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Respiratory Examination

From Mediwikis

Wash Hands

Introduction, Explanation, Consent

  • Ask about pain, breathless
  • Patient positioned lying at 45 degrees
  • Expose shoulder to abdomen

General Observation

  • Surroundings - O2, inhalers, nebulisers, chest drain, sputum pots
  • Generally well
  • Breathless, using accessory muscles
  • Cough
  • Wheeze/Stridor
  • Cyanosis
  • Pulse & breathing rate for 30 seconds
  • Blood pressure

Hands

  • Clubbing (lung cancer, fibrosis, chronic infection)
  • Nicotine staining
  • Temperature
  • Cyanosis
  • Wasting
  • Fine tremor
  • Extend and cock hands back to check for CO2 retention flapping tremor

Pulse + Breathing rate

Eyes

  • Anaemia of conjunctiva
  • Horners Sign (ptosis)
  • Malar Flush
  • Cushingoid

Mouth

  • Central cyanosis of lips and underside of tongue
  • Dental Hygiene

Neck

  • Tracheal tug - three fingers on trachea, ask patient to breath in
  • Tracheal deviation (side to side)
  • Accessory muscle use during inspiration
  • Raised JVP
  • Goitre

Chest

Inpection

  • Asymmetry
  • Ant-Post diameter enlarged (barrel chest)
  • Scars - try to name procedure e.g. sternotomy

Palpation

  • Chest expansion at 3 points, opposing thumbs
    • Symmetry
    • Amount of movement
  • Do not perform vocal fremitus

Percussion

  • Clavicles & 4 locations (on both sides) down the chest
    • Symmetrical
    • Resonant (normal)
    • Hyper-resonant (air)
    • Dull (fluid)

Auscultation

Supraclavicular fossa (bell) and three other areas

  • Added sounds
    • Crackles
    • Wheeze
    • Stridor
    • Pleuritic Rub
    • Bronchial Breathing ("tubular", louder expiration)
  • Vocal resonance - patient says '99' each time

Neck

  • Lymphadenopathy

Back

Inpection

  • Asymmetry
  • Scars

Palpation

  • Chest expansion at 3 points, opposing thumbs
    • Symmetry
    • Amount of movement
  • Do not perform vocal fremitus

Percussion

Ask patient to fold arms across chest

5 locations (on both sides) down the chest

  • Symmetrical
  • Resonance (normal)
  • Hyper-resonance (air)
  • Dullness (fluid)

Auscultation

  • Added sounds
    • Crackles
    • Wheeze
    • Stridor
    • Pleuritic Rub
    • Bronchial Breathing ("tubular", louder expiration)
  • Vocal resonance - patient says '99' each time

Legs

  • Pitting oedema

Wash Hands

Summary

  • Heart rate, respiration rate
  • No peripheral signs of respiratory disease
  • Chest expansion was normal, symmetrical
  • Percussion resonant throughout
  • Normal air entry throughout with no added breath sounds
  • Vocal resonance normal and symmetrical
  • No pedal oedema

Further examination