Related Subjects: Asthma
|Acute Severe Asthma
|Exacerbation of COPD
|Pulmonary Embolism
|Cardiogenic Pulmonary Oedema
|Pneumothorax
|Tension Pneumothorax
|Respiratory (Chest) infections Pneumonia
|Fat embolism
|Hyperventilation Syndrome
|ARDS
|Respiratory Failure
Immediate Assessment |
Airway: Check airway is patent; clear airway and suction
Breathing: If no respiratory effort then CALL ARREST TEAM
Circulation: If no palpable pulse then CALL ARREST TEAM
Disability: If GCS < 9 then CALL ANAESTHETIST
|
Actions
- Has the patient COPD and do you need to set the target to 88-92%
- How is the patient. Well. Is the patient breathless?
- Sit the patient up, Raising the head of the bed promotes effective breathing and diaphragmatic descent, maximizes inhalation, and decreases the work of breathing.
- Airway: Head tilt and chin lift.
- Oxygen therapy: Can give up to 15L/min unless COPD give 24-28%
- Breathing: Look at effort. Is the patient comatose? Consider Glucose 100 ml of 10% or Naloxone 400 micrograms. If hypoventilating and becoming comatose get anaesthetic help and consider bag valve mask ventilation. If comatose then get help to stabilise and consider CT head if other causes of coma sorted. See coma
- Circulation: Is there shock - see the subject. Get IV access. Start IV fluids 0.9% Saline unless fluid overloaded
- Senior help: involve medical registrar if the patient does not quickly improve
- Focused Examination:
- Bronchospasm : Asthma or COPD try Nebuliser
- Hypoventilation: Excess Sedation, Seizure or other causes of reduced GCS. Obesity. Sit up. Give oxygen. Consider Naloxone. Usually T2RF
- Raised JVP, Tachycardia, Overloaded, Basal Creps: IV Furosemide
- Clear chest: Possible PE - Get CTPA
- Cough, sputum, fever: COVID19 or Bacterial pneumonia
- Bronchospasm : Anaphylaxis: IM Adrenaline and Salbutamol(Albuterol)
- Atelectasis and mucus plugging. Encourage coughing and chest physio
- Arterial blood gases
- Assess O2 and CO2, pH , HCO3, Base excess
- Determine if Type 1 or 2 Respiratory failure
- Portable CXR
- 12 lead ECG
Differential
- Pneumothorax
- Asthma
- Pulmonary oedema
- Pulmonary embolism
- COPD
- Hypoventilation due to sedation / opiates / hypoglycaemia / obesity / OSA
- Chest infection
- Mucus plugging
- Lung collapse