When a patient has a changing respiratory status, and is in Respiratory Distress, notifying the provider is required. When making the call, you will need to provide several data points to determine what treatment will be necessary. Being prepared is key to helping this patient, and is providing advanced care! The following is a list of what is needed, and we call it The Respiratory Package.
Advanced Care of Acute Changes
Respiratory Distress
STEP 1 Assess Patient and Gather Information – Gather Respiratory Package
Respiratory Package
Surgical information – reason for admission/surgery
Vital Signs – SaO2, O2 settings, Heart Rate/Rhythm/Blood Pressure
Symptoms – change in mentation, chest pressure, dizziness, etc.
Mild – RR 15-20, able to speak full sentences
Moderate – RR 20-30, speak in broken sentences, use of accessory muscles, orthopnea, forward leaning
Severe – RR 30+, one-word sentences, altered mental status, diaphoretic
Lungs – wheezing/rales/absent on left, etc
I/O’s – recent and 24hr, what IVF/boluses received last 24hrs
Chest Tube status – suction, air leak (small or large), drainage, clamped? not kinked
Recent Imaging
Inhalers/Nebs – times given?
Medications/drips times given, and home doses
Is Pulmonology team already involved, and any other relevant findings/information
STEP 2 Communication – Send Telemediq page to team
Template for the Telemediq page (adapt text in red to your patient)
Patient in ____ is tachypneic, mild/mod/severe respiratory distress, currently on O2 at __L, current vitals are, please call back at ____-_____.
Template for the Conversation (adapt text in red to your patient)
This is _______ calling about patient _______ in room_____ who is __y/o admitted with and is postop day __ from a left robotic upper lobectomy is having a sudden/gradual decline in respiratory status
Pt is on O2 at 6L and appears to be in moderate distress with RR of 25, speaking in broken sentences, with increased work of breathing.
HR is 100, sinus, and BP is 156/88
On exam pt is wheezing, and diaphoretic.
Last 24 I/O’s were 2.1L/1.8L – is receiving IVF LR at 150cc/hr, and had 2x500cc boluses last 24hrs.
Pt has no recent CXR and is ordered duonebs q6hr prn, and last treatment was 24hrs ago.
Pt has a history of COPD, and is not being seen pulmonology.
STEP 3 Follow up – As needed, communicate any further changes
Template for follow up Telemediq page
Patient name in _____ heart rate is now ____ and is up to ___L O2, is showing no improvement etc.
Call back number is ____-_____