Respiratory Exam

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Respiratory Exam

  1. 1. Respiratory examination pathways for clinical learning
  2. 2. History• Six principal symptoms• Dyspnoea• Wheeze• Cough• Sputum• Haemoptysis• Chest pain pathways for clinical learning
  3. 3. History• Acute or chronic• Preceding systemic disturbance• Past medical history• Drug history• Social history – smoking, pets• Family history• Occupational history – allergens/asbestos pathways for clinical learning
  4. 4. Physical examination• Look around• Hands, pulse, BP• Face & Neck• Chest examination – Inspect – Palpate – Percuss – Auscultate• Other bits pathways for clinical learning
  5. 5. Look around• Initial impression – Audible cough – Wheeze – Stridor – Hoarseness – Dyspnoea• O2, Nebs, Inhalers• TPR & Sputum sample pathways for clinical learning
  6. 6. Hands, pulse, BP• Perfusion• Peripheral cyanosis• Tremor• Flap – type II respiratory failure• Tar staining• Finger clubbing• Pulse• BP pathways for clinical learning
  7. 7. Face• Central cyanosis• Pursed lips pathways for clinical learning
  8. 8. Neck• Neck veins• Lymphadenopathy• Neck muscles• Trachea• Crepitus• Indrawing pathways for clinical learning
  9. 9. The Chest• Inspection• Palpation• Percussion• Auscultation pathways for clinical learning
  10. 10. Inspection• Shape• Scars• Lesions• Respiratory rate• Respiration depth• Abnormal movement – inspiration – expiration – asymmetry pectus carinatum excavatum pathways for clinical learning
  11. 11. Palpation• Chest expansion• Tactile vocal fremitus pathways for clinical learning
  12. 12. Percussion• Compare both sides• Map out abnormal area pathways for clinical learning
  13. 13. Percussion technique• Palm over chest wall• Middle finger strikes 2nd phalanx• Movement from wrist pathways for clinical learning
  14. 14. Percussion• Resonant - normal• Dull – no air – consolidation – collapse – pleural thickening• Stony dull – pleural effusion• Hyperresonant - pneumothorax pathways for clinical learning
  15. 15. Auscultation• Air entry• Vocal sounds – vesicular – bronchial• Added sounds – wheeze – crackles/creps – rub pathways for clinical learning
  16. 16. Breath Sounds• Vesicular – normal breath sounds with a “rustling quality”• Diminished - localised or diffuse – reduced airflow something between the chest wall and the lung• Bronchial – consolidation – altered quality with distinct inspiratory and expiratory phases pathways for clinical learning
  17. 17. Added sounds• Wheeze – musical notes – expiratory: mucosal oedema or spasm inspiratory: secretions or obstruction• Crackles – non-musical – inspiratory• Pleural sounds – rubs and clicks pathways for clinical learning
  18. 18. Vocal sounds• Vocal resonance• Increased – voice sounds are louder and more distinct e.g. consolidation• Reduced – transmission impeded e.g. effusion, collapse pathways for clinical learning
  19. 19. Information...• Type and amplitude of breath sounds• Type of added sounds and location• Quality of vocal sounds pathways for clinical learning
  20. 20. Auscultation technique• Diaphragm of stethoscope• Mouth open• Breathing deeply• Systematic approach – left and right – Anteriorly to 6th rib – Posteriorly to 8th rib• Vocal resonance: say “one one one” or “ninety nine” pathways for clinical learning
  21. 21. Other bits• Peak flow• Oedema• Pulsatile liver pathways for clinical learning
  22. 22. Interpretation of findings• Breath sounds – locally reduced or absent: pleural effusion, thickened pleura, collapsed area – diffusely reduced: emphysema, asthma• Wheeze: asthma, COPD• Crackles: Infection, LVF – localised in area of consolidation• Pleural rub: pleurisy, PTE pathways for clinical learning
  23. 23. Pleural effusionPleural effusion• Trachea deviated AWAY• reduced tactile vocal fremitus• reduced chest expansion• stony dull• reduced air entry• no added sounds• reduced vocal resonance pathways for clinical learning
  24. 24. ConsolidationConsolidation• increased tactile vocal fremitus• reduced expansion• dull percussion• bronchial breathing• coarse creps• increased vocal resonance• whispering pectoriloquy pathways for clinical learning
  25. 25. CollapseCollapse• deviated trachea TOWARDS• reduced tactile vocal fremitus• dull percussion• reduced air entry• +/- creps pathways for clinical learning
  26. 26. PneumothoraxPneumothorax• deviated trachea (tension) AWAY• reduced tactile vocal fremitus• hyper-resonance• reduced air entry• reduced vocal resonance pathways for clinical learning
  27. 27. Questions markmeded.blogspot.co.ukwww.slideshare.net/hallmarkie pathways for clinical learning

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