Respiratory Examination
Respiratory Examination
General Knowledge
Focus points
GENERAL APPEARANCE General state of health and sick or not sick?The examination is performed with the patient sitting over the edge of the bed or on a chair
Observe for nasal prongs, oxygen masks, metered dose inhalers (puffers) and other medications, and the presence of a sputum in tissues/mug
Respiratory pattern / Signs of dyspnoea at rest.
Tripod leaning forward with their arms on their knees, this compresses the abdomen and pushes the diaphragm upwards, and braces the accessory muscles
Tracheal tug: due to increased diaphragmatic movements causes downward displacement of the trachea during inspiration-.
Rate
Count the respiratory rate surreptitiously over 30 seconds; normal rate at rest < 25 breaths per minute (range 16-25).
Tachypnoea > 25.
Bradypnoea < 8 a level associated with sedation and adverse prognosis.
Rhythm (i:e)
Prolonged expiratory phase is associated with obstructive airway diseases.
Effort.
In normal relaxed breathing, the diaphragm is the only active muscle and only in inspiration; expiration is a passive process. Observe for use of accessory muscles the accessory muscles which cause elevation of the shoulders with inspiration, and aid respiration by increasing chest expansion, diaphragmatic paralysis or abdominal disassociation.
Cyanosis
Examination of the tongue differentiates central from peripheral cyanosis.
Significant ventilation-perfusion imbalance, such as pneumonia, COPD and pulmonary embolism, may cause reduced arterial oxygen saturation.
Cyanosis becomes evident when SaO2 falls below 90% in a person with a normal Hb level. Absence of cyanosis does not exclude hypoxia
Cough
Evidence of haemoptysis or sputum in tissues, sputum mugs etc.
The colour, volume and type (purulent, mucoid or mucopurulent), Ask the patient to cough several times.
A muffled, wheezy, ineffective cough obstructive pulmonary disease.
A loose productive cough
General Knowledge
Focus points
GENERAL APPEARANCE General state of health and sick or not sick?The examination is performed with the patient sitting over the edge of the bed or on a chair
Observe for nasal prongs, oxygen masks, metered dose inhalers (puffers) and other medications, and the presence of a sputum in tissues/mug
Respiratory pattern / Signs of dyspnoea at rest.
Tripod leaning forward with their arms on their knees, this compresses the abdomen and pushes the diaphragm upwards, and braces the accessory muscles
Tracheal tug: due to increased diaphragmatic movements causes downward displacement of the trachea during inspiration-.
Rate
Count the respiratory rate surreptitiously over 30 seconds; normal rate at rest < 25 breaths per minute (range 16-25).
Tachypnoea > 25.
Bradypnoea < 8 a level associated with sedation and adverse prognosis.
Rhythm (i:e)
Prolonged expiratory phase is associated with obstructive airway diseases.
Effort.
In normal relaxed breathing, the diaphragm is the only active muscle and only in inspiration; expiration is a passive process. Observe for use of accessory muscles the accessory muscles which cause elevation of the shoulders with inspiration, and aid respiration by increasing chest expansion, diaphragmatic paralysis or abdominal disassociation.
Cyanosis
Examination of the tongue differentiates central from peripheral cyanosis.
Significant ventilation-perfusion imbalance, such as pneumonia, COPD and pulmonary embolism, may cause reduced arterial oxygen saturation.
Cyanosis becomes evident when SaO2 falls below 90% in a person with a normal Hb level. Absence of cyanosis does not exclude hypoxia
Cough
Evidence of haemoptysis or sputum in tissues, sputum mugs etc.
The colour, volume and type (purulent, mucoid or mucopurulent), Ask the patient to cough several times.
A muffled, wheezy, ineffective cough obstructive pulmonary disease.
A loose productive cough