Thursday, 29 May 2008

Check list for respiratory examination:

Introduce yourself & identify the patient’s details
Gain informed consent from the patient
Patient should have their chest exposed & lying in a semi-supine position (at an angle of 45%) or sitting on the end of the bed.
Examine the sputum pot

· General inspection from edge of the bed including respiratory rate
· Inspection of the hands: - Finger clubbing? Nicotine staining? Tremor? Peripheral cyanosis?
· Inspection of chest wall: Movement; scars present? Deformities?
· Face: Central cyanosis present?

Increase rate (i.e. tachycardia) may indicate respiratory disease (e.g. in severe asthma). Increased pulse volume may be present in CO2 retention. Pulsus paradoxus present?

· Position of trachea (deviation,crico-sternal distance)
· Location & character of apex beat
· chest expansion


Percuss the supraclavicular, anterior, axillary & posterior aspects of the chest. Remember to compare sides. Percussion note: Resonant, Dull, Stony dull or Hyper-resonant”?

With the diaphragm component of your stethoscope auscultate the supraclavicular, anterior, axillary & posterior aspects of he chest remember to compare sides. Make to ascertain: Intensity of air entry, breath sounds & the presence of any added sounds
Ask the patient to say "99" every time you change your stethoscope position over the patients’ chest wall. Vocal resonance is increased over solid areas of lung with open airways - for example, consolidation; and decreased by pleural fluid

What is a whispering pectoriloquy?
A whispering pectoriloquy is the increase in vocal resonance, to the extent that when a patient whispers, his voice may be heard clearly with a stethoscope on his chest over an area of lung consolidation.
what is aegophony?
Aegophony is a term for the high pitched nasal bleating quality of speech heard over the top of a pleural effusion where low frequency sounds are dispersed.

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