Respiratory Examination (Handguide Version) Flashcards
1
Intro
2
General inspection of the bed area e.g. inhalers, nebuliser, oxygen mask, sputum pot
General observation of the patient (colour, breathing, comfort, position, purse-lipped
breathing in COPD, nutritional state (obesity may suggest obstructive sleep apnoea, Pickwickianism))
3
Inspect the hands
Look for a tremor
Temp
4
Assess pulse rate, rhythm and character
also assess respiratory rate, rhythm, pattern and effort
Note the presence of pulsus paradoxus (an exaggeration of the normal decrease in blood pressure during inspiration). The ‘paradox’ is that you can detect beats on auscultation of the heart during inspiration that cannot be palpated at the radial artery due to a fall in blood pressure. Pulsus paradoxus is seen in severe obstructive airways disease and cardiac tamponade.
5
Check the blood pressure
6
Check for raised JVP, suggesting cor pulmonale. A raised non-pulsatile JVP may be seen in superior vena cava (SVC) obstruction due to a lung cancer, in which case there
will be oedema of the face and neck.
7
Look for respiratory disease in the eyes:
-Horner’s syndrome
-Chemosis
8
Look for respiratory disease in the face and mouth:
9
Expose the chest and inspect
I’d inspect lymph nodes here also
10
Check the trachea for deviation.
Deviation occurs toward the side of the pathology with pulmonary fibrosis or collapse, but away from the pathology with a tension pneumothorax or massive effusion.
11
Check the apex beat for deviation
Deviation occurs toward the side of the pathology with pulmonary fibrosis or collapse, but away from the pathology with a tension pneumothorax or massive effusion.
12
Assess chest expansion (normal = 3-5cm; abnormal <2cm). Remember to ask the patient to exhale fully before assessing expansion.
13
Assess tactile vocal fremitus (“say ninety-nine”). (Transmission of vibrations is increased in consolidation as sound travels quicker through solid than air. Transmission is decreased with an effusion or pneumothorax as the lung tissue becomes separated from the chest wall).
14
Percussion
Starting at the apices, percuss from side to side anteriorly. Consider the surface marking of the lungs and their fissures whilst percussing. Ensure that you have percussed every lobe (including the right middle lobe).
15
Auscultation
Starting at the apices, auscultate from side to side anteriorly and laterally with open mouthed breathing (clavicle to 6th rib, mid-clavicular line; Axilla to 8th rib, mid-axillary line).
