Breathlessness SMART
Breathlessness
1. Presenting condition (PC) = Increase SOB
2. History of presenting condition (HPC) = Gradual decline or sudden. Any changes or normal exercise tolerance. Sleep at night, does lying flat make it worse? What makes it better/worse?
3. Past Medical History (PMH)
4. Drug History
5. Social History – include smoking, family history ect.
6. Examination of patient
O – onset
L – Location
D – Duration
C – Character
A – Aggrevating
R – Relieving
T - Treatment
TAKING A HISTORY
Started with increase SOB, cough, fever, sweats, wheeze chest pain,
EXAMINATION OF PATIENT
Position of patient e.g. lying back, lying forward
Exhaustion - Difficulty in speaking in full sentences, talking in single words or unable to talk.
Upper airway nasal flaring
Central cyanosis resp rate, heart rate, BP, SPo2, temp intercorstal recession, chest wall shape and movement. Tracheal tug, stridor, Peak flow rate
Ankle oedema
Sputum – colour consistency.
Auscultation – Air entry, difference between lungs, right and left, apex and bases.
ASTHMA
Airflow limitation, usually reversible.
Hyperesponsiveness of airways.
Inflammation of bronchi.
Increase mucosal swelling with increase mucous and increased airway constriction.
PC – increased sob
HPC – started with a cough which developed increase sob and wheeze
PMH - ? known Asthma, allergies
DH - ? on nebulizers/inhalers
SH - ? Smoker, lives with other smokers, normal exercise tolerance if known asthmatic
Examination
1. Look at patients position and colour.chest wall shape & movement, intercostals recession. 2. Listen – wheeze 3. Measure – obs, peak flow, sputum colour and consistency
COPD
Chronic, progressive and irreversible, Exaserbations with or without infection , element of reversibility. Possible C0 2 retainers.
PC – increased SOB
HPC – started with a cough which developed into chest wheeze and tightness
PMH ? COPD ( inc previous exacerbations) normal levels of exercise tolerance.
DH – inhalers,
1. Presenting condition (PC) = Increase SOB
2. History of presenting condition (HPC) = Gradual decline or sudden. Any changes or normal exercise tolerance. Sleep at night, does lying flat make it worse? What makes it better/worse?
3. Past Medical History (PMH)
4. Drug History
5. Social History – include smoking, family history ect.
6. Examination of patient
O – onset
L – Location
D – Duration
C – Character
A – Aggrevating
R – Relieving
T - Treatment
TAKING A HISTORY
Started with increase SOB, cough, fever, sweats, wheeze chest pain,
EXAMINATION OF PATIENT
Position of patient e.g. lying back, lying forward
Exhaustion - Difficulty in speaking in full sentences, talking in single words or unable to talk.
Upper airway nasal flaring
Central cyanosis resp rate, heart rate, BP, SPo2, temp intercorstal recession, chest wall shape and movement. Tracheal tug, stridor, Peak flow rate
Ankle oedema
Sputum – colour consistency.
Auscultation – Air entry, difference between lungs, right and left, apex and bases.
ASTHMA
Airflow limitation, usually reversible.
Hyperesponsiveness of airways.
Inflammation of bronchi.
Increase mucosal swelling with increase mucous and increased airway constriction.
PC – increased sob
HPC – started with a cough which developed increase sob and wheeze
PMH - ? known Asthma, allergies
DH - ? on nebulizers/inhalers
SH - ? Smoker, lives with other smokers, normal exercise tolerance if known asthmatic
Examination
1. Look at patients position and colour.chest wall shape & movement, intercostals recession. 2. Listen – wheeze 3. Measure – obs, peak flow, sputum colour and consistency
COPD
Chronic, progressive and irreversible, Exaserbations with or without infection , element of reversibility. Possible C0 2 retainers.
PC – increased SOB
HPC – started with a cough which developed into chest wheeze and tightness
PMH ? COPD ( inc previous exacerbations) normal levels of exercise tolerance.
DH – inhalers,