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