Respiratory Examination Applicability :)

Respiratory Examination Applicability :)

1. 1. Set up Patient

   • 2. Introduction
     • Consent
     • Confidentiality
     • 3. General Examination
       • A) Hands + Nails
         • Nicotine
         • Peripheral Cyanosis
         • Koilonychia
         • Clubbing
         • Carbon Dioxide Flapping Tremor Test
           • Hypercarbia/Hypercapnia
         • B) Pulse
           • C) Respiratory Rate
             • D) Jugular Venous Pressure
               • High?
               • E) Conjunctiva
                 • Pale?
                 • F) Mouth/Mucous Membranes
                   • Dehydrated
                   • Central Cyanosis
                   • G) Lymph Nodes
                     • Supraclavicular
                     • Cervical
                     • Axillary
                     • H) Expose Chest Wall
                       • Pattern of Breath if not done already
                         • Are they using Accessory Muscles for breathing
                       • Shape of Chest
                         • Barrel Chest (Obstructive Disorders
                       • Scars
                         • Previous wounds/surgeries
                       • I) Palpate Trachea
                         • Pneumothorax
                         • Central to Sternal Notch
                         • J) Apex Beat
                           • Sinus Tachycardia
                           • 5th Intercostal Space Midclavicular Line
                           • K) Chest Expansion
                             • Both thumbs on costal margin and have them breathe
                             • L) Percussion
                               • Normal
                               • Dull
                               • Hyper-resonant
                               • M) Auscultation
                                 • Anterior
                                 • Lateral
                                 • Posterior
                                 • Breath Sounds
                                   • Vesicular
                                     • Normal Breath Sound
                                   • Bronchial
                                     • Loud and tubular sounds in peripheral areas
                                   • Wheeze
                                     • Expiration Sound
                                     • Smaller Airways
                                     • Can be hear throughout
                                       • COPD
                                     • Fixed Wheeze
                                       • Obstruction
                                   • Stridor
                                     • Inspiration Sound
                                     • Large Airways
                                   • Crackles/Crepitations
                                     • Coarse
                                       • Clear Cough
                                       • Mucus in Big Airways
                                     • Fine
                                       • Early Inspiration
                                         • Infection
                                         • Bronchiolitis
                                       • End Inspiration
                                         • Fibrosis
                                         • Left Ventricular Failure
                                         • Infection
                                 • M1. Auscultation: anything abnormal
                                   • N) Vocal Resonance
                                     • Tactile Fremitus
                                     • Vocal Fremitus
                                     • O) Also consider: STOP
                                       • Sputum
                                         • Temperature
                                           • Oxygen saturation
                                             • Peak Flow
                                               • P) End Consultation
                                                 • Documentation
                       • Palpate (if no pain)
                         • Lumps, Bumps= Cysts, Carcinomas etc
   • Patient 45 degrees

2. ALWAYS Compare both sides of patient