Resp Exam Flashcards
(13 cards)
Introduction
- Wash hands
- Introduce
- Patient details
- Permission: Today I have been asked to perform a respiratory examination - this will involve me having a look, a feel and a listen to your chest. We have our examiner here as chaperone. Does that sound okay?
- Exposure - waist upwards
- Reposition - 45 degree
- Any questions? Any pain?
General inspection?
Inspection from the bed:
Accessory muscle usage, pursed lip breathing
Obvious chest wall deformities
Scars
Medical paraphernalia around the bed, Cigarettes
Hands inspection
Peripheral Cyanosis, Tar staining, resting fine tremor, clubbing, small muscle wasting
Hands
Clubbing
CO2 Retention Flap (need to do for 30 seconds to say not present)
Capillary Refill
Radial Pulse: rate and rhythm
Breathing rate
Blood Pressure
Face
Eyes - Horner’s Syndrome (ptosis, miosis, enopthalmos, red eye), conjunctival pallor
Mouth - Central Cyanosis, hydration status
Neck
JVP - Hepatojugular Reflex
Tracheal Deviation
Chest inspection
Closer inspection for scars (including axilla)
Pectus Excavatum / Pectus Carinatum
Anterior chest palpation
Expansion
Anterior chest percussion
At least 3 different levels + axilla
Anterior chest auscultation
At least 3 different levels + axilla
Repeat for vocal fremitus (“say 99”)
Anterior chest wall locations
Supraclavicular region: lung apices
Infraclavicular region
Chest wall: percuss over 3-4 locations bilaterally
Axilla
Posterior chest wall
Sit forwards
1. Cervical lymph nodes
Hug shoulders
2. Palpation - chest expansion
3. Percussion - 4 levels
4. Auscultation - 4 levels (+ vocal fremitus)
5. Sacral oedema
6. Pedal oedema
To conclude
THANK, WASH HANDS AND STETHOSCOPE, OFFER TO HELP GET DRESSED
Check patient’s observations
Measure Peak Flow
Consider Sputum Pot
Consider checking inhaler technique
