Respiratory Flashcards
How do you start the examination?
Wash hands
Introduction
Identification
Explanation and consent
What do you look for in general inspection of the patient?
Colour Breathing Comfort Position Nutritional state
What do you inspect the hands for?
Clubbing Tar staining Wasting of intrinsic muscles Flapping tremor (respiratory failure) Fine tremor (beta agonists)
What do you look for in the pulses?
Rate
Rhythm
Character (bounding in co2 retention)
What do you assess while assessing pulse?
Resp rate
Rhythm
Pattern
Effort
What is pulsus paradoxus?
You detect beats at apex beat that can’t be palpated at radial during inspiration.
When might you see pulsus paradox?
Severe obstructive airways disease and cardiac tamponade
What do you need to say you would check?
BP
What do you check for in the neck?
Raised JVP
What respiratory reason might there be for a raised non pulsatile JVP?
Superior vena cava obstruction due to lung cancer
What signs do you look for in the eyes?
Horners syndrome (pinpoint pupils) Chemosis (conjuctival oedema with hypercapnia due to COPD)
What do you look for in the face and mouth?
Facial swelling (SVC obstruction) Dental carries (cause lung abscess) Central cyanosis
What do you examine in the chest?
Shape Symmetry Scars Muscle wasting Type of breathing/ using accessory muscles Recession
Types of abnormal chest shapes
Barrel chest (emphysema) Severe kyphoscoliosis (curved spine) Severe pectus excavatum (funnel chest) Pectus carinatum (pigeon chest)
What do you do on palpation?
Check trachea and apex beat for deviation
Assess expansion (3-5cm)
Assess tactile vocal fremutis
How do you perform auscultation?
Start at apices
Side to side anteriorly and laterally
Clavicle to 6th rib mid clav line
Axilla to 8th rib, mid axillary line
What types of breathing may you hear?
Vesicular breath sounds Bronchial breathing Wheezes Crackles/creps (check after cough, is it secretion or fibrosis) Pleural rub
How do you assess vocal resonance?
Say 99 while auscultating
Effusion or pneumothorax (reduced)
Consolidation (increase)
What after you do all the stuff to front?
Do the back!
Spine of scapula to 11th rib
What are the finishing steps?
Cervical lymph nodes
Ankle oedema
Sputum pot?
Assess peak flow
How to complete exam
Thank patient
Redress
Wash hands
