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What are the 3 steps to solving each problem encountered while completing a clinical simulation? -first you will be asked to assess a patient with a respiratory or respiratory related problem -second you will need to study the information and determine the primary problem -third you must decide what type of therapy or response will be the best for the problem What are the 4 obstructive diseases? Emphysema Chronic bronchitis Bronchiectasis Sleep disorders What are the 5 traumas in respiratory? Chest trauma/Flail chest Pneumothorax Hemothorax Thermal Injuries ARDS What are the 5 Neurologic/Neurosurgical pathologies? Myasthenia Gravis Guillian-Barre Syndrome Drug Overdose Stroke CVA/TIA Poliomyelitis/ Tetanus/ Muscular dystrophy/ ALS What are the 7 Cardiovascular pathologies? Chest pain/ myocardial infarction CHF/Pulmonary edema Arrhythmias Shock Cor Pulmonale Pulmonary embolism Peripheral Vascular disease What are the 6 pediatric pathologies? Croup Epiglottitis Pediatric Poisoning/Toxic substance ingestion Cystic fibrosis bronchiolitis Foreign body obstruction What are the 8 neonatal pathologies? Delivery room care Apnea of prematurity Meconium Aspiration Congenital Heart defects IRDS Bronchopulmonary dysplasia Transient tachypnea of the newborn Congenital Diaphragmatic Hernia What are the general medical/surgical pathologies? Asthma (adult and pediatric) Exposure/Accidental Hypothermia Infectious Disease/ Pneumonia Near Drowning Diabetes/Renal Failure AIDS Thoracic Surgery Head Trauma/surgery Neck/spinal injury/surgery Abdominal surgery Laryngectomy What are the main things to look for in a visual assessment? General appearance Appearance of the chest Respiratory pattern/rate sensorium Posture Patient color What is the information obtained in the interview at the bedside assessment? Symptoms History of present illness Medical history Family history Advanced directives (DNR) What information is obtained at the bedside through palpation/percussion? Pulse Tracheal Shift Diagnostic Chest Percussion Temperature What information is obtained at the bedside through auscultation? Breath sounds Blood pressure Bowel Sounds Heart Sounds What information is obtained at the bedside through non invasive monitoring? Capnography Oximetry ECG Monitor Transcutaneous Monitoring What are the "other" assessments obtained at the bedside? Reflexes (pupil, gag, trans-tracheal, Babinski etc) Range of motion Capillary refill Hemodynamic monitoring What are the basic lab tests? Arterial Blood gases CBC 12 lead electrocardiogram electrolytes Chest x ray What are the special laboratory tests? Sputum Culture and sensitivity Urinalysis Blood Culture What are the special pulmonary tests? Volumes Flowrates Pre-post bronchodilators What are the special tests for image studies? CT scan MRI Lateral Neck Angiograms PET scans Lateral Decubitus What are the special tests for cardiopulmonary function? Bronchoscopy Stress Test Echocardiogram What are the special tests for hemodynamic monitoring? Arterial lines Pulmonary Artery line (swans-ganz) Intracranial Pressure (ICP) What are the "other" special diagnostic tests? Sweat chloride V/Q scan Elisa Test (AIDS) Edrophonium Test Apgar Score Cardiac Enzymes Polysomnography Glascow Coma Scale What is used to provide Oxygen therapy? FiO2 Equipment What is used to provide hyperinflation therapy? Incentive spirometry/Lung expansion therapy IPPB What is used for mechanical ventilation? Tidal volume/pressure Rate FiO2 PEEP/CPAP SIMV or assist control Other Modes (APRV, IRV, PRVC, HFV, NPPV, etc ) Weaning Protocols and procedures What is used for airway management? Intubation/Extubation Suctioning Bronchopulmonary Hygiene What is the tools used in aerosol therapy? Heated Aerosol Medication Nebulizers MDI (Metered Dose inhaler) DPI (dry powder inhaler) What is used in the treatment or management of rehab/homecare? Equipment Procedures What are the pharmacologicals used in the treatment or management of respiratory system? Bronchodilators Cardiovascular drugs Steroids/ decongestants Antibiotics/Antivirals Mucolytics /Wetting agent Sedation/ Pain medication Cholinergics (anticholinergics) Surfactant drugs Paralyzing agents Diuretics Specialized Drugs (Nicotine patch, Pulmonary vasodilators, respiratory stimulants, Surfactant Replacement therapy) What are the two types of COPD problems on the clinsim? Conservative Critical Care Define COPD chronic obstructive pulmonary disease is a preventable and treatable disease state characterized by air flow limitation that is not fully reversible Define emphysema pathologically is the presence of permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis. Define chronic bronchitis clinically is a chronic productive cough for three months in each of two successive years in a patient for whom other causes of the productive cough have been excluded. True or False? In COPD both Chronic bronchitis and emphysema symptoms may be present? True What are the predisposing factors for COPD/Emphysema? Tobacco Smoke Genetic Predisposition Indoor or outdoor air pollution What is the description often used to describe a Type A COPD patient? Pink Puffer What is the description often used to describe a patient with Type B COPD with chronic bronchitis? Blue Bloater What is the general appearance of the body of a patient with Type A COPD (emphysema)? Thin, underweight What is the body build of the typical patient with Type B COPD (chronic bronchitis)? Stocky overweight What is the past medical history usually seen in patients with type A and Type B COPD and chronic bronchitis? Tobacco use