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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?

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The Respiratory Exam

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  1. The Respiratory Exam

  2. Surroundings • Is the patient on a respirator? • Is he/she on oxygen? • Delivery system? (nasal prongs, mask etc) • How many litres a minute?

  3. General Appearance • Is the pt dyspnoeic? • Are they using their accessory breathing muscles? • Are they blue and bloated or pink and puffing? • DISCUSS PHYSIOLOGY

  4. Hands • 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 osteoarthropathy- associated 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 inspiration-indicates obstructive lung disease like asthma or COPD)

  5. Face • Eyes • Ptosis and pupil constriction (horners syndrome) • Conjunctival palour • Sinuses (tenderness) • Nose- polyps • Mouth- tongue; central cyanosis

  6. Neck • Trachea • Deviation: thoracic mass, pnoemothorax etc • Tracheal tug (downward movements)-aortic aneurism • JVP- elevated in heart failure, cor pulmonale • Lymph nodes

  7. Chest • Inspect- scars, barrel chest, kyphosis & deformity • Palpate • Chest expansion • Percussion (compare sides) • Auscultate • Vocal resonance • Breath sounds • Check for bony tenderness & sacral oedema

  8. Abdomen • Pulsatile liver

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