Respiratory history for dental examination Flashcards

Question

Check radial pulse

Answer 1

Assess for rate >100bpm may reflect underlying disease Also associated with anxiety

Answer 2

Clubbing – cancer/ bronchiectasis/ fibrosis Flapping tremor – severe CO2 retention (late sign) Wasting of muscles of hands -bilateral – cachexia assoc. with COPD/ cancer/ motor neurone disease (late sign) -unilateral - compression of lower brachial plexus (pancoast tumour)

Answer 3

Pallor – check conjuctiva for anaemia Check tongue colour Think possible lung abscess or pneumonia as result of rotten tooth Obese/collar>17” – OSA; at risk of ventilatory failure Moon face – chronic oral steroid use (Asthma/ILD) (see upper panel) Rare: -facial plethora – SVCO (panel A&B)

Answer 4

``` Is the airway patent? How is the breathing? -RR -SpO2 -chest movement -cyanosis How is the circulation? -pulse -blood p -peripheral circulation How is the neurological status? -disability -GCS ```

Answer 5

``` Respiratory rate>20/min Difficulty completing sentences Using accessory muscles Cyanosis Audible Wheeze ```

Answer 6

``` Peak Expiratory Flow (PEF) Meter In benefit in pts with asthma Good correlation with symptoms -normal>75% of either predicted or best for pt Best of x3 blows; Standing position “like blowing out candles” ```

Answer 7

Noninvasive measurement of arterial Hg saturation Uses differential absorbance of light by oxyhemoglobin and deoxyhemoglobin to estimate the oxygen saturation SpO2 92% roughly equal to 8kPa Below 90-92% correlation to pO2 less reliable

Answer 8

give Short Acting Brochodilator Give 4 puffs (inhaler) via spacer Give 2 puffs/2mins & assess response up to 10puffs or Salbutamol 5mg nebuliser (ideally by 6l/min O2) Consider oral steroids Consider immediate referral to GP/ walk-in centre/ 999

Answer 9

Give (salbutamol) ventolin 5mg dose & (ipratropium bromide) 500mcg via nebuliser driven (not via oxygen) If nebuliser not to hand – administer 4 puffs of short acting beta agonist via spacer Less likely COPD patients to develop acute bronchospasm post dental intervention compared to asthma patients Consider referring immediately to GP/walk-in centre/999

Answer 10

The initial oxygen therapy is nasal cannulae at 2–6 l/min (preferably) or simple face mask at 5–10 l/min unless stated otherwise. For patients not at risk of hypercapnic respiratory failure who have saturation <85%, treatment should be commenced with a reservoir mask at 10–15 l/min. The recommended initial oxygen saturation target range is 94–98%. If oximetry is not available, give oxygen as above until oximetry or blood gas results are available. Change to reservoir mask if the desired saturation range cannot be maintained with nasal cannulae or simple face mask (and ensure that the patient is assessed by senior medical staff). If these patients have co-existing COPD or other risk factors for hypercapnic respiratory failure, aim at a saturation of 88–92% pending blood gas results but adjust to 94–98% if the PaCO2 is normal (unless there is a history of previous hypercapnic respiratory failure requiring NIV or IPPV) and recheck blood gases after 30–60 min.

Answer 11

Aminopenicillin Tetracycline Macrolide Oral course of prednisolone (if dyspnea impact on daily life) GP review/refer to A&E/walk-in centre (see NICE COPD guidance 2010)

Answer 12

Difficult to delineate from LRTI without clinical examination or CXR Re-visit treatment for infective exacerbation of COPD (minus steroids) but ideally need assessment by GP/Walk-in centre/999