2nd Edition

Respiratory
Notes
Respiratory Therapist’s Pocket Guide

Gary C. White, M.Ed., RRT, RPFT

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BASICS ASSESS PHARM PULM PROC AIR VENT NEO PEDS TOOLS
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Therapist’s Pocket Guide Diagnostic Reasoning
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 113
Obstructive Diseases 114
Restrictive Diseases 118
Neuromuscular Diseases 120
Infectious Diseases 127
Circulatory Diseases 131
Neoplastic Disease 134
Chest Trauma 135
Pediatric Diseases 138
Neonatal Diseases 140

PULM
 Obstructive Diseases
Bedside
Disease Etiology Assessment Laboratory Data Treatment
Chronic Smoking Tachypnea Arterial blood gases Antibiotics for
bronchitis history Accessory (ABGs): Compensated infections
Air pollution muscle use respiratory acidosis Sympathomimetic
Chronic Increased may be hypoxemic bronchodilators
infections anteroposterior Pulmonary function Inhaled

114
Gastric reflux (A-P) diameter tests (PFTs): corticosteroids
Cough/sputum Decreased FVC, FEV1, Bronchial hygiene
PULM

production FEV1/FVC, FEF25%–75%; O2 therapy for

Diminished Increased RV, FRC, hypoxemia
breath sounds RV/TLC Smoking cessation
Hyperresonance Chest radiograph: Pulmonary
on percussion Increased rehabilitation
radiolucency,
enlarged lung fields,
flattened diaphragms,
increased retrosternal
airspace
 Bedside
Disease Etiology Assessment Laboratory Data Treatment
Asthma Allergic Tachypnea ABGs: Acute (early) O2 therapy for
triggers Accessory respiratory alkalosis hypoxemia
Infections muscle use with hypoxemia IV corticosteroids (ER
Exercise or Prolonged Severe (late/status treatment)
cold air expiratory asthmaticus) Sympathomimetic
exposure phase respiratory acidosis bronchodilators
Gastric reflux Increased A-P with hypoxemia Inhaled
Air pollution diameter PFTs: Decreased FVC, corticosteroids
115

Cough/sputum FEV1, FEV1/FVC, PEFR, Bronchial hygiene

production FEF25%–75%; Increased Mechanical

PULM
Hyperresonance RV, FRC, RV/TLC ventilation for
on percussion Chest radiograph: respiratory failure
Diminished Increased retrosternal
breath sounds airspace,
and wheezing hyperinflation,
flattened diaphragms,
increased
radiolucency
Continued
 Bedside
Disease Etiology Assessment Laboratory Data Treatment
Emphysema Genetic Dyspnea ABGs: Compensated O2 therapy for
(alpha-1- Accessory respiratory acidosis hypoxemia
antiprotease muscle use with hypoxemia Bronchial hygiene
deficiency) Increased A-P PFTs: Decreased FVC, Sympathomimetic
Cigarette diameter FEV1, FEV1/FVC, bronchodilators

116
smoking Cough/sputum FEF25%–75%; Increased Antibiotics for
Occupational production RV, FRC, RV/TLC pulmonary
PULM

exposure Hyperresonance Chest radiograph: infections

Air pollution on percussion Hyperinflation, Prolastin replacement
Diminished flattened diaphragms, therapy for alpha-1
breath sounds, increased deficiency
wheezing, radiolucency, Pulmonary
crackles, and increased retrosternal rehabilitation
rhonchi airspace
 Bedside
Disease Etiology Assessment Laboratory Data Treatment
Cystic Genetic Dyspnea ABGs: Compensated O2 therapy for
fibrosis Accessory respiratory acidosis hypoxemia
muscle use with hypoxemia Bronchial hygiene
Increased A-P PFTs: Decreased FVC, Inhaled medications:
diameter FEV1, FEV1/FVC, • Bronchodilators
117

Digital clubbing FEF25%–75%; Increased • Corticosteroids

Cough/sputum RV, FRC, RV/TLC • Antibiotics

PULM
production Chest radiograph:
Diminished Hyperinflation,
breath sounds, flattened diaphragms,
wheezing, increased
crackles, and radiolucency,
rhonchi increased retrosternal
airspace
 Restrictive Diseases
Bedside
Disease Etiology Assessment Laboratory Data Treatment
Interstitial Inhalation of Dyspnea ABGs: Increased O2 therapy for
lung inorganic dusts Digital clubbing Pa-AO2, hypoxemia hypoxemia
disease Inhalation of organic Dull percussion PFTs: Decreased Inhaled medications

118
dusts note FVC, FEV1; Normal • Sympathomimetic
Drugs Bronchial breath or increased FEV1/ bronchodilators
PULM

(nitrofurantoin, sounds, FVC, FEF25%–75%, • Corticosteroids

aspirin, bleomycin, crackles, PEF; Decreased RV,
cyclophosphamide, wheezing FRC
methotrexate, Chest radiograph:
amiodarone, Patchy infiltrates,
heroin, methadone) granulomas,
Idiopathic pleural plaques, air
bronchograms