Respiratory examination Flashcards
What are the introductory steps for a respiratory examination?
- Wash hands
- Put on PPE
- Introduce yourself to the patient
- Ask name and DOB.
- Explain the examination.
- Acquire consent.
- Offer a chaperone.
- Adjust bed head to 45.
What comes after the introduction?
General inspection.
What does general inspection entail?
Inspect around the bed for any equipment/medications.
Inspect the patient:
- Build?
- Breath rate?
- General comfort level?
What comes after general inspection?
Inspection of the hands.
What can be picked up on from inspection of the hands?
- Clubbing? (Bronchiectasis, lung cancer, ILD, CF)
- Colour? (Pallor - anaemia. Cyanosis - Hypoxia).
- Tar staining? Suggestive of a heavy smoking history).
What comes after inspection of the hands?
- Flapping tremor test.
How is the flapping tremor test conducted?
- Extend wrists and elbows in front of patient.
- Hold there for 10 seconds.
- Flap suggestive of hypercapnia.
What comes after the flapping tremor test?
- Radial pulse assessment.
What can be picked up on from a radial pulse assessment?
- Bounding pulse suggestive of CO2 retention.
- Pulsus paradoxus. Get patient to take a deep breath in and hold. If some beats become unpalpable in the radial pulse, but they can be auscultated using a stethescope directly on the heart, this is a +ve pulsus paradoxus.
Pulsus paradoxus is suggestive of severe respiratory disease or cardiac tamponade.
What comes after assessment of the radial pulse?
Measure the BP of the patient (probably not in OSCE).
What comes after BP measurement?
- JVP assessment.
How is JVP assessed.
- Ensure bed has been set at 45.
- Get patient to look over their left shoulder.
- Look for a dual-pulse waveform in the neck.
- Measure the distance between this and the angle of Louis.
- If greater than 3cm, suggestive of a raised JVP (cor pulmonale).
What comes after JVP assessment?
- Assessment of breathing.
How is breathing assessed?
Observe the breathing of the patient for approx. 10s, noting:
- Rate
- Rhythm
- Effort
- Pursed lips?
What comes after assessment of breathing?
- Inspection of face.
What can be picked up on from facial inspection?
Eyes:
- Conjunctival pallor (anaemia).
- Eyeball displacement (Horner’s syndrome).
- Conjunctival oedema (CO2 retention, COPD).
Mouth:
- Central cyanosis (hypoxia).
What comes after facial inspection?
Palpation of the neck.
How is the neck palpated and what are the potential findings?
Palpate the trachea, checking it is central:
- Deviates towards collapsed lung or pulmonary fibrosis.
- Deviates away from pneumothorax.
Palpate the cricosternal distance.
- Should be 3-4 fingertips long.
What comes after neck palpation?
At this point, ask the patient to remove their top and reoffer a chaperone.
Palpation of the cervical lymph nodes.
What comes after palpation of the cervical lymph nodes?
Inspection of the chest.
What are the potential findings of inspection of the chest?
- Surgical scars.
- Asymmetrical breathing.
- Reduced breath volume.
- Barrel chest? (COPD).
- Use of accessory muscles (increased resp. effort).
What comes after inspection of the chest?
Palpation of the chest.
How is the chest palpated?
Wrap hands around the chest wall just inferiorly to the nipple, with thumbs medial. Ask the patient to breathe in and out deeply:
- Normally, thumbs should move up and out during breath in, and down and in during a breath in.
Palpate the chest for the apex beat (usually in the fifth intercostal space at the midclavicular line).
What comes after palpation of the chest?
Percussion of the chest.
