respiratory assessment and monitoring pact pdf

Respiratory assessment and monitoring pact pdf

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Haemodynamic Monitoring

Promoting the 6Cs of nursing in patient assessment

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Respiratory assessment and monitoring - PACT - ESICM

Capnograph is an indispensable tool for monitoring metabolic and respiratory function. Capnometry, measuring the concentration of carbon dioxide CO2 in the atmosphere, was used for the first time during World War II as a tool for monitoring the internal environment 1. It was used in medicine for the first time in to measure the amount of CO2 exhaled during anesthesia.

Haemodynamic Monitoring

European Society of Intensive Care Medicine. All rights reserved. Recognise acute lung diseases through history, clinical manifestations and imaging2.

Underst and the relationship between PaO 2 , SaO 2 and arterial oxygen content and the use of pulse oximetry3. Evaluate respiratory function using end-tidal CO 2 measurements, analysis ofcapnographic curves, and dead space calculations4. Interpret airway pressure and flow tracings and oesophageal pressure tracings5.

Select the appropriate parameters to monitor during mechanical ventilation and weaning. Estimation of static airway pressures Several diseases can impair the function of therespiratory system and although specific treatment for the underlying diseasemay differ, the ability to assess, interpret and monitor physiological changes inthe respiratory function over time is essential to providing optimal supportivetreatment and detecting the physiological response to therapeutic interventions.

The aim of this module is to provide a systematic approach to evaluating and monitoring patients with respiratory impairment. Monitoring is the assessment of a patient at predetermined intervals, repeatedly or continuously, with theintention of detecting abnormalities and triggering a response if an abnormalityis detected. This starts with simple skills and devices and can be later supportedby the increasingly more sophisticated equipment now available at the bedside.

Critical care staff need to be familiar with the most common respiratory monitoring devices and techniques and develop an awareness of the moresophisticated monitoring modalities being adopted into respiratory critical care.

The initial assessment of a patient with respiratory failure requires a thoroughclinical history and physical examination in conjunction with baselineinvestigations. Further respiratory monitoring is necessary to assess response totreatment and outcome. Much of the material of this module relates to patients undergoing mechanicalventilation and it and the glossary of terms can be read in conjunction with the PACT module on Mechanical ventilation. The initial clinicalexamination provides a baseline reference.

It is essential for the differentialdiagnosis and treatment planning. The clinical examination of the respiratory system comprises history taking,physical examination inspection, palpation, percussion and auscultation and the evaluation of laboratory data and radiological findings.

Clinical historyThe history taking includes the past medical and surgical history, currentmedications, as well as the presenting complaint. Information about risk factors for lung disease is obtained:A history of current or previous smoking is noted and a record made ofthe number of years the patient has smoked, the number of cigarettes perday and the interval since smoking cessation.

A history of significant passive exposure to smoke may be a risk factor forneoplasia or an exacerbating factor for airway diseases such as chronicobstructive lung disease. A history of sleep-disordered breathing is typical in obese patients. The pathologic increase in the PaCO 2 partial pressure ofcarbon dioxide in the arterial blood modifies the strength of the historyreported by these patients.

Obese patients suffering from sleep disordersmay complain of early morning headache, daytime somnolence, and apnoea or shortness of breath during night-time. These disorders are alsoimportant as predictors of difficult intubation. Exposure to inhaled agents associated with lung disease is ascertained. Among these are inorganic dusts especially asbestos and silica and organic antigens especially antigens from moulds and animal proteins.

Asthma is often exacerbated by exposure to environment allergens oroccupational exposure. Exposure to infectious agents can be suggested in previously healthypeople having contact with individuals with known respiratory infections tuberculosis.

Healthy people travelling in specific areas of the world canbe exposed to pathogens. For an appropriate management plan, adetailed travel history is important. Immunisation status is evaluated in children and in the newborn or in adults with splenectomy.

Systemic rheumatic diseases such as rheumatoid arthritis aresometimes the cause of pleural and parenchymal lung diseases. These patientsmay need long-term non-invasive ventilation, perhaps via atracheostomy. The past surgical history should pay particular attention to all operationsperformed in the neck, throat and thorax of the patient. It is important toexclude lesions of the phrenic nerve after surgery in the cervical orthoracic region.

CoughCough is the most frequent of all respiratory symptoms. There are various typesof cough. Chronic cough is commonamong tobacco smokers, and can occur in asthmatics, in patients with gastrooesophagealreflux or on ACE inhibitors. Cough associated with inflammation ofthe pleura pleurisy is characteristically dry and short.

Here the act of coughingcauses pain owing to the movement of the inflamed pleura, and so the cough iscut short by the pain. Cough is accompanied by purulent sputum in bacterialinfections. SputumSputum varies in amount and character according to the nature and extent ofthe lung disease. Sometimes in the early stages of disease, sputum may beabsent and appears later when the lesion in the respiratory tract has progressed.

