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Hypoxia and Oxygen saturation (measurement, normative values, pathology) ------------------------------------------------------------------------ ABGs -- what they measure and how to interpret. -------------------------------------------------------------------- - Measures p...

Hypoxia and Oxygen saturation (measurement, normative values, pathology) ------------------------------------------------------------------------ ABGs -- what they measure and how to interpret. -------------------------------------------------------------------- - Measures partial pressure oxygen - Oxygen content in arterial blood - Normal: 80-100 mmHg - Low (hypoxemia): \ | | | | | | - Strength: weak, moderate, | | | strong | | | | | | - Sound quality: dry or moist | | | | | | Secretion clearance: productive | | | or non-productive (NP) -- if | | | productive, can comment on volume | | | & viscosity | +-----------------------------------+-----------------------------------+ | **Sputum** | Healthy adults produce up to 100 | | | mL of tracheobronchial secretions | | | each day | | | | | | Unwell/Respiratory conditions -- | | | may produce excess | | | tracheobronchial secretions - | | | need to be cleared from the lungs | | | by coughing/huffing | | | | | | - Baseline -- Do they normally | | | cough up sputum? | | | | | | - The colour: can indicate | | | disease severity | | | | | | - Volume: how much is someone | | | able to cough up? How many | | | times a day | | | | | | Viscosity: how thick are the | | | secretions? Cough up | | | independently, nebulisers, | | | physiotherapy etc? | +-----------------------------------+-----------------------------------+ | **Dyspnea/shortness of Breath** | Defined as an uncomfortable and | | | abnormal awareness of breathing | | | | | | Pathological if it occurs | | | disproportionate to | | | activity/conditions | | | | | | - Onset -- what causes SOB | | | | | | - Duration -- how long does it | | | last? | | | | | | - Aggravating and easing | | | factors- What makes it worse? | | | What makes it better? | | | | | | Quantify: BORG à training target | | | 3-4 | +-----------------------------------+-----------------------------------+ | **Wheeze** | A whistly sound causes by | | | narrowing of the airways during | | | expiration (Often indicates | | | airway obstruction) | | | | | | Obstruction may be due to | | | bronchospasm (asthma), oedema | | | (heart failure) sputum, foreign | | | bodies. | | | | | | - High pitched wheeze = near | | | total obstruction | | | | | | - Fixed monophonic wheeze = | | | single obstructed airway | | | | | | - Polyphonic wheezes (multiple) | | | widespread narrowing | | | | | | - Localised wheeze = sputum | | | retention | | | | | | - **Baseline** -- Do they | | | normally have a wheeze? | | | | | | - **Duration** -- is it | | | constant or intermittent? How | | | long does it take to settle | | | down | | | | | | **Aggravating and easing | | | factors**- What makes it worse? | | | What makes it better? | +-----------------------------------+-----------------------------------+ | **Hemoptysis** | Refers to the presence of blood | | | in the sputum. | | | | | | - Frank haemoptysis | | | (significant amounts of | | | blood) can be life | | | threatening that may require | | | bronchial artery embolisation | | | or surgery | | | | | | - Isolated haemoptysis (tinged | | | or streaked) may be the | | | initial sign of bronchogenic | | | carcinoma | | | | | | - Patients with chronic | | | infective lung diseases may | | | suffer from recurrent | | | haemoptysis (e.g. CF, | | | bronchiectasis) | | | | | | - **Baseline** -- Do they | | | normally have haemoptysis? | | | | | | **Volume:** How much have they | | | coughed up? | +-----------------------------------+-----------------------------------+ | **Smoking History** | There is a linear relationship | | | between pack years and risk of | | | cancer | | | | | | - *Work out their pack year | | | smoking Hx ( = pck/day x | | | years smoked)* | | | | | | | | | | | | - **History:** Have you ever | | | smoked? | | | | | | - **Duration:** How long for? | | | | | | - **Amount:** How many | | | cigarettes a day? | | | | | | **Cessation:** When did you stop? | +-----------------------------------+-----------------------------------+ | **Home Oxygen** | Patients must not have been | | | smoking for a minimum of four | | | weeks. Requirement that patients | | | should continue not to smoke | | | Safety | | | | | | - **Time:** How long have they | | | been on home oxygen for? | | | | | | **Dosage:** How many litres and | | | hours do they require home oxygen | | | for? | +-----------------------------------+-----------------------------------+ | **Chest Pain** | Chest pain in usually originates | | | from musculoskeletal, cardiac, | | | pleural or tracheal inflammation | | | | | | Stable angina vs Unstable angina. | | | MI's | | | | | | - **Onset:** How long have they | | | had it for? Have they had it | | | previously? | | | | | | **Location**: Where is the pain? | | | Is it localized or referred? | +-----------------------------------+-----------------------------------+