Situation
A patient is very chesty pre operatively. What do you do ?
Exclude cardiac cause by clinical examination, CXR and echocardiography. Bronchoscopy
and washouts with culture to guide preoperative antibiotic therapy if sputum infected.
Nebulisers, physiotherapy and admission to the ward preoperatively to try and
enforce cessation of smoking. A prophylactic minitracheostomy post operatively
may also help.