CAE B: Assessment

• 1. Dyspnea
• 2. Chest tightness
• 3. Coughing (may be only symptom, esp in kids)
• 4. Wheezing

• 1. Irritability, quietness or fatigue
• 2. Runny / stuffy nose ***
• 3. Chest pain / heart palpatations
• 4. Dark circles under eyes / watery eyes
• 5. Scratchy throat
• 6. Flare up of eczema ***
• 7. Heartburn
• 8. Children c/o upset stomach

• 1. Complete medical hx
• 2. Physical exam
• 3. PFT
• 4. Additional test to exclude other possibilities

• Alert / responsive
• Lethargic
• Stuporous
• Semicomatose (only respond to pain)
• Coma (no response to pain)
• Obtunded - drowsy state, dec cough or gag

• 1. Bathing with sponge, bath or shower
• 2. Dressing
• 3. Toilet use
• 4. Transferring to bed or chair
• 5. Urine / bowel continence
• 6. Eating

• Orthopnea
• General malaise
• Dyspnea
• Pain
• Nose / throat symptoms

• Dyspnea except in upright position
• (heart problems, CHF)

Electrolyte imbalance

• Grade 1 - normal dyspnea after unusual exertion
• Grade 2 - dyspnea after hills or stairs
• Grade 3 - dyspnea after normal speed walk
• Grade 4 - dyspnea after short slow walk
• Grade 5 - dyspnea at rest

• 1. Location
• 2. Quality
• 3. Severity (on 10 pt scale)
• 4. Aggrivating factors
• 5. Relieving factors
• 6. Hx
• 7. Context
• 8. Accompanying symptoms

• 1. Excessive nasal secretions from irritants, pollution, allergens
• 2. Itching or burning of nose / throat
• 3. Dysphagia / hoarseness

• HR: 60-100
• RR: 12-20
• BP: 120/80
• Temp: 37C or 98.6F

• HR: 80-120
• RR: 20-30
• BP: 100/65
• Temp: 37C or 98.6F

• 1. Hyperexpanded chest
• 2. Hunched shoulders
• 3. Accessory muscle use
• 4. Chest deformity
• 5. Prolonged exhalation
• 6. Nasal mucosal swelling, secretions, nasal polyps, sinusitis, rhinitis
• 7. Skin conditions (atopic dermatitis or eczema)

Vocal fremitus - voice vibrations

Pleural rub fremitus - grating sensation du to roughened pleural surfaces

Rhonchial fremitus (palpable rhonchi) - secretions in the airways

• Resonance - normal air filled lungs (hollow)
• Flatness - sternum, muscles, atelectasis
• Dullness - fluid filled organs, pleural effusion, pneumonia (drum sound)
• Tympany - air filled stomach, hyperinflation
• Hyperresonance - asthhma, emphysema, pneumothorax (booming sound)

3 to 5 cm

• Silent
• Bronchial breath sound - normal over trachea or bronchi
• If over lung periphery, lung consolidation

• Not asthma
• Foreign body obstruction

• Wheeze
• Silent chest
• Rales and ronchi - secretions
• Stridor - Inspiration, swelling or foreign body obstruction

• Increased bronchial wall markings (inflammation)
• Flattened diaphragm
• Patchy infiltrates from atelectasis

Uncompensated respiratory alkalosis with hypoxemia

Needs oxygen therapy

Uncompensated respiratory acidosis with hypoxemia

Needs mechanical ventilation and oxygen therapy

• Male: 4.7 to 6.1 million cells / mcl
• Femal: 4.2 to 5.4

• Male: 13.8 to 17.2 gm/dl
• Female: 12.1 to 15.1

• Male: 40.7 to 50.3%
• Female: 36.1 to 44.3%

• 4500 to 10000 cells/mcl
• elevated indicates bacterial infection
• reduced indicates viral infection

• < 350 cells/mcl
• elevated indicates allergic diseases or asthma

antibodies produced by the immune system in response to bacteria, viruses or foreign bodies

if IgE levels are high, allergy testing!

To determine if diseases are present to make it difficult for the body to fight infections

• r/o cystic fibrosis
• diagnosis of asthma in children < 3 is difficult

5

variability (improvement or deterioration) experienced in PFTs within one day

• When asthma is under control
• Then every 1 to 2 years

• Both
• Primarily obstructive that can cross over to restrictive
• Goal: manage before it becomes restrictive

• FVC: 4.8 L
• FEV1: 70% of FVC (minimum)

• 10 L/sec or 600 L/min
• Best way to monitor pt with asthma and measure MDI
• 60 L/m or >=20% in PF is dianostic of asthma
• Should measure daily

• 80-100% Normal
• 60-79% Mild
• 40-59% Moderate
• <40% Severe

• FEV1: 12% and 200ml
• or 12% in FVC

• SABA: 4-6 hours
• LABA: 12 hours
• Methylxanthines: 12 hours
• Slow release methylxanthines: 24 hours
• Ipratropium bromide: 6-8 hours

(Post FEV1 - Pre FEV1) / (Pre FEV1) X 100

• Methacholine
• Histamine
• Cold air
• Exercise

• Bronchodilators: 8 hours
• Methylxanthines: 12 hours
• Cromolyn Sodium: 24 hours
• Antihistamines: 48 hours

• helps differentiate between asthma and emphysema
• Normal is 25 ml CO/min/mmHg (STPD)
• Normal in asthma

• Antigen or allergen inhaled or ingested
• Immune system detects and releases IgE antibodies
• IgE attach to mast cells and basophils to act as guards
• When allergen/antigen contacts mast cell, IgE shoots hole into the mast cell
• Mast cell releases histamine, leukotrienes and chemicals resulting in allergic reaction

Antihistamines: 2 days

Skin-prick: red bumps within 20 minutes

• Intracutaneous test: only if skin prick inconclusive
• monitor patient for systemic reaction

• Use if not advisable to dc antihistamines
• Radioallergensorbent testing (RAST)
• Enzyme-lined immunosorbent assay test (ELISA)
• Less accurate, more expensive, slower
• Thus, less used

• Decreases IgE
• Increasing doses of allergen extract 1-2 per week
• Maintenance dose in 3 to 6 months (symptom relief)
• Then, once a week, reducing to every 4 weeks
• Wait 20 minutes
• Program lasts 3 to 5 years

• Sputum and blood for eosinophilic cationic protein ECP
• FeNO
• Metabolites in exhaled breath condensate EBC
• Needs further studies before approved to monitor
• not usually asked

• 1. Allergic rhinits (hay fever) or sinusitis ***
• 2. Swallowing problems
• 3. Congenital heart disease
• 4. Obstruction of the large or small airways
• 5. Tumors or enlarged lymph nodes
• 6. Cystic fibrosis ***

• 1. COPD ***
• 2. Pulmonary embolism
• 3. Heart disease
• 4. VCD ***
• 5. Airway tumors
• 6. Coughing due to drug reaction
• 7. Pregnancy
• 8. GERD ***