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EXAMINATION of the RESPIRATORY system

EXAMINATION of the RESPIRATORY system. Prof MARK WOODHEAD. EXAMINATION of the RESPIRATORY System can only be learnt at the bedside. Learn the steps Learn the skills/techniques Identify what’s normal Identify what’s abnormal. CLINICAL EXAMINATION. GENERAL.

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EXAMINATION of the RESPIRATORY system

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  1. EXAMINATION of the RESPIRATORY system Prof MARK WOODHEAD

  2. EXAMINATION of the RESPIRATORY System can only be learnt at the bedside

  3. Learn the steps • Learn the skills/techniques • Identify what’s normal • Identify what’s abnormal

  4. CLINICAL EXAMINATION GENERAL Introduce yourself Explain what you are about to do and why Obtain informal consent Check that patient has no tender/painful areas Position the patient

  5. CLINICAL EXAMINATION GENERAL Awake/alert

  6. CLINICAL EXAMINATION GENERAL Awake/ alert Comfortable / in distress Signs of self neglect

  7. CLINICAL EXAMINATION GENERAL Awake/ alert Comfortable / in distress Signs of self neglect Tachypnoeic or not - able to complete sentences, move on bed, undress

  8. CLINICAL EXAMINATION GENERAL Awake/ alert Comfortable / in distress Signs of self neglect Tachypnoeic /breathless or not - able to complete sentences, move on bed, undress Obesity / Signs of recent weight loss

  9. CLINICAL EXAMINATION GENERAL Awake/ alert Comfortable / in distress Signs of self neglect Tachypnoeic /breathless or not - able to complete sentences, move on bed, undress Signs of recent weight loss Temperature

  10. CLINICAL EXAMINATION HANDS Tar staining

  11. CLINICAL EXAMINATION HANDS Finger clubbing - cancer - brinchiectasis - pulmonary fibrosis

  12. CLINICAL EXAMINATION HANDS Finger clubbing - cancer - brinchiectasis - pulmonary fibrosis Small muscle wasting – cancer

  13. CLINICAL EXAMINATION HANDS Finger clubbing - cancer - brinchiectasis - pulmonary fibrosis Small muscle wasting – cancer Tremor – Fine - -agonists - Flapping - carbon dioxide retention

  14. CLINICAL EXAMINATION FACE Pursed-lip breathing – emphysema Cyanosis – SaO2 < 85%, PaO2 < 55mmHg - beware anaemia, polycythaemia

  15. CLINICAL EXAMINATION FACE Pursed-lip breathing – emphysema Cyanosis – SaO2 < 85%, PaO2 < 55mmHg - beware anaemia, polycythaemia Herpes Simplex – infection

  16. CLINICAL EXAMINATION FACE Pursed-lip breathing – emphysema Cyanosis – SaO2 < 85%, PaO2 < 55mmHg - beware anaemia, polycythaemia Herpes Simplex – infection Swelling – SVC obstruction Stridor - large airway narrowing

  17. CLINICAL EXAMINATION FACE Eyes – Horner’s syndrome – miosis, ptosis, anhydrosis, enophthalmos

  18. CLINICAL EXAMINATION MOUTH Teeth - lung infection,

  19. CLINICAL EXAMINATION MOUTH Teeth - lung infection Candida - cancer, immune suppression Tongue - cyanosis

  20. CLINICAL EXAMINATION NECK Lymphadenopathy - cancer, tuberculosis

  21. CLINICAL EXAMINATION NECK Lymphadenopathy - cancer, tuberculosis Raised JVP - Cor pulmonale Fixed JVP - SVC obstruction

  22. CLINICAL EXAMINATION NECK Lymphadenopathy - cancer, tuberculosis Raised JVP - Cor pulmonale Fixed JVP - SVC obstruction

  23. CLINICAL EXAMINATION NECK Lymphadenopathy - cancer, tuberculosis Raised JVP - Cor pulmonale Fixed JVP - SVC obstruction Cricosternal distance < 3 finger breadths - airflow obstruction

  24. CLINICAL EXAMINATION MEDIASTINUM / THORAX Inspection Palpation Percussion Auscultation

  25. CLINICAL EXAMINATION MEDIASTINUM Trachea - central / displaced Apex Beat - position

  26. CLINICAL EXAMINATION MEDIASTINUM Trachea - central / displaced Apex Beat - position effusion collapse

  27. CLINICAL EXAMINATION THORAX INSPECTION Shape - scoliosis, kyphosis,

  28. CLINICAL EXAMINATION THORAX INSPECTION Shape - kyphosis, scoliosis - flail segment - scars

  29. CLINICAL EXAMINATION THORAX INSPECTION Shape - kyphosis, scoliosis - flail segment - scars - lumps

  30. CLINICAL EXAMINATION THORAX INSPECTION Shape - kyphosis, scoliosis - flail segment - scars - lumps

  31. CLINICAL EXAMINATION THORAX INSPECTION Shape - kyphosis, scoliosis - flail segment - scars - lumps Movement - respiratory rate - severity - pattern - Cheyne-Stokes - asymmetry - intercostal recession - severity - paradoxical abdominal movement - diaphragm weakness

  32. CLINICAL EXAMINATION THORAX Expansion - symmetry - amount - lateral / vertical - local / global abnormality

  33. CLINICAL EXAMINATION THORAX Expansion - symmetry - amount - lateral / vertical - local / global abnormality Percussion - resonant - air - dull, stony dull - fluid / tissue

  34. CLINICAL EXAMINATION THORAX Expansion - symmetry - amount - lateral / vertical - local / global abnormality Percussion - resonant - air - dull, stony dull - fluid / tissue Vocal fremitus -  - pleural fluid/solid, collapse Vocal resonance -  - consolidation

  35. CLINICAL EXAMINATION THORAX - AUSCULTATION Breath sounds - present / reduced / absent - bronchial breathing - aegophany, whispering pectoriloquy

  36. CLINICAL EXAMINATION THORAX - AUSCULTATION Breath sounds - present / reduced / absent - bronchial breathing - aegophany, whispering pectoriloquy

  37. Repeat on the posterior thorax

  38. CLINICAL EXAMINATION THORAX - AUSCULTATION Breath sounds - present / reduced / absent - bronchial breathing - aegophany, whispering pectoriloquy Added sounds - wheeze - local / generalised - inspiratory / expiratory - mono / polyphonic - crackles - fine / coarse - inspiratory / expiratory - persistent (cough) - pleural rub

  39. CLINICAL EXAMINATION OTHER Abdomen – liver edge - cor pulmonale, metastases Ankles - oedema - cor pulmonale Sputum pot - colour - amount - blood Peak Flow Bedside clues - Inhalers, oxygen etc

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