Yellow sputum usually indicates a large number of white cells and underlyinginfection. However, light yellow sputum might be seen in patients with asthmabecause of a high sputum eosinophil count. Green discolouration indicates3.

Bronchial carcinoma, pulmonary infarction, pulmonary tuberculosis,bronchiectasis and mitral stenosis are the most common causes of massivebleeding. DyspnoeaDyspnoea occurs as a symptom in a wide variety of lung and heart diseases. Itis defined as the subjective experience or perception of uncomfortablebreathing. It should be distinguished from hyperpnoea, where the minuteventilation is increased, but no abnormal sensation is felt, and tachypnoea, anexcessive respiratory rate.

CyanosisIn children, respiratory rate must be evaluated according to age. Cyanosis depends on the absolute amount of reduced haemoglobin in the blood. Peripheral cyanosis is due to a greater oxygen extraction by the tissues fromnormally saturated arterial blood normal SaO 2 when the circulation isimpaired by vasoconstriction or low cardiac output.

Central cyanosis is due tohaemoglobin desaturation low SaO 2 from poor gas exchange in the lungs, anabnormal haemoglobin derivative or the presence of a right to left shunt e. A combination of central and peripheral cyanosis mayoccur as, for example, in cardiogenic shock with pulmonary oedema.

Cyanosis is very difficult to see in anaemic patients, and in severe anaemiaeven marked arterial desaturations may not lead to the manifestation of cyanosis. Theadvice should be to always use pulse oximetry for correct diagnosis. Chest painChest pain caused by diseases of the respiratory system frequently originatesfrom involvement of the parietal pleura.

Chronic or recurrent chest pain mayreflect pulmonary vascular or pleural disorders. Physical examinationThe physical examination should be directed both to lung and thoracicabnormalities and to generalised findings that may reflect underlying lungdiseases. Normally the findings on physical examination of the chest areequivalent on both sides. Finger clubbingClubbing of the digits hypertrophic osteoarthropathy may be hereditary,idiopathic, occupational pneumatic hammer operators or can be found inassociation with: metastatic lung cancer, interstitial lung disease and chroniclung infections such as lung abscess and empyema.

The chestOn inspection, the rate and pattern of breathing, as well as the depth and symmetry of lung expansion, are examined. Breathing that is associated withthe use of accessory muscles indicates an increase in the work of breathing seeTask 3. A note should be made of the rate and characteristics of the breathingpattern, the type and severity of the cough and the amount and character of thesputum. Asymmetric expansion of the chest is always due to a localised processaffecting one or other lung e.

Thoracic abnormalities such as kyphoscoliosis and ankylosing spondylitis arerecorded on inspection because of the related decrease in total lung capacity and increase in the risk of pneumonia. Skeletal abnormalities such as an increase inthe antero-posterior diameter of the chest could be due to severe emphysema. Enlarged lymph nodes in the cervical and supraclavicular regions are evaluated,as they may be associated with several diseases, including cancer. Peripheraloedema lower extremities may be related to pulmonary vascular hypertension and right ventricular failure.

It is wise to consider pulmonary hypertension inevery patient with chronic respiratory failure. In patients with chronic respiratory failure, look for signs of cor pulmonale, inparticular raised jugular venous pressure, signs of tricuspid regurgitation TR , loud S2 and hepatomegaly.

If these signs are present, it is appropriate to perform atransthoracic echocardiogram to look at TR jet velocity and to estimate pulmonaryartery PA pressures.

On palpation, findings observed by inspection may be confirmed. Thesymmetry of lung expansion can be assessed. The chest wall should be carefullyexamined for soft tissue abnormalities such as cutaneous lesions, subcutaneousswelling or subcutaneous emphysema crepitation on palpation , bulging orretraction of intercostal spaces.

The consistency of lymph nodes is noted. By percussion the sound of a normal lung is resonant while the consolidatedlung or a pleural effusion is dull, and emphysema is hyperresonant.

On auscultation the quality and intensity of breath sounds are assessed usinga stethoscope. The categories of findings include normal breath sounds,decreased or absent breath sounds, and abnormal breath sounds.

Vesicular sounds are smooth, lowtone, and widespread over the thorax of normal patients. Vesicular sounds are louder and longer during inspiration than expiration. These sounds are generated by air movements in the bronchi modified by thegas content in terminal bronchioli and the alveoli. Reduced breath sounds mayreflect reduced airflow to a lung region due to its over-inflation e.

There are several types of abnormal breath sounds: rales, rhonchi and wheezes are the most common. Crackles rales are discontinuous, generallyinspiratory, clicking, bubbling or rattling sounds. They are believed to occurwhen air opens closed alveoli air spaces. Rhonchi are sounds that resemblesnoring. They are produced when air movement through the large airways isobstructed or turbulent.

