Dr.Ahmed Sabra
08-Nov-2007, 11:58 PM
السلام عليكم
http://www.elu.sgul.ac.uk/cso/skills/windows.php?filename=respiratory/respiratory.wmv
Download this video - Windows Media (17.07 MBs) (http://www.elu.sgul.ac.uk/cso/skills/windows.php?filename=respiratory/respiratory.wmv)
Basic Respiratory Examination
CSO would like to acknowledge Dr Navin Ramachandran
for performing this examination technique
Q1: How should the patient be positioned?
The patient should be ideally positioned at 45 degrees on the bed to assess JVP.
They should be unclothed down to underwear (legs exposed to look for e.g. peripheral oedema).
Usually, in real life, the top half should be uncovered (for e.g. the bra kept on in women).
Q2: What are you looking for on a general inspection?
On general inspection you are looking for:
Overall appearance (e.g. cachexia) and posture (including kyphoscoliosis)
Signs of respiratory distress
Shortness of breath
Accessory muscle use
Nasal flaring
Intercostal recession
Cyanosis (peripheral/central)
Chest shape (asymmetry, pectus excavatum, pectus carinatum)
Scars (sternotomy, thoracotomy, thoracoplasty, phrenic nerve crush)
Things around the patient (oxygen, inhalers, peak flow meter)
Q3: What are you looking for in the hands?
You are looking for the following in the hands:
Clubbing
Signs of anaemia (causes SOB)
Tremor
Bounding pulse (sign of CO2 retention)
Warm sweaty hands (sign of CO2 retention)
Rheumatoid arthritis (associated with lung fibrosis)
Hypertrophic pulmonary osteoarthropathy (associated with bronchogenic carcinoma)
Q4: What types of tremor are you looking for?
Two examples of tremor:
Resting tremor due to beta2-agonist (e.g. salbutamol) use.
Flapping tremor (aka asterixis) due to CO2 retention. Looks the same as a liver flap.
http://www.elu.sgul.ac.uk/cso/skills/windows.php?filename=respiratory/respiratory.wmv
Download this video - Windows Media (17.07 MBs) (http://www.elu.sgul.ac.uk/cso/skills/windows.php?filename=respiratory/respiratory.wmv)
Basic Respiratory Examination
CSO would like to acknowledge Dr Navin Ramachandran
for performing this examination technique
Q1: How should the patient be positioned?
The patient should be ideally positioned at 45 degrees on the bed to assess JVP.
They should be unclothed down to underwear (legs exposed to look for e.g. peripheral oedema).
Usually, in real life, the top half should be uncovered (for e.g. the bra kept on in women).
Q2: What are you looking for on a general inspection?
On general inspection you are looking for:
Overall appearance (e.g. cachexia) and posture (including kyphoscoliosis)
Signs of respiratory distress
Shortness of breath
Accessory muscle use
Nasal flaring
Intercostal recession
Cyanosis (peripheral/central)
Chest shape (asymmetry, pectus excavatum, pectus carinatum)
Scars (sternotomy, thoracotomy, thoracoplasty, phrenic nerve crush)
Things around the patient (oxygen, inhalers, peak flow meter)
Q3: What are you looking for in the hands?
You are looking for the following in the hands:
Clubbing
Signs of anaemia (causes SOB)
Tremor
Bounding pulse (sign of CO2 retention)
Warm sweaty hands (sign of CO2 retention)
Rheumatoid arthritis (associated with lung fibrosis)
Hypertrophic pulmonary osteoarthropathy (associated with bronchogenic carcinoma)
Q4: What types of tremor are you looking for?
Two examples of tremor:
Resting tremor due to beta2-agonist (e.g. salbutamol) use.
Flapping tremor (aka asterixis) due to CO2 retention. Looks the same as a liver flap.