What is bronchial breathing associated with?
Consolidation - pneumonia, pulmonary oedema, haemorrhage, aspiration etc
What are quiet/reduced breath sounds associated with?
reduced air entry - pleural effusion, pneumothorax
What is pleural effusion?
abnormal accumulation of fluid in pleural space - transudate like heart failure, nephrotic syndrome etc, or exudate like pneumonia, tuberculosis etc
What do blood gases measure?
pH - acid base status, PCO2 - ventilation, PO2 - oxygenation, HCO3 - metabolic/renal contribution, O2 saturation
When is an arterial blood gas indicated?
Low Spo2
How do you administer oxygen in critically unwell patients?
Non rebreathe mask with oxygen flow rate of 15l
How do you assess airway?
Ensure there is no blockage, head tilt chin lift, jaw thrust, suctioning, finger sweep
How do you assess breathing?
inspect tracheal position, chest expansion, percussion of chest, auscultation of chest consider ABG or CXR, offer oxygen
How do you assess circulation?
review heart rate (60-99bpm), assess fluid balance, inspect pallor and oedema, palpate hands for temperature, measure capillary refill time - should be under 2 seconds, assess pulse and blood pressure
What are causes of tachycardia?
hypovolaemia, arrhythmia, infection, hypoglycaemia, thyrotoxicosis, anxiety, pain and drugs
What are causes of bradycardia?
acute coronary syndrome, ischaemic heart disease, electrolyte abnormalities, drugs
what are types of acute coronary syndrome?
unstable angina, non st elevated myocardial infarction, st elevated myocardial infarction
what is the difference between nstemi and stemi?
nstemi - partial temporary coronary occlusion
stemi - complete and sustained coronary occlusion
what is considered reduced urine output?
less than 0.5ml/kg/hour
How do we assess disability?
A- alert, C- confusion, V- verbal, P- pain, U- unresponsive. use GCS, assess pupils,
What are causes of depressed consciousness?
hypovolaemia, hypoxia, hypercapnia, metabolic disturbance, seizures, raised ice, drug overdose, hypoglycaemia
How do we assess exposure?
ask if there is pain, assess skin, assess abdomen and calves, assess temperature, palpate for peritonitis
what are quiet/reduced breath sounds associated with?
pleural effusion and pneumothorax - reduced air entry into lung region
what is wheeze associated with?
asthma, cold, bronchiectasis
what are coarse crackles associated with?
pneumonia, bronchiectasis, pulmonary oedema
what are fine end inspiratory crackles associated with?
pulmonary fibrosis
how do we manage acute coronary syndrome?
MONA - morphine, oxygen, nitrates, aspirin
How do we rate the Glasgow coma scale?
mild - 13 to 15, moderate 9-12 severe 3-8