Wheezing can sometimes be heard without a stethoscope. Pleuralfriction or rub is a diagnostic sign of pleural inflammation.

It is a grating orcreaking sound, unaltered by coughing, audible during both inspiration and expiration. Stridor is a specific sound, usually inspiratory, secondary toobstruction of upper airways. Some diseases that most commonly affect the respiratory system, such assarcoidosis, can have findings on physical examination not related to the respiratorysystem, including ocular findings uveitis, conjunctival granulomas and skin findings erythema nodosum.

Management plans and differential diagnosis should be formulated followingthe history taking, physical examination, and review of available laboratory data and lung imaging X-rays, computed tomography CT scan, ultrasound.

In your next ten patients, check the quality of your history taking and physical examination: how complete are they, how do you judge consistency? Ask acolleague to observe you while you take a history and perform a physical examination.

Promoting the 6Cs of nursing in patient assessment

Format: Virtual fully booked Dates: April , ESICM rewards your fidelity! If you have attended 5 or more master classes in Brussels or virtually during the past two years you can benefit from ONE free registration to any of the future master classes. The 2nd edition of the Haemodynamic Monitoring Master Class has just wrapped up. Here are some of their comments on what they liked best about their experience:.

PDF | Intensive Care Medicine (ICM) is a medical specialty where doctors from a Acute heporlc failure 'examination Respiratory monitoring.

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Skip to Main Content. A not-for-profit organization, IEEE is the world's largest technical professional organization dedicated to advancing technology for the benefit of humanity. Use of this web site signifies your agreement to the terms and conditions. Monitoring of Cigarette Smoking Using Wearable Sensors and Support Vector Machines Abstract: Cigarette smoking is a serious risk factor for cancer, cardiovascular, and pulmonary diseases. Current methods of monitoring of cigarette smoking habits rely on various forms of self-report that are prone to errors and under reporting.

Respiratory assessment and monitoring - PACT - ESICM

Background: Currently, there is no standardized approach for determining psychosocial readiness in pediatric transplantation. We examined the utility of the Psychosocial Assessment of Candidates for Transplantation PACT to identify pediatric kidney transplant recipients at risk for adverse clinical outcomes. PACT assessed candidates on a scale of 0 poor candidate to 4 excellent candidate in areas of social support, psychological health, lifestyle factors, and understanding.

Respiratory assessment and monitoring - PACT - ESICM

Mechanical ventilation , assisted ventilation or intermittent mandatory ventilation IMV , is the medical term for artificial ventilation where mechanical means are used to assist or replace spontaneous breathing. Mechanical ventilation is termed "invasive" if it involves any instrument inside the trachea through the mouth, such as an endotracheal tube , or the skin, such as a tracheostomy tube. The two main types of mechanical ventilation include positive pressure ventilation where air or another gas mix is pushed into the lungs through the airways, and negative pressure ventilation where air is usually, in essence, sucked into the lungs by stimulating movement of the chest. Apart from these two main types, there are many specific modes of mechanical ventilation , and their nomenclature has been revised over the decades as the technology has continually developed. Mechanical ventilation is indicated when the patient's spontaneous breathing is inadequate to maintain life. It is also indicated as prophylaxis for imminent collapse of other physiologic functions, or ineffective gas exchange in the lungs.

Swiftly rising inpatient admissions drew heavily on inpatient resources, and Pulmonary and Critical Care Medicine PCCM providers were immersed in frontline care. Infection control efforts reduced availability of post-acute and ambulatory rehabilitation centers; provider resources were reallocated to augment in-hospital rehabilitation programs and support safe discharges. Non-COVID research, outside of select clinical trials, was largely halted, and thus, clinical effort was expanded for many faculty members who traditionally serve in dual clinical and research roles. Potential ambulatory needs of COVID survivors were extrapolated from other viral respiratory diseases, including severe acute respiratory syndrome SARS coronavirus, Middle East respiratory syndrome MERS coronavirus, and influenza; 11 , 12 , 13 , 14 , 15 data are notably limited. Patients developing acute respiratory distress syndrome ARDS were anticipated to be at risk for long-term respiratory complications, 16 and there were emerging reports of potential complications in multiple organ systems. A key consideration was the provision of ongoing care to uninsured and underinsured patients and collaboration with language translation services, given the disproportionate burden of COVID in traditionally under-resourced populations. The procurement of a physical location for care delivery, which typically requires substantial justification within a formal business plan, can be a barrier to rapid implementation.

Haemodynamic Monitoring


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  • Camil C. 30.04.2021 at 23:53

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    Respiratory assessment and monitoring - PACT - ESICM. TRAININGRespiratory assessment andmonitoringSkills and techniquesUpdate (pdf)Module.


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