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DIRECT REFERRAL (SPUTUM (HAEMOPTYSIS (BROKEN CAPILLARY (Symptom of serious…

- - - - Urgent
        
        CURB score of 3 or more
      - Oxygen saturation below 94%
      - Consider
        
        CURB score of 1 or 2
    - - Coloured mucoid sputum
      - Rust-coloured sputum
        
        Characteristic of pneumococcal (lobar) pneumonia
        
        High fever
        
        Sweats
  - - - White, grey or clear with black particles
    - - Sputum turns yellow or green
  - - - Clear, thin sputum
        
        Result of pulmonary oedema
      - Patient wakes in middle of night
        
        Shortness of breath
  - - - Caused by coughing
      - Harmless
      - Symptom of serious disease
        
        Lung cancer
        
        TB
    - - Blood coughed up after
      - Harmless
- - - - No audible wheeze
  - - - Heart failure
- - - - Upper front part of the chest
        
        Sore in early stages
      - Cause inflammation
        
        Trachea
        
        Tracheitis
      - Flu-like infections
        
        Non-specific muscular pain
        
        Myalgia
    - - Knife-like pain
      - Localised pain
      - Aggravated by
        
        Taking a breath or coughing
      - Caused by
        
        Respiratory infection
        
        Possibly underlying pneumonia
    - - Less common
      - Blood clot in pulmonary artery after travelling from elsewhere
    - - Pain similar to pleurisy
      - Following coughing
    - - Less common
      - Small leak in lung
        
        Lung collapses
    - - Following
        
        Violent coughing
        
        Injury
  - - - Acid contents of the stomach
        
        Leaks back into the oesophagus
        
        Gullet
      - Burning sensation
        
        Spreads upwards towards
        
        Throat
        
        Severe as to mimic cardiac pain
    - - Tight, gripping,vice-like, dull pain
        
        Centrally
        
        Across the front of the chest
        
        Move down one or both arms
        
        Sometimes neck
      - Angina
        
        Pain
        
        Brought on by exercise
        
        Relieved by rest
      - Heart attack / myocardial infarction
        
        Pain
        
        Come on at rest
        
        Similar to angina
        
        More severe & prolonged
    - - Common cause
      - Pain
        
        Result of hyperventilation
        
        May not be obvious
- - - - Rate of breathing too high for bodily requirements
      - Harmless
      - Caused by anxiety
      - Numbness
  - - - Present gradually or as an emergency
        
        Congestive heart failure
        
        Breathlessness on exertion
        
        Associated with ankle oedema
        
        Most common in elderly
      - Acute left ventricular failure
        
        Severe breathlessness
        
        Cough present
        
        Clear frothy sputum
  - - - GP refer to specialist
        
        CHILDREN
        
        Nasal polyps
        
        Swelling of normal nasal lining
        
        Family history of unusual chest disease
        
        Persistent wet or productive cough
        
        Severe URTI
        
        Excessive vomiting or posseting (babies)
        
        Unexplained clinical findings
        
        Inspiratory stridor
        
        Dysphagia
        
        Abnormal voice or cry
        
        Focal signs
        
        Failure to thrive
        
        ADULTS
        
        Marked blood eosinophilia
        
        Chest x-ray shadowing
        
        Unexplained restrictive spirometry
        
        Chronic sputum production
        
        Persistent non-variable breathlessness
        
        Unexpected clinical findings
        
        Crackles
        
        Monophonic wheeze or stridor
        
        Clubbing
        
        Cardiac disease
        
        Cyanosis
        
        Weight loss
        
        Fever
        
        Myalgia
      - Pharmacist refer to GP
        
        Associated with wheeze
        
        Recurrent nocturnal cough
        
        Between attacks
        
        Normal breathing
        
        Attacks
        
        Precipitated by
        
        Viral infections
        
        Colds
        
        Allergens
    - - GP refer to specialist
        
        Haemoptysis
        
        Dysfunctional breathing
        
        Rapid decline in FEV1
        
        Bullous lung disease
        
        Cor pulmonale
        
        Suspected severe COPD
        
        Frequent infectios
      - Caused by cigarette smoking
      - Permanent breathlessness
        
        With productive cough
      - Worsens due to infection
        
        Increase in coloured sputum production