INFO GATHERING HINTS

ABG

Acid-base balance, oxygenation or ventilation

Tracheal position

Atelectasis or pneumothorax

• shifts to atelectasis and away from pneumothorax

Chest inspection

General appearance, distress, retractions, accessory muscle use, respiratory impairment

Percussion

Density or air in thorax

MIP/NIF

Respiratory muscle strength for weaning or spontaneous breathing: neuromuscular patients

Vital capacity

Ability to take a deep breath, cough, weaning readiness

Peak Flow

Asses daily expiratory airflow, primarily for asthma, not COPD

Peak Cough Flow

Ability to cough, protect airway, only for neuromuscular patients

Spirometry

Presence of obstructive lung disease vs restrictive lung disease

RSBI

Adequacy of ventilation for weaning

Sputum

Assess the patients sputum to check for an infection

Spirometry

select certain PFT tests to check to see if the disease is obstructive or restrictive

DLCO

Diffusion across alveolar capillary membrane, emphysema

CBC

overall health, includes RBC/ HGB,HCT,WBC, platelets, chemistry

RBC/Hgb/ Hct

Assess ability to oxygenate

WBC / Differential

Infection- viral vs bacterial, allergies

Serum electolytes

Cardiac arrhythmias ( Na,CI,K,Na,CO2 )

Serum lactate

Tissue perfusion and adequacy of oxygenation in heart failure

CVP Monitoring

Heart Failure, fluid overloading

ECG

Cardiac rate and arrhythmias, not usually needed for neo and pedi unless congenital cardiac patient

Urine output

Assessing cardiac output / perfusion to kidneys

Chest X-ray

Lung or pleural space problems

Neck X-ray

Croup, epiglottis, foreign body aspiration

Ct Angiography

Pulmonary embolism

ICP

Head injury

Glasgow Coma Scale

Unconscious, head injury

6 MWT

Assess exercise tolerance and the institution of a PR program

Sleep Study

Assess sleep disordered breathing

Level of consciousness

Head injury, drug overdose, exacerbation/ high CO2 narcosis, initial assessment in the ER

Respiratory Pattern

Assess distress, especially for newborn and child

APGAR

Newborn assessment, toleration of delivery

Swallow Ability

Neurologic exam, GB, MG, ALS, spinal cord injury

Gag reflex

Brain death assessment

Vd/Vt ratio

Adequacy of ventilation

Sweat Chloride

New diagnosis of CF

Pupil Reflex

Head injury, neurological exam

Deep tendon reflexes

Neuromuscular assessment, GB, MG

Cuff leak test

readiness for extubation, reduction in airway swelling

Peripheral pulses

Indication of systemic perfusion, cardiac output

Pedal edema

cardiac impairment, heart failure

Pre-Postductial SpO2

Newborn oxygenation assessment for cardiac anomaly

Co-Oximeter

Carbon monoxide poisoning, methemoglobinemia from excessive inhaled nitric oxide

Secretions in the airway for CF and bronchiectasis pts

• HFCWO

• oscillatory PEP

• pulmozyme

• hypertonic saline

Secretions in the airway for everyone

• deep breathing and cough

• acapella/ oscillatory PEP

Wheezing in a bronchospasm

bronchodilator for bronchospasm

Wheezing in heart failure

rec diuretics

Wheezing can also mean

foreign body

recommend bronchoscopy

Stridor

racemic epinephrine or cool mist

Atelectasis

• lung expansion therapy

• IS, EzPAP, deep breathing

Weak cough

• deep breathing training

• IS

• EzPAP

• IPPB

pH less than 7.25

intubate

Albuterol is a

SABA

Formoterol is a

LABA

Ipratropium bromide ( atrovent ) is

SAMA

Tiotropium bromide ( spiriva ) is

LAMA

Tiotropium bromide is used for

the maintenance treatment of chronic obstructive pulmonary disease COPD and asthma It opens the airways to ease breathing, but it is not a rescue inhaler for sudden attacks.

Ipratropium bromide ( atrovent ) used for

To treat breathing problems from chronic obstructive pulmonary disease ( COPD ) , asthma symptoms and a runny nose from allergies It works by relaxing the muscles around the airways or stopping fluid release in the nose

Formoterol is used for

used to control and precent COPD and asthma attacks and stop wheezing

Fluticasone / salmeterol ( advair )

long acting bronchodilator and inhaled steriod

Fluticasone / salmeterol ( advair ) used for

Daily maintenance treatment of asthma and COPD It helps prevent wheezing, coughing, chest tightness, and shortness of breath. It is not a rescue inhaler and will not stop a sudden attack.

Montelukaast ( singular ) is a

leukotrine-modifying agent

Omalizumab ( xolair )

IgE immunoglobin antagonist

Theophylline or caffeine citrate is used to treat

apneic conditions and indicates that need for home apnea monitoring

Dornase alfa ( pulmozyme )

a mucolytic for cystic fibrosis

N-acetylcysteine is a

mucolytic agent

Guaifenesin ( robtisussin )

over the counter expectorant

Tobramycin ( TOBI ) is

an antibiotic for CF

Cayston is also a

antibiotic for CF

Iloprost ( ventavis) and inhaled nitric oxide is used for

pulmonary hypertension

Lasix

a diuretic

Inotropic drugs

Increase or decrease the force of contraction

Chronotropic drugs

increase or decrease the heart rate

Lidocaine HCI is a

topical anesthetic

Propofol

lorazepam ( ativan )

midazolam HCI ) versed

are all a

sedative

Ketamine ( ketalar )

is an anesthetic and will lead to resp depression and hypoventilation

Morphine and fentanyl citrate ( sublimaze ) is a

analgesic

Vecuronium bromide ( norcuron ) is a

paralytic

Pulmonary edema chest x-ray

• batwing

• butterfly pattern

• fluffy infiltrates

Atelectasis X-ray

• patchy infiltrates

• platelike infiltrates

• crowded pulmonary vessels

• crowded air bronchograms

ARDS

• diffuse bilateral radiopacity

• honeycomb pattern

• ground glass apperance

Pleural effusion

• blunting / obliteration of costophrenic angle

• basilar infiltrates w meniscus

• concave superior interface/ border

Pneumonia

Air bronchograms

Pulmonary emboli

Peripheral wedge shaped infiltrate

Tuberculosis

Cavity formation

Increased WBC

Infection

Low Hgb

Anemia

Decreased platelets

bleeding risk

Infiltrates on chest x ray reveal

infection

Hyperlucency on chest x-ray

pneumothorax

Obstructive

Decreased FEV1/FVC < 70%

Restrictive

Decreased TLC and VC

PERF less than 80% predicted

airway obstruction

Exudate pleural effusion

LDH and protein is high

Transudate pleural effusion

CHF, liver / kidney failure

Decreased PETCO2

poor perfusion or hyperventilation

Rhonchi or tactile fremitus

Secretions in the large airways

Dull percussion + bronchial sounds

• atelectasis

• infiltrates

• consolidation

Hyperresonance to percussion

pneumothorax

Dull percussion + decreased sounds

pleural effusion