Respiratory History

Question 1

What are you looking for in a respiratory Primary Survey?

Answer 1

• Cyanosis - central and peripheral
• Tripoding
• Audible noise - bubbling, stridor
• Resp rate and WOB
• Cigarrete use
• Home O2
• Medication - inhalers
• Chemicals, smells, damp

Question 2

What Focused History topics need to be asked? (Respiratory)

Answer 2

• Cough
• SOB
• Haemoptysis
• Wheeze
• Sputum Production

Question 3

Haemoptysis Questioning

Answer 3

• Pink, frothy or Frank red sputum
• Any nausea/vomit (rule out haemoetemesis)
• Originates from the glottis
• If 40+ have a scan within 2 weeks for presence of cancer

Question 4

Sputum Production

Answer 4

• What colour is the sputum?
• Is that normal for you?
• What does it taste or smell like?

Question 5

Meaning of Sputum Colours

Answer 5

Green/Yellow - infection
Rusty Red - pneumococcal pneumonia
Pink/Frothy - pulmonary oedema, cancer, haemoptysis
White/Clear/Grey - pulmonary disease, COPD

Question 6

SOB Questioning

Answer 6

• Have you felt SOB recently
• When did it start?
• Are you normally SOB?
• What are you doing when it starts?
• Is it worse on excretion?
• Is it worse when lying flat or at night? (paroxysmal nocturnal dyspnea)

Question 7

Wheeze Questioning

Answer 7

• Are you asthmatic?
• If so, have you taken your inhaler?
• If wheeze is present; salbutamol/ibotropbium/O2
• Caused by bronchospasm, tumour, foreighpn body

Question 8

Coughing Questioning

Answer 8

• Have you had a cough recently?
• How long have you had the cough?
• Is the cough productive?
• Is it normal for you? (smoker, COPD, asthma)
• Is the cough new or worse? = new infection
• Is the cough worse on excretion?
• What does the cough sound like?

Question 9

Sounds of Coughs

Answer 9

Hollow Bovine - laryngeal nerve palsy
Loud Brassy - tracheal pressure
Barking Croup - acute epiglottis (obstruction/inflammation)
Dry Chronic Cough - COPD, asthma, oesophagal reflux, ACE inhibitors, acid inflammation to lungs

Question 10

PMH

Answer 10

• Any diagnosis of breathing problems (COPD, asthma, pulmonary fibrosis, cystic fibrosis
• Any family history of breathing problems?
• Do you work with chemicals or hazards?
• Any allergies?
• Been near anyone with an illness?
• Have you ever been to the ICU with breathing difficulties?
• Do you take regular medications?

Question 11

PE risks

Answer 11

• Contraceptive pill?
• Recent hospital admissions? = HAI
• Recent surgery?
• Prolonged immobility?
• Calf pain? Swelling? = DVT