Respiratory examination: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 25: Line 25:
* Patient's body mass (look for wasting, cachexia, puffiness)
* Patient's body mass (look for wasting, cachexia, puffiness)
* Check for any instruments present like inhalers, peak flow meter, or oxygen cylinder
* Check for any instruments present like inhalers, peak flow meter, or oxygen cylinder
 
===Chest wall===
==Inspection==
* [[Vertebrate trachea|Tracheal]] deviation (can suggest of [[tension pneumothorax]])
* [[Vertebrate trachea|Tracheal]] deviation (can suggest of [[tension pneumothorax]])
===Chest wall deformities===
* [[Kyphosis]] - curvature of the spine - anterior-posterior
* [[Kyphosis]] - curvature of the spine - anterior-posterior
* [[Scoliosis]] - curvature of the spine - lateral
* [[Scoliosis]] - curvature of the spine - lateral
Line 35: Line 32:
* [[Pectus excavatum]]
* [[Pectus excavatum]]
* [[Pectus carinatum]]
* [[Pectus carinatum]]
===Signs of respiratory distress===
===Signs of respiratory distress===
* [[Cyanosis]] - person turns blue
* [[Cyanosis]] - person turns blue

Revision as of 17:38, 14 June 2012

WikiDoc Resources for Respiratory examination

Articles

Most recent articles on Respiratory examination

Most cited articles on Respiratory examination

Review articles on Respiratory examination

Articles on Respiratory examination in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Respiratory examination

Images of Respiratory examination

Photos of Respiratory examination

Podcasts & MP3s on Respiratory examination

Videos on Respiratory examination

Evidence Based Medicine

Cochrane Collaboration on Respiratory examination

Bandolier on Respiratory examination

TRIP on Respiratory examination

Clinical Trials

Ongoing Trials on Respiratory examination at Clinical Trials.gov

Trial results on Respiratory examination

Clinical Trials on Respiratory examination at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Respiratory examination

NICE Guidance on Respiratory examination

NHS PRODIGY Guidance

FDA on Respiratory examination

CDC on Respiratory examination

Books

Books on Respiratory examination

News

Respiratory examination in the news

Be alerted to news on Respiratory examination

News trends on Respiratory examination

Commentary

Blogs on Respiratory examination

Definitions

Definitions of Respiratory examination

Patient Resources / Community

Patient resources on Respiratory examination

Discussion groups on Respiratory examination

Patient Handouts on Respiratory examination

Directions to Hospitals Treating Respiratory examination

Risk calculators and risk factors for Respiratory examination

Healthcare Provider Resources

Symptoms of Respiratory examination

Causes & Risk Factors for Respiratory examination

Diagnostic studies for Respiratory examination

Treatment of Respiratory examination

Continuing Medical Education (CME)

CME Programs on Respiratory examination

International

Respiratory examination en Espanol

Respiratory examination en Francais

Business

Respiratory examination in the Marketplace

Patents on Respiratory examination

Experimental / Informatics

List of terms related to Respiratory examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

In medicine, the respiratory examination is performed as part of a physical examination, or when a patient presents with a respiratory problem (dyspnea (shortness of breath), cough, chest pain) or a history that suggests a pathology of the lungs.

Position/Lighting/Draping

Position - patient should sit upright on the examination table. The patient's hands should remain at their sides. When the back is examined the patient is usually asked to move their arms forward (hug themself position) so that the scapulae are not in the way of examining the upper lung fields.

Lighting - adjusted so that it is ideal. Draping - the chest should be fully exposed. Exposure time should be minimized.

The basic steps of the examination can be remembered with the mnemonic IPPA:

  • Inspection
  • Palpation
  • Percussion
  • Auscultation

Video: Respiratory Examination

{{#ev:youtube|akr40RXu_H8}}

General physical examination

  • The mnemonic 'PICKLE' is used sometimes for general physical examination. PICKLE stands for Pallor, Icterus, Cyanosis, Clubbing, Koilonychia, Lymphadenopathy, and Edema

Inspection

  • Check whether the patient is well oriented with time place, and person
  • Any chest deformity, swelling or scar
  • Patient's body mass (look for wasting, cachexia, puffiness)
  • Check for any instruments present like inhalers, peak flow meter, or oxygen cylinder

Chest wall

Signs of respiratory distress

  • Cyanosis - person turns blue
  • Pursed-lip breathing - seen in COPD (used to increase end expiratory pressure)
  • Accessory muscle use (scalene muscles)
  • Diaphragmatic paradox - the diaphragm moves opposite of the normal direction on inspiration; suspect flail segment in trauma
  • Intercostal indrawing

Palpation

  • Tracheal deviation - check whether trachea is in centre line.
  • Tactile fremitus - the patient says boy-O-boy or ninety-nine, whilst physician sense with ulnar aspect of hand for changes in sound conduction.
  • Respiratory expansion - check whether expansion is equal
  • Location of apex beat - check if there has been deviation of heart

Percussion

Middle finger strikes the middle phalanx of the other middle finger. The sides of the chest are compared.

Ausculation

  • Inspiratory crackles (decompensated congestive heart failure)
  • Expiratory wheezes (asthma, emphysema)
  • Stridor and other upper airway sounds
  • Bronchial vs. vesicular breath sounds
  • Appropriate ratio of inspiration to expiration time (expiration time increased in COPD)

Vocal fremitus (not usually done)

Respiratory System at a Glance

Main lobes are outlined in black. The following abbreviations are used: RUL = Right Upper Lobe; LUL = Left Upper Lobe; RML = Right Middle Lobe; RLL = Right Lower Lobe; LLL = Left Lower Lobe.

(Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)

Anterior View

Posterior View

Right Lateral View

Left Lateral View

Trachea

Possible Examination Findings

Pectus Excavatum

Barrel Chest

Kyphosis

Scoliosis

External links

Template:WH Template:WS