Lesson 1Focused respiratory exam: breath sounds, work of breathing, accessory muscle use, pulse oximetry, end-tidal CO2 interpretation, and peak flow when feasibleOffers a structured respiratory examination for complex patients, including inspection, palpation, and auscultation. Prioritises work of breathing, accessory muscle employment, pulse oximetry, EtCO2 waveform analysis, and peak flow where practical and secure.
Assessing respiratory rate, pattern, and effortInspection for accessory muscle use and postureSystematic lung auscultation and key findingsPulse oximetry limits and artefact recognitionEtCO2 values and waveform interpretation in COPDUsing peak flow to gauge obstruction severityLesson 2Airway escalation: when to use BVM, supraglottic airway, or perform RSI—drug selections, preoxygenation, and rapid sequence technique in respiratory failureSpecifies when to advance from basic airway actions to BVM, supraglottic airway, or RSI in respiratory failure. Reviews preoxygenation, drug choice, dosing, and rapid sequence method, with focus on COPD and overdose physiology.
Indicators for BVM support and optimisationChoosing and placing supraglottic airwaysWhen to proceed to RSI in respiratory failurePreoxygenation strategies in COPD and obesitySedative and paralytic choices and dosingPost-intubation ventilation and confirmationLesson 3Rapid history and scene clues: medication lists, smoke/odour, witness accounts, and assessment of mental statusFocuses on securing a swift, aimed history and utilising scene hints to detect COPD, overdose, or combined pathology. Encompasses medication inventories, pill containers, smells, equipment, witness narratives, and mental state to direct initial treatment choices.
Primary survey and immediate life threatsKey questions for bystanders and caregiversInterpreting medication lists and pill bottlesEnvironmental clues: smoke, chemicals, paraphernaliaAssessing baseline versus new mental status changeIntegrating scene clues into working diagnosisLesson 4Monitoring and transport considerations: ventilator vs spontaneous breathing, continuous capnography, and pre-notification of receiving facilityTackles monitoring and transport planning for ventilated and naturally breathing patients. Discusses ongoing capnography, ventilator against BVM aid, positioning, destination selection, and pre-notification to ready the receiving facility.
Continuous SpO2 and EtCO2 during transportManaging patients on transport ventilatorsWhen to use BVM versus spontaneous breathingPositioning and securing airway and tubingChoosing destination and level of receiving careEffective pre-notification and handoff reportsLesson 5Naloxone use for suspected opioid overdose: dosing strategies, routes (IV/IM/IN), titration to avoid acute withdrawal, and monitoringReviews naloxone pharmacology, indications, and contraindications in suspected opioid overdose with respiratory suppression. Covers IV, IM, and IN paths, dosing approaches, titration to sufficient breathing, and surveillance for recurrence or withdrawal.
Recognising opioid toxidrome in the fieldNaloxone mechanism, onset, and durationChoosing IV, IM, or IN route for naloxoneInitial dosing and careful titration strategiesManaging acute withdrawal and agitation risksPost-reversal monitoring and transport needsLesson 6Differentiating COPD exacerbation, cardiogenic pulmonary oedema, aspiration, and opioid/sedative overdose—key exam and device findingsDetails distinguishing COPD exacerbation, cardiogenic pulmonary oedema, aspiration, and opioid or sedative overdose. Prioritises targeted exam, lung sounds, mental state, and device information like EtCO2, oximetry, and ECG results.
Typical history and triggers in COPD exacerbationSigns of cardiogenic pulmonary oedema in the fieldClues to aspiration and airway contaminationRecognising opioid and sedative overdose patternsUsing lung sounds, EtCO2, and SpO2 to differentiateRole of ECG, blood pressure, and jugular veinsLesson 7Bronchodilator therapy: beta-agonists, anticholinergics, dosing, routes, and nebuliser vs MDI considerationsCovers bronchodilator choices for COPD and asthma crossover in respiratory failure. Reviews beta-agonists and anticholinergics, indications, contraindications, dosing, and paths, plus practical variances between nebulisers and MDIs with spacers.
Short-acting beta-agonists: agents and dosingAnticholinergic bronchodilators and combinationsNebuliser setup, flow rates, and timingMDI with spacer: technique and coachingAdverse effects and monitoring during treatmentWhen to repeat or escalate bronchodilator therapyLesson 8Oxygen and ventilation strategies: titration targets for COPD, indications for high-flow nasal cannula, NIV (CPAP/BiPAP) settings and contraindicationsCovers oxygen titration aims in COPD, choice of delivery devices, and criteria for high-flow nasal cannula and NIV. Reviews CPAP/BiPAP setup, starting settings, fault-finding, and chief contraindications in unstable patients.
SpO2 and PaO2 targets in COPD and CO2 retainersChoosing nasal cannula, mask, or Venturi devicesIndications and setup for high-flow nasal cannulaInitiating CPAP and BiPAP: starting pressuresContraindications and complications of NIV useTroubleshooting mask leaks and patient intoleranceLesson 9Adjunct medical therapy: systemic corticosteroids (dosing and timing), magnesium, and diuretics for suspected cardiogenic pulmonary oedemaInvestigates indications, dosing, and timing of systemic corticosteroids and magnesium in COPD or asthma crossover. Reviews diuretic choice and dosing for suspected cardiogenic pulmonary oedema, including contraindications and monitoring requirements.
Indications for systemic corticosteroids in COPDCommon steroid agents, doses, and onset timesUse of IV magnesium in severe bronchospasmRecognising cardiogenic pulmonary oedema in the fieldDiuretic choices, dosing, and contraindicationsMonitoring response and adverse medication effects
