Severity scores

Question 1

What are physical impressions to look out for?

Answer 1

• Dusky/ cyanosed
• Lips, mucous membranes
• Anxious/frightened
• ## Exhausted/tired

Question 2

What is the overal impression resp examination?

Answer 2

• Resp rate < 8/ > 30/min
• cannot finish sentences, can be confused or agitated
• uses accessory muscles of respiration
• purse lip breathing
• subcostal and intercostal recession
• see saw resp pattern

Question 3

What is the general cardiorespiratory examination?

Answer 3

• Pulse rate, BP,Sp02 <88% (approx. Pa02 < 8KPa)

Question 4

What are some urgent clinical investigations?

Answer 4

• ABG
• Chest x ray
• ECG
• Blood tests
• Inspect sputum
• FEV1/ FVC
• Septic screen

Question 5

Why is imaging important?

Answer 5

• May indicate :
• consolidation
• pulmonary embolism
• non-cardiogenic pulmonaty oedema
• Mass, bronchiogenic carcinoma
• Pulmonary oedema
• Plueral effusions
• Pneumothorax
• trauma/rib fracture
• diffuse lung disease

Question 6

What are some severity indicators?

Answer 6

• Confusion dementia= abbreviated mental test (AMT)
• Respiratory scores - preferably UK based
• NICE
• GOLD (COPD)
• BTS- British Thoracic Society

Question 7

What is the MRC dyspnoea score?

Answer 7

Grade :
1- Not troubled by breathless except on strenous exercise
2- Short of breath when hurrying on a level or when walking up a slight hill
3- Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace
4- Stops for breath after walking 100 yards or after a few mins on level ground
5 - too breathless to leave the house, breathless when dressing/ undressing

Question 8

What is the CURB test?

Answer 8

C- confusion of new onset defined as an AMT score of 8 or less)
U- Urea greater than 7mmol/l (19 mg/dL)
R- Respiratory rate of 30 breaths per minute or greater
B- Blood pressure less than 90 mmHg systolic/ diastolic blood pressure 60mmHg or less
- age 65 or older
- AMT = abbreviated mental health test

Question 9

What is AMT?

Answer 9

1. Age
2. DOB
3. Time (to nearest hour)
4. Year
5. Name of hospital
6. Recognising 2 people ( doctor or nurse)
7. Recall their dress
8. Date of their 1st World War
9. Name of the present monarch
10. Count backwards (20-1)

Question 10

Why are CURB?

Answer 10

• 0- 0.6%
• 1- 3.2%
• 2-13.0%
• 3 - 17.0%
• 4- 41.5%
• 5- 57.0%
• Treatment 0-1 (outpatient)
• 2 (hospitalised) : 3-5 (possible ICU)