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Dr Katie Dumble
eview the respiratory examination
ommon respiratory findings
ommon x-rays
lood gases
ntroduction
ermission
ash hands
osition – patient at 45 degrees
xposure – remove clothing from upper body
ain – patient co...
http://knol.google.com/k/-/-/UtI7gr91/rIGkBA/clubb
ing2small.JPG
http://cancergrace.org/lung/files/2009/0
2/clubbing.jpg
h...
http://knol.google.com/k/-/-/UtI7gr91/rIGkBA/clubb
ing2small.JPG
http://cancergrace.org/lung/files/2009/0
2/clubbing.jpg
h...
eripheral stigmata of respiratory disease:
– peripheral cyanosis
– anaemia
– Clubbing
–Tar (not nicotine) staining
– wasti...
eripheral stigmata of respiratory disease:
– peripheral cyanosis
– anaemia
– clubbing
– Tar (not nicotine) staining
– wast...
Miosis
Anhydrosis
Ptosis
Associated with
Pancoast’s
Tumour
- tumour in apical
area of lung
eroding T1 root.
Horner’s Syndr...
http://www.unige.ch/cyberdocuments/thes
es2002/MeiriSD/these_body.html
http://www.unige.ch/cyberdocuments/thes
es2002/MeiriSD/these_body.html
Autoimmune connective
tissue disease
Features:
•Tot...
lood pressure
VP
arotid pulse to assess pulse volume – may be bounding
in CO2 retention or sepsis.
yes:
– Anaemia
– Horner...
ymmetry- Get patient to take deep breath in and out
cars- Tracheotomy, Thoracotomy (lift arms up), Midline
sternotomy
http...
ymmetry- Get patient to take deep breath in and out
cars- Tracheotomy, Thoracotomy (lift arms up), Midline
sternotomy
hest...
Chronic
hyperinflation
e.g.
Asthma
COPD
http://www.wrongdiagnosis.com/bookimages/16/5373.1.png
http://samtah.net/vb/uploaded/5481_0122068
2920.jpg
K. Kenigsberg, MD.
http://emedicine.medscape.com/article/
1003047-media
PECTUS EXCAVATUM
evelopmental defect
ay restrict ventilatory capacity
PECTUS CARINATUM
yperinflation whilst still
developi...
ymmetry- Get patient to take deep breath in and out
cars- Tracheotomy, Thoracotomy (lift arms up), Midline
sternotomy
hest...
alpation:
– Apex beat
– Chest expansion
ercussion
uscultation
– Breath sounds- loud/quiet, wheeze, crackles
– Vocal resona...
nspection
– scars
– sacral oedema
– deformity
alpation
– chest expansion
ercussion
uscultation
– Breath sounds
o conclude my examination I would like to:
– Look at observations chart
– Check any sputum pots
– Peak flow or bedside spi...
heeze- due to partial obstruction of airway
 Polyphonic (asthma or COPD- multiple airways)
 Monophonic (e.g tumour parti...
Position
of trachea
Percussion
Note
Breath
Sounds
Vocal
resonance
Likely
diagnosis
Central Stony Dull ↓ ↓↓
Central Dull Br...
Position
of trachea
Percussion
Note
Breath
Sounds
Vocal
resonance
Likely
diagnosis
Central Stony Dull ↓ ↓↓ Pleural effusio...
4yr old man
day history of progressively worsening SOB,
wheeze and productive cough with thick yellow
sputum
ife says he h...
atient has had COPD for 10years, has 3 chest
infections a year on average. Does not use
home oxygen but has nebulisers at ...
ncreased work of breathing, accessory muscles
used.
arm sweaty hands
achycardic bounding pulse. RR 28
yperinflated barrel ...
hat investigations would you do?
loods - Hb 10.1, WCC 15, Neut 11.7, CRP 121, Urea
8.1, Cr 129, Na 138, K 4.3, normal LFTs.
XR- hyperinflation, consolidati...
H 7.41 (7.35-7.45)
O2 9.0 (11-14)
CO2 8.3 (4.7-6.0)
CO3 33 (22-28)
H 7.41 (7.35-7.45) pH normal
O2 7.5 (11-14) Hypoxic
CO2 8.3 (4.7-6.0) High
CO3 33 (22-28) High
xacerbation of COPD.
ype 2 respiratory failure.
anagement?
