This is a draft cheat sheet. It is a work in progress and is not finished yet.
Introduction:
W |
Wash |
I |
Introduce Yourself + Patient's Identity |
P |
Permission to Proceed |
P |
Patient Position + Pain |
E |
Explain |
Patient Details:
Name: |
Age: |
Date of Birth: |
Gender: |
Presenting Complaint:
Cough: |
Timing, Exacerbation, Type |
Sputum: |
Onset, Amount, Colour, Smell + Taste |
Dyspnoea: |
Onset, Severity, Progression, Associated Symptoms |
Breath Sounds: |
• Stridor - Inspiratory, Upper Respiratory
• Wheeze - Expiratory, Lower Respiratory |
Pain: |
• Pleuritic Chest Pain - Sharp and worse on inspiration/coughing
• Muscular Pain - Following prolonged coughing |
Haemoptysis: |
Amount, Colour, Associated Symptoms |
Fever: |
Duration, Onset |
HAPPENED BEFORE? |
Sputum:
• Foul Smelling/Tasting = Anaerobic Infection
• Pink and Frothy/Foamy = Pulmonary Oedema
Medications:
Contraceptive Pill: |
Risk of DVT → PE |
ACE Inhibitor: |
Dry Cough - Could also be Interstitial Lung Disease |
Inhalers: |
Especially in Asthmatics - Has β-agonist use increased? |
Home Oxygen |
Cytotoxic Drugs: |
Methotrexate - ILD |
Past/Social History:
Smoking/Vaping: |
Current/Ex-, Pack Year Hx., When Stopped |
Occupational Exposures: |
• Coal - Coal Worker's Pneumoconiosis
• Silica - Silicosis
• Asbestos - Asbestosis
• Talc - Talcosis |
Allergic Alveolitis: |
• Bird Fancier's Lung
• Farmer's Lung (Aspergillus fumigatus) |
Alcohol Consumption: |
Aspiration Pneumonia |
IV Drug Use: |
Lung Abscess/Drug related Pulmonary Oedema |
Sexual History: |
HIV |
Family History: |
α1-antitrypsin deficiency |
Red Flag Symptoms:
F |
Fever |
L |
Lethargy |
A |
Anorexia |
W |
Weight Loss |
S |
Night Sweats |
Think of the following depending on red flag symptoms:
• Tumour
• Tuberculosis
• Infection
Differentials:
Cough: |
Acute: (<3 weeks)
• URTI
• LRTI (Pneumonia, Exacerbation of COPD)
• Inhaled Irritation (Smoke Fumes)
Chronic:
• COPD - Smoking
• Asthma
• GORD
• Bronchiectasis - Very Productive
• Carcinoma
• Cardiac Failure
|
Haemoptysis: |
• Bronchitis - Small Amounts
• Carcinoma - Frank Blood
• Bronchiectasis - Large amounts of sputum + blood
• Pneumonia - Fever, Recent Onset
• Pulmonary Infarct - Dyspnoea, pleuritic pain
• TB
• Foreign Body
|
Dyspnoea Onset: |
Seconds to Minutes:
• Asthma Attack
• PE
• Pneumothorax
• Anaphylaxis
Hours to Days:
• COPD Exacerbation
• Cardiac Failure
• Infection
• Pleural Effusion
• Metabolic Acidosis
Weeks:
• Pulmonary Fibrosis
• COPD
• Anaemia |
Always investigate other causes for Haemoptysis: Haematemesis and Nasopharyngeal Bleeding
Further Investigations:
Chest X-Ray |
Pulse Oximetry |
Lung Function Assessment: |
• Peak Flow Meter
• Spirometry
|
6-Minute Walking Test: |
Reduction in SpO2 >5% is abnormal |
Chest CT: |
Greater radiation dose |
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