Respiratory System Assessing the Patient Part III Diana Jones Paramedic

General Assessment A similar assessment is performed on all medical patients regardless of chief complaint What differentiates the respiratory patient is the additional focus on this particular system But remember not to develop tunnel vision, as the respiratory system is tied to other systems as well and concomitant treatment may be necessary

General Assessment What is the nature of illness? i.e., chief complaint Primary Survey – should be the same on all patients General impression – how does this patient appear to you Level of consciousness – AVPU Apparent life threats – i.e., not breathing, severe hemorrhaging Airway and breathing – this is a quick, initial survey, NOT a focused exam, questions you should ask yourself….Patent/self-maintained airway? Adequate rate? Supplemental oxygen needed?

General Assessment Primary survey continued Circulation – Obviously, check for a pulse! What is their skin….color? temperature? condition? History of Present Illness (HPI) – remember your mnemonics…OPQRST and any additional questions needed to clarify Past Medical History (PMHx) – here’s another mnemonic…SAMPLE Include a baseline set of vital signs

General Assessment Remember that much of the Primary Survey can be done simultaneously Upon meeting the patient, you are beginning the assessment Is patient answering questions appropriately? (LOC) Can they answer in full sentences? (ease/difficulty of breathing) Feel their pulse while talking (you can’t count a rate and have a conversation at the same time, but you should be able to quickly tell…too fast? too slow? and how does their skin feel? cold? hot? wet? dry?

Secondary Assessment Now it is time to focus on a particular system For the respiratory patient there are additional questions you should be asking and physical exams you should be performing You already have HPI and PMHx, so we’ll continue from there

Secondary Assessment Pertinent Negatives – something you would expect based on chief complaint and it is absent, c/o difficulty breathing/SOB and patient is not in tripod position Additional questions – chest pain? (pleuritic vs. cardiac) productive cough? (color of sputum) Additional physical exam should assess - edema? JVD? accessory muscle use? retractions? nasal flaring? pursed lip breathing? Auscultation of breath sounds – compare bilaterally each field before assessing a different field – eupneic, wheezing, crackles, rhonchi, rales, stridor

Secondary Assessment Points for clarification Pleuritic vs. cardiac chest pain – only with deep inspiration? point tenderness? reproducibility? Auscultation of breath sounds – be sure to listen in each field during entire cycle (inspiration through end of expiration)

Part IV will cover respiratory diseases and management Now What? You’ve assessed your patient, so what comes next? Differential Diagnosis – distinguishing of disease or condition from others presenting with similar signs and symptoms (Merriam-Webster) Management Part IV will cover respiratory diseases and management

Questions?