Assessment, diagnostic and manifestations

health history and risk factors

• Smoking, environmental/occupational exposures

• Chronic illnesses (asthma, COPD, CF, heart disease)

• Allergies, prior lung infections, family history

• Medications (steroids, inhalers, diuretics)

respiratory effort

(work of breathing, accessory muscle use, tripod position)

breathing rate/pattern

(tachypnea, bradypnea, apnea, orthopnea)

breath sounds

(wheezing, crackles, stridor, diminished/absent)

color

(pallor, cyanosis, clubbing in chronic hypoxia)

mental status

(restlessness → confusion → LOC changes)

assessment

Pulse ox and vital signs

ABG (Arterial blood gas)

Checks oxygenation (PaO₂), ventilation (PaCO₂), acid-base balance (pH, HCO₃).

allen test

Performed before radial artery puncture to confirm adequate collateral circulation.

capnography

• Noninvasive, continuous monitoring of CO₂ in exhaled breath.

• Normal ETCO₂: 35–45 mmHg.

• Early warning of hypoventilation/respiratory compromise.

bronchoscopy

• Scope inserted into bronchi; used for diagnosis, biopsy, secretion removal.

• Pre: NPO, consent, sedation.

• Post: Check gag reflex before food/water, monitor for bleeding, hypoxia, pneumothorax.

thoracentesis

• Needle inserted into pleural space to remove fluid/air.

• Position: Upright, leaning forward.

• Risks: Pneumothorax, bleeding, infection.

• Post: Monitor breath sounds, O₂ sat, chest X-ray to rule out pneumothorax.

Obstructive sleep apnea (OSA)

• Recurrent upper airway obstruction during sleep.

• Signs: Loud snoring, witnessed apneas, daytime sleepiness, morning headache.

• Risk: HTN, arrhythmias, heart failure.

• Tx: CPAP, weight loss, avoid sedatives/alcohol.

laryngectomy

• Surgical removal of larynx (partial/total).

• Total → permanent tracheostomy, no natural speech.

• Risks: Airway obstruction, altered communication, aspiration risk.

asthma

• Reversible airway inflammation/bronchoconstriction.

• Classic triad: SOB, wheezing, chest tightness.

• Severe: Silent chest (ominous), status asthmaticus = life-threatening.

• Tx: Rescue bronchodilators, steroids, trigger avoidance.

copd

• Chronic airflow limitation (emphysema + chronic bronchitis).

• Symptoms: Dyspnea, chronic cough, sputum, barrel chest, clubbing.

• Risk: Cor pulmonale, chronic hypoxia, CO₂ retention.

• Caution with O₂ (hypoxic drive).

tonsilitis

• Inflamed tonsils (viral or strep).

• Symptoms: Sore throat, difficulty swallowing, fever.

• Tx: Antibiotics (if bacterial), pain control; T&A surgery if recurrent/severe.

croup

• Viral inflammation of larynx/trachea.

• Symptoms: Barking cough, stridor, worse at night.

• Tx: Cool mist, corticosteroids, racemic epinephrine if severe.

epiglottitis

• Sudden airway obstruction from epiglottis swelling.

• 4 D’s: Drooling, Dysphagia, Dysphonia, Distressed breathing.

• Tx: Keep calm, NPO, O₂, prepare for intubation. Never use tongue depressor.

• Peds Emergency

bronchiolitis/RSV

• Viral infection (infants, <1 yr).

• Symptoms: Tachypnea, wheezing, retractions, copious mucus.

• Tx: Supportive, hydration, O₂, suction. Palivizumab for prevention in high-risk infants.

cystic fibrosis

• Genetic disorder → thick mucus in lungs & GI.

• Respiratory: Chronic cough, infections, wheezing.

• GI: Steatorrhea, poor weight gain, FTT.

• Tx: Airway clearance therapy, bronchodilators, mucolytics, pancreatic enzymes, high-calorie/protein diet.