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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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slide1

EXAMINATION

of the

RESPIRATORY

system

Prof MARK WOODHEAD

slide2

EXAMINATION

of the

RESPIRATORY

System

can only be learnt

at the bedside

slide3

Learn the steps

  • Learn the skills/techniques
  • Identify what’s normal
  • Identify what’s abnormal
slide4

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

slide5

CLINICAL EXAMINATION

GENERAL

Awake/alert

slide6

CLINICAL EXAMINATION

GENERAL

Awake/ alert

Comfortable / in distress

Signs of self neglect

slide7

CLINICAL EXAMINATION

GENERAL

Awake/ alert

Comfortable / in distress

Signs of self neglect

Tachypnoeic or not

- able to complete sentences, move on bed, undress

slide8

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

slide9

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

slide10

CLINICAL EXAMINATION

HANDS

Tar staining

slide11

CLINICAL EXAMINATION

HANDS

Finger clubbing - cancer

- brinchiectasis

- pulmonary fibrosis

slide12

CLINICAL EXAMINATION

HANDS

Finger clubbing - cancer

- brinchiectasis

- pulmonary fibrosis

Small muscle wasting – cancer

slide13

CLINICAL EXAMINATION

HANDS

Finger clubbing - cancer

- brinchiectasis

- pulmonary fibrosis

Small muscle wasting – cancer

Tremor – Fine - -agonists

- Flapping - carbon dioxide retention

slide14

CLINICAL EXAMINATION

FACE

Pursed-lip breathing – emphysema

Cyanosis – SaO2 < 85%, PaO2 < 55mmHg

- beware anaemia, polycythaemia

slide15

CLINICAL EXAMINATION

FACE

Pursed-lip breathing – emphysema

Cyanosis – SaO2 < 85%, PaO2 < 55mmHg

- beware anaemia, polycythaemia

Herpes Simplex – infection

slide16

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

slide17

CLINICAL EXAMINATION

FACE

Eyes – Horner’s syndrome –

miosis, ptosis, anhydrosis, enophthalmos

slide18

CLINICAL EXAMINATION

MOUTH

Teeth - lung infection,

slide19

CLINICAL EXAMINATION

MOUTH

Teeth - lung infection

Candida - cancer, immune suppression

Tongue - cyanosis

slide20

CLINICAL EXAMINATION

NECK

Lymphadenopathy - cancer,

tuberculosis

slide21

CLINICAL EXAMINATION

NECK

Lymphadenopathy - cancer,

tuberculosis

Raised JVP - Cor pulmonale

Fixed JVP - SVC obstruction

slide22

CLINICAL EXAMINATION

NECK

Lymphadenopathy - cancer,

tuberculosis

Raised JVP - Cor pulmonale

Fixed JVP - SVC obstruction

slide23

CLINICAL EXAMINATION

NECK

Lymphadenopathy - cancer,

tuberculosis

Raised JVP - Cor pulmonale

Fixed JVP - SVC obstruction

Cricosternal distance

< 3 finger breadths - airflow obstruction

slide24

CLINICAL EXAMINATION

MEDIASTINUM / THORAX

Inspection

Palpation

Percussion

Auscultation

slide25

CLINICAL EXAMINATION

MEDIASTINUM

Trachea - central / displaced

Apex Beat - position

slide26

CLINICAL EXAMINATION

MEDIASTINUM

Trachea - central / displaced

Apex Beat - position

effusion

collapse

slide27

CLINICAL EXAMINATION

THORAX

INSPECTION

Shape - scoliosis, kyphosis,

slide28

CLINICAL EXAMINATION

THORAX

INSPECTION

Shape - kyphosis, scoliosis

- flail segment

- scars

slide29

CLINICAL EXAMINATION

THORAX

INSPECTION

Shape - kyphosis, scoliosis

- flail segment

- scars

- lumps

slide30

CLINICAL EXAMINATION

THORAX

INSPECTION

Shape - kyphosis, scoliosis

- flail segment

- scars

- lumps

slide31

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

slide32

CLINICAL EXAMINATION

THORAX

Expansion - symmetry

- amount

- lateral / vertical

- local / global abnormality

slide33

CLINICAL EXAMINATION

THORAX

Expansion - symmetry

- amount

- lateral / vertical

- local / global abnormality

Percussion - resonant - air

- dull, stony dull - fluid / tissue

slide35

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

slide36

CLINICAL EXAMINATION

THORAX - AUSCULTATION

Breath sounds - present / reduced / absent

- bronchial breathing

- aegophany, whispering pectoriloquy

slide37

CLINICAL EXAMINATION

THORAX - AUSCULTATION

Breath sounds - present / reduced / absent

- bronchial breathing

- aegophany, whispering pectoriloquy

slide39

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

slide40

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