Respiratory Examination
Last modified: 20 March 2021, 7:35:44 PM AEDT
Position1 / 7
- upright
General inspection2 / 7
- age
- young = likely asthma / CF
- older = COPD / ILD / Ca
- treatments
- O2
- inhalers
- nebulisers
- sputum pots
- SOB / SOBAR
- full sentences?
- cyanosis
- cachexia
- Ca / CF / COPD
- cough
- productive = bronchiectasis / COPD / CF
- dry = asthma / ILD
- wheeze = expiratory = asthma / COPD / bronchiectasis
- stridor = inspiratory = upper airway obstruction
Hands3 / 7
Inspect
- tar staining = smoker
- clubbing = lung Ca / interstitial lung disease / bronchiectasis
- peripheral cyanosis = SpO2 < 85
- features of rheumatological disease (eg. RA => pleural effusions, etc)
- features of steroid use (bruising + thinning) = ILD / asthma / COPD
- fine tremor = ADR of beta-2 agonist (eg. salbutamol)
- flapping tremor = CO2 retention
Palpate
- temperature
- cool = peripheral vasoC / poor perfusion
- pulse
- rate
- rhythm
- pulsus paradoxus
Head and neck4 / 7
Inspect
- conjunctival pallor
- ask patient to lower an eyelid
- anaemia
- Horner's syndrome
- central cyanosis
- JVP
Thorax5 / 7
Inspection
- scars
- chest drains = MAL
- thoracotomy = horizontal postero-lateral
- radiotherapy scars
- asymmetry = major surgery
- pneumonectomy
- deformity
- barrel chest = COPD
- pectus excavactum
- pectus carinarum
Palpation
- tracheal deviation
- towards = pneumonectomy, lobar collapse
- away from = pleural effusion, pneumothorax
- cricosternal distance
- suprasternal notch + cricoid cartilage
- < 3 patient fingers = hyperinflation
- apex beat
- RV heave = cor pulmonale
- chest expansion
- hands on patient's chest, with thumbs meeting in midline
- deep inspiration
- asymmetry = likely reduced expansion
- lung collapse
- pneumonia
Percussion
- areas
- supraclavicular = lung apices
- infraclavicular
- chest wall = 3 locations bilaterally
- axilla
- percussion note
- resonant = normal
- dullness = increased tissue density
- consolidation
- fluid
- tumor
- collapse
- stony dullness = pleural effusion
- hyper-resonance = decreased tissue density
- pneumothorax
Auscultation
- breath sounds
- quality
- vesicular = normal
- bronchial = consolidation
- volume
- quiet = reduced air entry = consolidation / collapse / pleural effusion
- added sounds
- wheeze = asthma / COPD
- coarse crackles = pneumonia / bronchiectasis / fluid overload
- fine crackles = pulmonary fibrosis
- vocal resonance
- "say 99" and auscultate chest
- increased volume = increased tissue density
- consolidation / tumor / collapse
- decreased volume
- pleural effusion
Other6 / 7
- Lymph nodes
- anterior + posterior triangles
- supraclavicular region
- axillary region
- Sacrum
- oedema
- Legs
- pitting oedema
- signs of DVT
- evidence of erythema nodosum (assoc w sarcoidosis)