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The Valley Hospital
MICU Department
Standards of Care
Respiratory Assessment
:
1.
Full set of ALS vitals (BP, pulse, respirations)
2.
Obtain a 12 lead ECG as applicable and necessary.
3.
Auscultate bilateral lung sounds
4.
Document degree of distress (accessory muscle usage, level of distress)
5.
Pulse oximetry reading; preferably pre and post-treatment
6.
Assess skin color, temperature and moisture
7.
Assess JVD
8.
Ascertain past medical history, medications and allergies
Intubation: (Subsection of above)
1.
Utilize 3-3-2 rule to ascertain feasibility of intubation
2.
Obtain and document end-tidal CO2 readings and waveforms for intubated patients
3.
A minimum of two end-tidal CO2 readings and wave-form is required
a.
First: when endotracheal intubation is completed and confirmed
b.
Second and subsequent: any time the patient is moved during transport including
movement to the Emergency Department stretcher (mandatory)
4.
Document the confirmation steps taken to confirm the endotracheal tube placement
which includes:
a.
Presence of bilateral breath sounds and chest rise
b.
Absence of epigastric sounds
c.
Direct visualization of vocal cords
d.
End-tidal CO2 readings and waveform