Respiratory Examination

1
Respiratory Examination

• Reference Talley OConnor. Examination
  Medicine.

2
Respiratory History

• Will be covered in Communications Tutorials
• Important to cover extensive Occupational
  History, Allergies, Snoring, Daytime somnolence,
  Sexual history, Hobbies and Pets

3
Respiratory Examination

• INSPECTION
• PALPATION
• PERCUSSION
• AUSCULTATION

4
Respiratory Examination

• OBSERVATION
• Remember Exposure Positioning
• General End of bed
• -General Condition of patient
• -Oxygen
• -Chest drains
• -Intravenous line

5
Respiratory Examination

• OBSERVATION CONTINUED
• SIT PATIENT UP
• B) Closer inspection
• -Fingernails
• clubbing (cyanotic heart lung diseases)
• peripheral cyanosis
• smoking stains
• -Wrists
• Hypertrophic Pulmonary Osteoarthropathy (HPOA)
• Count Respiratory Rate over one minute. Observe
  the rate, rhythm, depth, and effort of breathing.
  Note whether the expiratory phase is prolonged.
  Observe for use of accessory muscles
  (sternomastoids, abdominals).

6
Respiratory Examination

• OBSERVATION CONTINUED
• Face
• -Reddish (CO2 retention)
• -Bluish (cyanosis)
• Eyes
• -Horners Syndrome (ptosis,pupillary miosis and
  facial anhydrosis)
• Eyelids
• -erythema/scaling/pigmentation (allergies)
• Conjuctiva
• -pale (anaemia)
• Nose
• -Allergic crease
• -Nasal flaring (respiratory distress)
• Teeth
• -nicotine staining

7
Respiratory Examination

• OBSERVATION CONTINUED
• Mouth
• WHEN SHOULD YOU NEVER LOOK IN THE MOUTH
  (drooling, febrile child in respiratory distress
  - ?epiglottitis)
• Lips/mucous membranes
• -cyanosis (central)
• -soft palate erythema/petechiae (streptococcus B
  tonsilitis, OSA)
• -tonsils (enlarged, obstructing, puss)

8
Respiratory Examination

• OBSERVATION CONTINUED
• Trachea
• -midline, heaving, tracheal tug
• -vessel congestion
• Chest
• -barrel, pigeon, rib recession, paroxysmal
  breathing
• Abdomen
• -central obesity (OSA)

9
Respiratory Examination

• PALPATION
• Lymph nodes
• -cervical chain, post auricular, sub-mental,
  axillae
• Chest
• Anterior, Posterior and Axillae
• Chest Expansion
• Vocal resonance 99 - hands
• Vocal Fremitus 99 stethoscope
• Whispering pectoriloquy - Ask the patient to
  whisper "ninety-nine" several times, auscultate
  several symmetrical areas over each lung, you
  should hear only faint sounds or nothing at all
  if you can hear this clearly is suggests
  pneumonia
• Increased fremitus indicates fluid in the lung.
  Decreased fremitus indicates sound transmission
  obstructed by chronic obstructive pulmonary
  disease (COPD), fluid outside the lung (pleural
  effusion), air outside the lung (pneumothorax),
  etc.

10
Respiratory Examination

• PERCUSSION
• -Side to side, top to bottom, comparing like with
  like
• -Dull to resonant
• Diaphragmatic excursion
• -percuss to the level of dullness bilaterally,
  ask the patient to inspire deeply and percuss
  both sides again (should be 3-5 cm difference)

11
Respiratory Examination

• ASCULTATION
• -Again, comparing like with like, side to side,
  top to bottom
• -Breath sounds vesicular (normal) to bronchial
  (fluid in airways eg pneumonia), increased or
  decreased, crackles (coarse, fine), wheeze
• Associated systems
• -CVS (cor pulmonale)

12
Respiratory Examination

• OSCE
• -6 minute stations (one minute to sum up)

13
Respiratory Examination

• Questions
• Thank You