal pattern

53
Q

Bradypnea respirations

A

Slow respirations <10 breaths/min; CVA diabetic coma, increased ICP, metabolic disorder, opioid overdose, sleep

54
Q

Tachypnea respirations

A

Fast, shallow respirations >24 breaths/min; anxiety, exercise, fever, shock

55
Q

Hyperpnea respirations

A

Deep, regular at a normal rate; diabetic ketoacidosis, emotional stress

56
Q

Kussmaul respirations

A

Regular, rapid, deep respirations; diabetic ketoacidosis, exercise, metabolic acidosis, renal failure

57
Q

Hypopnea respirations

A

Shallow, regular respirations at a normal rate; anxiety asthma, hyperventilation, obesity, pneumonia, pulmonary edema, sedatives, shock, tonsillitis

58
Q

Ataxic respirations

A

Irregular, disorganized, varying depth; CVA, medullary, brain trauma

59
Q

Biot respirations

A

Irregular, disorganized with periods of apnea; brain trauma, CNS disorder, CVA, opioid overdose, spinal meningitis

60
Q

Cheyne-Stokes respirations

A

Increasing depth followed by apnea; altitude sickness, brain stem injury, CO poisoning, CHF, CVA, increasing ICP, metabolic encephalopathy, uremia

61
Q

Air trapping respirations

A

Increasing expiratory difficulty; asthma, bronchiolitis obliterans syndrome, chronic bronchitis, emphysema

62
Q

Obstructive respirations

A

Prolonged expirations; asthma, COPD

63
Q

Sighing respirations

A

Regular breathing with frequent deep breaths; anxiety, asthma, fatigue, hyperventilation syndrome

64
Q

Apneustic respirations

A

Prolonged inspiration and expiration; brain stem lesion, CVA, brain stem injury

65
Q

Atonal respirations

A

Occasional reflex driven gasps; anoxia, cardiac arrest, cerebral ischemia, hypoxia

66
Q

Apnea respirations

A

Absence of breathing; CVA, brain trauma, deceased

Respiratory Emergencies (6 decks)

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