Phys Clinical Cases · respiratory
Respiratory Failure and Non-Invasive Ventilation — DCE Clinical Case
DCE short-case station: respiratory examination of the breathless patient — work of breathing, cyanosis, CO2 retention signs, hyperinflation and cor pulmonale — with presentation template and probing questions.
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FRACP DCEMRCP PACES
Prompt
DCE short-case station: respiratory examination of the breathless patient — work of breathing, cyanosis, CO2 retention signs, hyperinflation and cor pulmonale — with presentation template and probing questions.
Approach before you touch the patient
Announce the frame: you are examining a breathless patient for signs of respiratory failure and its complications, not just for a chest diagnosis. Position him at 45 degrees, expose the chest fully, and take ten seconds at the end of the bed — the highest-yield ten seconds of the station, because work of breathing is assessed by watching, not palpating [1].
References5ShowHide
- [1]Davidson AC, Banham S, Elliott M, et al. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults Thorax, 2016.PMID 26976648
- [2]O'Driscoll BR, Howard LS, Earis J, et al. BTS guideline for oxygen use in adults in healthcare and emergency settings Thorax, 2017.PMID 28507176
- [3]Abdo WF, Heunks LM Oxygen-induced hypercapnia in COPD: myths and facts Crit Care, 2012.PMID 23106947
- [4]Osadnik CR, Tee VS, Carson-Chahhoud KV, et al. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease Cochrane Database Syst Rev, 2017.PMID 28702957
- [5]Williams AJ ABC of oxygen: assessing and interpreting arterial blood gases and acid-base balance BMJ, 1998.PMID 9794863