Respiratory Assessment

• Airway
– Open and Clear
– Needs Intervention
• Breathing
– Inspection
– Palpation
– Percussion
– Pulse Oximetry
– Auscultation
• Circulation & Vital Signs
• History
 Inspection
•Rate and Quality of Respirations
•Level of Distress
•Accessory muscle use or retractions
•Uneven chest rise
•Midline Trachea
•Central cyanosis (tongue & mucus membranes)
•Shape of the Thorax
 Palpation
•Subcutaneous air

•Hematoma

•Mass

•Fracture

•Flail Segment
Percussion
• Hyper-resonance
• Hypo-resonance

Pulse Oximetry
Normal Value = 92% - 100%
 Auscultation
Please note quality, location, & symmetry
Breath sounds
Listen through both inspiration and expiration
Normal, decreased, or absent
•Wheezes
•Inspiratory
•Expiratory
•Rales/ Crackles
•Rhonchi
Airway and Respiratory
Emergencies
Presented by:
Tamsil Syafiuddin
Auscultation
Sequence
Pulmonary Assessment: HISTORY
Chief complaint? Cough, dyspnea, fatigue, pain

C character
O onset
L location
D duration
E exacerbation
R relief
R radiation
 History (continued)

What Medications are they taking?

Pre-existing factors
Smoking
Previous Chest Surgery
Orthopnea (can’t breathe laying down)
Nocturnal dyspnea
Occupation
Exposure
 Initial Interventions
ABC’s
Pulse Oximetry
Vital Signs
Treatment of Hypoxia (Oxygen delivery)
Chest X-ray
CBC
ABG
EKG (If cardiovascular problem is suspected)
Radiological Evaluation

•Chest X-ray
PA & Lateral
Portable or single view AP
Assess for pregnancy
 ABG’s Made Simple
•Arterial blood gases are a window to
assess ventilation, acid-base balance,
and oxygenation.
•The most important part of analyzing
any lab value is to treat the patient, not
the numbers.
•Lab results should always be correlated
with good clinical data.
•An accurate history and physical
examination are a clinician's best
resources.
 Respiratory Distress
Impaired oxygenation, ventilation, or perfusion
General signs and symptoms:
Altered Level of Consciousness (ALOC)
Dyspnea
Abnormal vital signs
Poor muscle tone
Abnormal breath sounds
Decreasing pulse oximeter reading
 Pulmonary Edema
•Respiratory problem that is cardiac in nature
Decreased left ventricular pumping
Usually secondary to AMI or CHF

Increased extracellular fluid volume

Usually seen in liver and renal failure

•Non-cardiac cause is ARDS

(Adult Respiratory Distress Syndrome)
 Signs and Symptoms

Dyspnea, ↑ resp. rate, & labored resp.

Heart failure: Poor left ventricular function, Increased JVD, Dependent and pedal edema
Weight gain
Bounding pulses with high BP
S3 & S4 heart sounds
Cool, pale, moist, cyanotic, low BP
(these are late signs and you patient is in trouble)
Productive cough (Sputum frothy white)
Rales or crackles on auscultation
 Emergency Treatment
• High flow O2
• Reduce cardiac workload
NTG
Nipride
Morphine
Diuretics
Ace inhibitors
• Bronchodialators and PEEP
 Emergency Treatment (CONT)
Increase contractility and cardiac output
Digoxin
Dobutamine
Intubation
CXR, CBC, CHEM, ABG,
Dig level
Foley (Strict I & O)
Consider IABP
 Pulmonary Embolism
•Clot or blockage to one or more of the
blood vessels in the lungs
Often confused with:
AMI
Pneumothorax
Rib fracture
Other diseases causing chest pain
•Usual cause is trauma to the lower
extremities, pelvic or long bone fractures,
or immobility
Precipitating factors
Obesity
Decreased circulation
CHF or MI
Thrombophlebitis
Acute infections
Child Birth
Diving
Birth control
Smoking
Neoplasms
 Signs and Symptoms
Short of breath, may have crackles
Increased HR and RR
Decreased cardiac output
Cough with hemoptysis
Fever
Syncope
Decreased O2 and CO2
Normal CXR
ECG changes: new onset RBBB & R axis
 Emergency Treatment
Oxygen (Depending on patient needs)
Intubation
Fluids
Analgesics and anxiolytic
Anticoagulants
Thrombolytic / Fibrinolytics TPA
Vasopressors to maintain BP
 Spontaneous Pneumothorax
•Sudden rupture of the lung causing
compression of the lung tissue and heart
•Usually seen in:
Tall thin males 20-40 years old
History of blebs
Weakened pleura
Increased Ventilation pressure
Invasive proceedures
 Signs and Symptoms
Mild dyspnea to severe distress
Hypoxia (↓ PO2 and dropping sat)
Chest pain on involved side
Subcutaneous emphysema
Cyanosis (late sign)
Hypotension (late sign)
 Emergency Treatment
•Pulse Oximetry
•Oxygen: titrate to needed PO2
If pneumothorax < 20% and the patient
has no major symptoms, he or she may
be observed
•Needle Aspiration
•Chest tube
Pneumothorax
 Tension
Pneumothorax
Hemothorax
Intubation
 Intubation Criteria

• Alteration in airway or airway protection

from aspiration of foreign material
• Apnea or respiratory arrest
• Altered Level of Consciousness (ALOC)
• Poor or life threatening ventilation and
oxygenation
 Intubation Criteria
•Unable to clear airway with suctioning of
trachea and bronchi
•PaO2 < 60mmHg
•PaCO2 > 50mmHg
 Terima kasih

Domo
Domo Arigatoo Gozaimasu
Domo ArigatooGozaimasu
Arigatoo Gozaimasu