Download The Respiratory Exam

The Respiratory Exam
Surroundings
• Is the patient on a respirator?
• Is he/she on oxygen?
– Delivery system? (nasal prongs, mask etc)
– How many litres a minute?
General Appearance
• Is the pt dyspnoeic?
• Are they using their accessory breathing
muscles?
• Are they blue and bloated or pink and puffing?
– DISCUSS PHYSIOLOGY
Hands
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Clubbing
Nicotine staining
Peripheral cyanosis
Pallor of the palmar creases
Wasting of intrinsic hand muscles- finger abduction
(apical lung tumour pressing on the brachial plexus)
Tenderness just below the wrist (pulmonary osteoarthropathyassociated with lung carcinoma an mesothelioma)
Asterixis (CO2 retention)
Pulse (tachycardia with beta blockers)
Resp rate (16-25)- 8>bradypnoea, 25<tachypnoea
BP (paradox- decrease of 10mmHg or more during inspirationindicates obstructive lung disease like asthma or COPD)
Face
• Eyes
– Ptosis and pupil constriction (horners syndrome)
– Conjunctival palour
• Sinuses (tenderness)
• Nose- polyps
• Mouth- tongue; central cyanosis
Neck
• Trachea
– Deviation: thoracic mass, pnoemothorax etc
– Tracheal tug (downward movements)-aortic
aneurism
• JVP- elevated in heart failure, cor pulmonale
• Lymph nodes
Chest
• Inspect- scars, barrel chest, kyphosis &
deformity
• Palpate
– Chest expansion
– Percussion (compare sides)
• Auscultate
– Vocal resonance
– Breath sounds
• Check for bony tenderness & sacral oedema
Abdomen
• Pulsatile liver