week 2 - Respiratory emergencies Flashcards
What are the indicators of potential respiratory involvement?
- Shortness of breath
- cough
- wheeze
- Cyanosis
- tight chest
- chest pain
- signs of infection
What are the signs of difficulty breathing?
- Tripod position
- Unable to complete sentences
- Use of accessory muscles
- Recession
- Flared nostrils
- Purse lip breathing
- Wheezing
- Stridor (HIGH PITCHED RESPIRATORY SOUND)
- Cyanosis
- Reduced consciousness
How do you inspect for potential respiratory issues?
- Respiratory RATE, DEPTH AND RHYTHM
- accessory muscles -> check scalene and Sternocleidomastoid
- Recession -> when skin pulls inward during inhalation, e.g: visible at sternocleidomastoid or ribs.
- Inspect chest wall markings.
- medication patches
- rashes
what do you look for during PALPATION, when undertaking a respiratory inspection on a patient?
INSPECT -> CHEST WALL, AXILLA AND POSTERIOR ASPECTS.
Feel for:
- tenderness
- CREPITUS: a grating sound or sensation produced by friction between bone and cartilage or the fractured parts of a bone.
- surgical emphysema.
what do you look for in terms of PERCUSSION when undertaking a respiratory inspection on a patient?
INSPECT CHEST WALL: ANTERIOR, AXILLA AND POSTERIOR ASPECTS.
PERCUSS FOR:
- Hyper-resonance.
- Normo-resonance.
- Hypo-resonance.
what do you look for in terms of AUSCULTATION when undertaking a respiratory inspection on a patient?
LISTEN for:
- Normal breath sounds
- Wheeze
- Fine crackles
- Coarse crackles
- Reduced breath sounds
- Pleural rub
What are other tests used during in a respiratory assessment?
- Peak flow = Peak expiratory flow rate (PEFR)
- ETCO2
- ECG
- Cardiac assessment
How do you work out Peak Expiatory Flow Rate?
To calculate your peak expiratory flow rate (PEFR), you can use a peak flow meter to measure how hard and fast you can exhale. You can then compare your PEFR to what’s expected for your age, height, and sex to help diagnose asthma.
STEP BY STEP:
1) Make sure the mouthpiece is clean and the marker is at the bottom of the scale.
2) Sit or stand up straight.
3) Take a deep breath in through your nose.
4) Place the mouthpiece between your teeth and close your lips around it.
5) Blow out as hard and fast as you can in one breath.
6) Read the number on the meter next to the marker.
7) Repeat the steps two more times.
8) Record the highest of the three numbers.
What is Asthma?
Immune reaction to an allergen, causing:
- acute airway inflammation
- Bronchoconstriction (narrowing of airway)
- Bronchospasm
- Bronchiole Oedema (fluid buildup)
- mucous production
Asthma - risk factors?
- being a WOMAN, more common in CHILDHOOD for BOYS.
- lower socio-economic status -> potentially have higher exposure to contaminants in the air such as mould and mildew.
- obesity
- smoke exposure
- respiratory infection in childhood
- allergies, industrial exposure to chemicals.
- family Hx (usually passed down maternally)
4 main symptoms of asthma?
- Rapid breathing
- Chest tightness
- Shortness of breath
- Wheezing
What are the four classifications of asthma in terms of severity?
- Mild
- Moderate
- Acute severe
- life threatening
What classifies as MILD ASTHMA?
- breathing below best level of functioning due to wheeze.
- Peak Expiratory Flow Rate (PEFR) higher than 75% (BEST SCORE USING PEFR OR PREDICTED SCORE)
- NO features of moderate or acute severe Asthma!!
What classifies as moderate Asthma exacerbation?
- able to speak in sentences.
- increasing symptoms
-PEFR of between 50-75% (BEST SCORE or PREDICTED SCORE)
- No features of acute severe asthma.
What classifies as Acute severe asthma?
ANY ON OF THE FOLLOWING WOULD CAUSE CONDITION TO BE CLASSIFIED AS ACUTE:
- PEFR between 33-50% (BEST SCORE or PREDICTED)
-SpO2 equal to or less than 92% (presenting with Hypoxemia)
- Inability to complete sentences in 1 breath.
- Pulse > 110/min in adults
- Respiratory rate exceeding 25breaths/minute.
