Percuss the chest: hyper-resonance may suggest a pneumothorax dullness usually indicates consolidation or pleural fluid.Stridor or wheeze suggests partial, but significant, airway obstruction. Listen to the patient’s breath sounds a short distance from his face: rattling airway noises indicate the presence of airway secretions, usually caused by the inability of the patient to cough sufficiently or to take a deep breath.If the patient is receiving supplemental oxygen, the SpO2 may be normal in the presence of a very high PaCO2. The pulse oximeter does not detect hypercapnia. Record the inspired oxygen concentration (%) and the SpO2 reading of the pulse oximeter.in acute severe asthma or a tension pneumothorax) note the presence and patency of any chest drains remember that abdominal distension may limit diaphragmatic movement, thereby worsening respiratory distress. Note any chest deformity (this may increase the risk of deterioration in the ability to breathe normally) look for a raised jugular venous pulse (JVP) (e.g.Assess the depth of each breath, the pattern (rhythm) of respiration and whether chest expansion is equal on both sides. A high (> 25 min -1) or increasing respiratory rate is a marker of illness and a warning that the patient may deteriorate suddenly. Look, listen and feel for the general signs of respiratory distress: sweating, central cyanosis, use of the accessory muscles of respiration, and abdominal breathing.acute severe asthma, pulmonary oedema, tension pneumothorax, and massive haemothorax). Take bloods for investigation when inserting the intravenous cannula.ĭuring the immediate assessment of breathing, it is vital to diagnose and treat immediately life-threatening conditions (e.g. Insert an intravenous cannula as soon as possible.Attach a pulse oximeter, ECG monitor and a non-invasive blood pressure monitor to all critically ill patients, as soon as possible. If there are any doubts about the presence of a pulse start CPR. If you are confident and trained to do so, feel for a pulse to determine if the patient has a respiratory arrest. If the patient is unconscious, unresponsive, and is not breathing normally (occasional gasps are not normal) start CPR according to the resuscitation guidelines.Ask a colleague to ensure appropriate help is coming. This first rapid ‘Look, Listen and Feel” of the patient should take about 30 s and will often indicate a patient is critically ill and there is a need for urgent help.Failure of the patient to respond is a clear marker of critical illness. If he speaks only in short sentences, he may have breathing problems. If the patient is awake, ask “How are you?” If the patient appears unconscious or has collapsed, shake him and ask “Are you alright?” If he responds normally, he has a patent airway, is breathing and has brain perfusion.First look at the patient in general to see if the patient appears unwell.Remember – it can take a few minutes for treatments to work, so wait a short while before reassessing the patient after an intervention. This will buy time for further treatment and making a diagnosis.
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