Respiratory Clinical Examination Dr Mazen Qusaibaty MD DIS
Respiratory Clinical Examination Dr Mazen Qusaibaty MD, DIS / Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health – Email: Qusaibaty@gmail. com 1
• Dr Mazen Qusaibaty • pulmedsyr • Syrian Thoracic Group • 0944320024 • Qusaibaty@gmail. com 2
4 The respiratory examination should include the following • Examination of the chest – repeated on the anterior and then the posterior chest wall. ¶Inspection ¶Palpation ¶Percussion ¶Auscultation
Preparation
Wash your hands 6
7 • Introduce yourself and clarify the patient’s identity • Explain what you would like to do • Gain the patient’s consent
8 • Equipment ¶Stethoscope ¶Peak Flow meter
9 Patient position
10 • The patient should be sitting up and exposed from the waist up at 45 degrees
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General Observations 12
13 General Observations • Look at the patient from the end of the bed 1. Hands 2. Face 3. Neck
Observe the patient from the end of the bed 14
15 • Check whether they are comfortable at rest / pain • Do they look tachypnoeic • Are they using accessory muscles • Are there any obvious abnormalities of the chest
16 • Audible breathing ¶Wheezing ¶Stridor
17 Also check for any Items around the bed such as: o Inhalers o Oxygen masks o Chest tube o Sputum pot o Cigarettes
Inspect the patient's hands 18
19 Patient's Hands • Hot, pink peripheries ¶A sign of carbon dioxide retention
Patient's Hands 20 Clubbing
Clubbing 21
Patient's Hands 22 Nicotine staining
Patient's Hands 23
24 Patient's Hands • A coarse flap may be a sign of carbon dioxide retention
Patient's Hands Take the radial pulse 25
26 Patient's Hands • A bounding pulse may indicate carbon dioxide retention
27 General Observations • Look at the patient from the end of the bed 1. Hands 2. Face
28 • Gently pull down lower eyelids and ask patient to look up • Inspect for pale conjunctiva of anaemia
Inspect the mouth and tongue 29
30 • Ask the patient to stick out their tongue and note its colour checking for anaemia or central cyanosis
31 • Remember to ask them to raise their tongue up and check underneath
32 General Observations • Look at the patient from the end of the bed 1. Hands 2. Face 3. Neck
Palpate for the left supraclavicular node 33
34 • Look for any use of accessory muscles such as the sternocleidomastoid muscle
35 • Also palpate for the left supraclavicular node ¶(Virchow’s Node)
Palpate the submental lymph nodes 36
Palpate the submandibular lymph nodes 37
Palpate the occipital lymph nodes 38
Palpate the pre-auricular lymph nodes 39
Palpate the post-auricular lymph nodes 40
Palpate the cervical lymph nodes 41
The Chest 42
The Chest • The chest wall must be examined completely (inspection, palpation, percussion, auscultation ) • First the whole of the front and then the whole of the back. • Examine from side to side and not top to bottom so that you can make comparisons.
44 Inspection - Anterior
With the chest exposed look carefully for • Chest wall abnormalities ¶Barrel Chest ¶Pectus Carinatum ¶Pectus Excavatum ¶Harrison’s Sulci ¶Kyphosis And Scoliosis
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47 Pectus Excavatum
48 Pectus Carinatum
49 Scoliosis Rib Cage Deformity
50 Scoliosis Rib Cage Deformity
51 Harrison’s Sulci
With the chest exposed look carefully for • Breathing pattern and asymmetry of movement
53 Palpation –Anterior
Palpate the trachea 54
Assess chest expansion 55
Percussion 56
Percuss the lung fields 57
Auscultation 58
Auscultate left lung 59
Auscultate right lung 60
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Characteristics of Breath Sounds
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Adventitious Lung Sounds
71 Adventitious Lung Sounds • Discontinuous Sounds ¶Crackles • Continuous Sounds ¶Wheezes ¶Rhonchi
Discontinuous Sounds Crackles Fine crackles Intensity Soft Pitch High Duration Very brief (5– 10 msec) 72
Discontinuous Sounds Crackles Fine crackles Coarse crackles Intensity Soft Some what louder Pitch High Lower Duration Very brief (5– 10 msec) Not quite so brief (20– 30 msec) 73
Continuous Sounds Rales Wheezes Pitch Quality Relatively high Have a hissing (around 400 or shrill quality Hz or higher) 74
Continuous Sounds Rales Wheezes Rhonchi Pitch Relatively high (around 400 Hz or higher) Relatively low Quality Have a hissing or shrill quality Have a snoring (around 200 Hz quality or lower) 75
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