Severity – Confusion, hypotension, low O2
all bad signs- Severe exacerbation of
COPD.
im
→Treat hypoxia, bronchospasm and ...
BC
xygen - Venturi mask. Aim for oxygen greater
than 8. If concerned about hypoxia give high
flow oxygen initially then sw...
Confusion (New AMT<8)
Urea >7mmol/L
Respiratory rate >30
BP <90mmHg systolic or 60mmHg diastolic
5 Age 65yrs or over
0.7%
3.2%
13.0%
17.0%
41.5%
57.0%
Therefore use score in
management:
0-1 Outpatient Care
2 Inpatient – short stay
3 Inpati...
lick, confident examination = pass finals Practice!→
lues before even touch patient
now basic findings for common respirat...
– Notes, Powerpoints, Videos, Podcasts and Practice
Questions. Community based so can share
information. Free.
astest or O...
Respiratory System
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Respiratory System

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Respiratory System

  1. 1. Dr Katie Dumble
  2. 2. eview the respiratory examination ommon respiratory findings ommon x-rays lood gases
  3. 3. ntroduction ermission ash hands osition – patient at 45 degrees xposure – remove clothing from upper body ain – patient comfortable? In any pain? ight – ensure lighting is adequate.
  4. 4. http://knol.google.com/k/-/-/UtI7gr91/rIGkBA/clubb ing2small.JPG http://cancergrace.org/lung/files/2009/0 2/clubbing.jpg http://tobacco.mededu.miami.edu/tobacco/studyPlan/slides/31-smoker%27s %20teeth%20and%20hands.jpg
  5. 5. http://knol.google.com/k/-/-/UtI7gr91/rIGkBA/clubb ing2small.JPG http://cancergrace.org/lung/files/2009/0 2/clubbing.jpg http://tobacco.mededu.miami.edu/tobacco/studyPlan/slides/31-smoker%27s %20teeth%20and%20hands.jpg Clubbing and peripheral cyanosis Clubbing Tar staining
  6. 6. eripheral stigmata of respiratory disease: – peripheral cyanosis – anaemia – Clubbing –Tar (not nicotine) staining – wasting of muscles of back of hand
  7. 7. eripheral stigmata of respiratory disease: – peripheral cyanosis – anaemia – clubbing – Tar (not nicotine) staining – wasting of muscles of back of hand – particularly between thumb and index finger – apical tumour e.g. pancoast’s tumour – erodes into brachial plexus (affects innnervation of muscles). ulse espiratory rate
  8. 8. Miosis Anhydrosis Ptosis Associated with Pancoast’s Tumour - tumour in apical area of lung eroding T1 root. Horner’s Syndrome
  9. 9. http://www.unige.ch/cyberdocuments/thes es2002/MeiriSD/these_body.html
  10. 10. http://www.unige.ch/cyberdocuments/thes es2002/MeiriSD/these_body.html Autoimmune connective tissue disease Features: •Total elimination of the facial expression •Telengiectasia •Pointy nose •Microstomia •Claw like hands Associated with Interstitial lung disease - organ fibrosis
  11. 11. lood pressure VP arotid pulse to assess pulse volume – may be bounding in CO2 retention or sepsis. yes: – Anaemia – Horner’s syndrome ose : if really thin and skin tight over it think systemic sclerosis
  12. 12. ymmetry- Get patient to take deep breath in and out cars- Tracheotomy, Thoracotomy (lift arms up), Midline sternotomy http://www.blebinfo.co.uk/media/use rimages/CIMG0779.jpg
  13. 13. ymmetry- Get patient to take deep breath in and out cars- Tracheotomy, Thoracotomy (lift arms up), Midline sternotomy hest deformity-
  14. 14. Chronic hyperinflation e.g. Asthma COPD http://www.wrongdiagnosis.com/bookimages/16/5373.1.png
  15. 15. http://samtah.net/vb/uploaded/5481_0122068 2920.jpg K. Kenigsberg, MD. http://emedicine.medscape.com/article/ 1003047-media
  16. 16. PECTUS EXCAVATUM evelopmental defect ay restrict ventilatory capacity PECTUS CARINATUM yperinflation whilst still developing, e.g asthma http://samtah.net/vb/uploaded/5481_0122068 2920.jpg K. Kenigsberg, MD. http://emedicine.medscape.com/article/ 1003047-media
  17. 17. ymmetry- Get patient to take deep breath in and out cars- Tracheotomy, Thoracotomy (lift arms up), Midline sternotomy hest deformity- – Barrel Chest – Pectus Carinatum – Pectus Excavatum – Kyphosis or scoliosis- restrictive ventilatory defect – Harrison’s sulcus- poorly controlled asthma, rickets
  18. 18. alpation: – Apex beat – Chest expansion ercussion uscultation – Breath sounds- loud/quiet, wheeze, crackles – Vocal resonance – Where all of above are most/least audible and stage of breath cycle hear.
