1. Respiratory System Assessing the Patient Part III
Diana Jones
Paramedic

2. General Assessment
A similar assessment is performed on all medical patients regardless of chief complaint
What differentiates the respiratory patient is the additional focus on this particular system
But remember not to develop tunnel vision, as the respiratory system is tied to other systems as well and concomitant treatment may be necessary

3. General Assessment
What is the nature of illness? i.e., chief complaint
Primary Survey – should be the same on all patients
General impression – how does this patient appear to you
Level of consciousness – AVPU
Apparent life threats – i.e., not breathing, severe hemorrhaging
Airway and breathing – this is a quick, initial survey, NOT a focused exam, questions you should ask yourself….Patent/self-maintained airway? Adequate rate? Supplemental oxygen needed?

4. General Assessment Primary survey continued
Circulation – Obviously, check for a pulse! What is their skin….color? temperature? condition?
History of Present Illness (HPI) – remember your mnemonics…OPQRST and any additional questions needed to clarify
Past Medical History (PMHx) – here’s another mnemonic…SAMPLE
Include a baseline set of vital signs

5. General Assessment
Remember that much of the Primary Survey can be done simultaneously
Upon meeting the patient, you are beginning the assessment
Is patient answering questions appropriately? (LOC)
Can they answer in full sentences? (ease/difficulty of breathing)
Feel their pulse while talking (you can’t count a rate and have a conversation at the same time, but you should be able to quickly tell…too fast? too slow? and how does their skin feel? cold? hot? wet? dry?

6. Secondary Assessment Now it is time to focus on a particular system
For the respiratory patient there are additional questions you should be asking and physical exams you should be performing
You already have HPI and PMHx, so we’ll continue from there

7. Secondary Assessment
Pertinent Negatives – something you would expect based on chief complaint and it is absent, c/o difficulty breathing/SOB and patient is not in tripod position
Additional questions – chest pain? (pleuritic vs. cardiac) productive cough? (color of sputum)
Additional physical exam should assess - edema? JVD? accessory muscle use? retractions? nasal flaring? pursed lip breathing?
Auscultation of breath sounds – compare bilaterally each field before assessing a different field – eupneic, wheezing, crackles, rhonchi, rales, stridor

8. Secondary Assessment Points for clarification
Pleuritic vs. cardiac chest pain – only with deep inspiration? point tenderness? reproducibility?
Auscultation of breath sounds – be sure to listen in each field during entire cycle (inspiration through end of expiration)

9. Part IV will cover respiratory diseases and management
Now What?
You’ve assessed your patient, so what comes next?
Differential Diagnosis – distinguishing of disease or condition from others presenting with similar signs and symptoms (Merriam-Webster)
Management
Part IV will cover respiratory diseases and management

10. Questions?