  19. 19. nspection – scars – sacral oedema – deformity alpation – chest expansion ercussion uscultation – Breath sounds
  20. 20. o conclude my examination I would like to: – Look at observations chart – Check any sputum pots – Peak flow or bedside spirometry – Look at any blood results, lung function tests, CXRs, ABGs that have been done – May want to test urine for Legionella antigen. hank patient. ash hands
  21. 21. heeze- due to partial obstruction of airway  Polyphonic (asthma or COPD- multiple airways)  Monophonic (e.g tumour partially blocking single airway) iming of crackles-  Early inspiratory= consolidation  Mid inspiratory = fibrosis
  22. 22. Position of trachea Percussion Note Breath Sounds Vocal resonance Likely diagnosis Central Stony Dull ↓ ↓↓ Central Dull Bronchial ↑ Towards Dull ↓ ↓ Central Hyper- resonant ↓ ↓ Away Hyper- resonant ↓↓ ↓
  23. 23. Position of trachea Percussion Note Breath Sounds Vocal resonance Likely diagnosis Central Stony Dull ↓ ↓↓ Pleural effusion Central Dull Bronchial ↑ Lobar Pneumonia Towards Dull ↓ ↓ Lung collapse Central Hyper- resonant ↓ ↓ Pneumothorax Away Hyper- resonant ↓↓ ↓ Tension pneumothorax
  24. 24. 4yr old man day history of progressively worsening SOB, wheeze and productive cough with thick yellow sputum ife says he has also been slightly muddled over last 2 days.
  25. 25. atient has had COPD for 10years, has 3 chest infections a year on average. Does not use home oxygen but has nebulisers at home. Gets SOB on walking 20yards normally. x smoker
  26. 26. ncreased work of breathing, accessory muscles used. arm sweaty hands achycardic bounding pulse. RR 28 yperinflated barrel chest
  27. 27. hat investigations would you do?
  28. 28. loods - Hb 10.1, WCC 15, Neut 11.7, CRP 121, Urea 8.1, Cr 129, Na 138, K 4.3, normal LFTs. XR- hyperinflation, consolidation lower zones putum culture lood culture
  29. 29. H 7.41 (7.35-7.45) O2 9.0 (11-14) CO2 8.3 (4.7-6.0) CO3 33 (22-28)
  30. 30. H 7.41 (7.35-7.45) pH normal O2 7.5 (11-14) Hypoxic CO2 8.3 (4.7-6.0) High CO3 33 (22-28) High
  31. 31. xacerbation of COPD. ype 2 respiratory failure.
  32. 32. anagement?
  33. 33. Severity – Confusion, hypotension, low O2 all bad signs- Severe exacerbation of COPD. im →Treat hypoxia, bronchospasm and infection.
  34. 34. BC xygen - Venturi mask. Aim for oxygen greater than 8. If concerned about hypoxia give high flow oxygen initially then switch. Do repeat ABGs V Fluids ntibiotics
  35. 35. Confusion (New AMT<8) Urea >7mmol/L Respiratory rate >30 BP <90mmHg systolic or 60mmHg diastolic 5 Age 65yrs or over
  36. 36. 0.7% 3.2% 13.0% 17.0% 41.5% 57.0% Therefore use score in management: 0-1 Outpatient Care 2 Inpatient – short stay 3 Inpatient- close monitoring, may require help with ventilation.
  37. 37. lick, confident examination = pass finals Practice!→ lues before even touch patient now basic findings for common respiratory conditions. nvestigations for common respiratory conditions- easy ones first. anagement- logical order, know why you are requesting tests. Always say ABC. They don’t expect you to know everything.
  38. 38. – Notes, Powerpoints, Videos, Podcasts and Practice Questions. Community based so can share information. Free. astest or ONExamination for practice MCQs and Extended Matching Questions.

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