3. ntroduction
ermission
ash hands
osition – patient at 45 degrees
xposure – remove clothing from upper body
ain – patient comfortable? In any pain?
ight – ensure lighting is adequate.
6. eripheral stigmata of respiratory disease:
– peripheral cyanosis
– anaemia
– Clubbing
–Tar (not nicotine) staining
– wasting of muscles of back of hand
7. eripheral stigmata of respiratory disease:
– peripheral cyanosis
– anaemia
– clubbing
– Tar (not nicotine) staining
– wasting of muscles of back of hand – particularly between thumb
and index finger – apical tumour e.g. pancoast’s tumour – erodes
into brachial plexus (affects innnervation of muscles).
ulse
espiratory rate
12. lood pressure
VP
arotid pulse to assess pulse volume – may be bounding
in CO2 retention or sepsis.
yes:
– Anaemia
– Horner’s syndrome
ose : if really thin and skin tight over it think systemic
sclerosis
13. ymmetry- Get patient to take deep breath in and out
cars- Tracheotomy, Thoracotomy (lift arms up), Midline
sternotomy
http://www.blebinfo.co.uk/media/use
rimages/CIMG0779.jpg
14. ymmetry- Get patient to take deep breath in and out
cars- Tracheotomy, Thoracotomy (lift arms up), Midline
sternotomy
hest deformity-
22. o conclude my examination I would like to:
– Look at observations chart
– Check any sputum pots
– Peak flow or bedside spirometry
– Look at any blood results, lung function tests, CXRs, ABGs that
have been done
– May want to test urine for Legionella antigen.
hank patient.
ash hands
23. heeze- due to partial obstruction of airway
Polyphonic (asthma or COPD- multiple airways)
Monophonic (e.g tumour partially blocking single
airway)
iming of crackles-
Early inspiratory= consolidation
Mid inspiratory = fibrosis
26. 4yr old man
day history of progressively worsening SOB,
wheeze and productive cough with thick yellow
sputum
ife says he has also been slightly muddled over
last 2 days.
27. atient has had COPD for 10years, has 3 chest
infections a year on average. Does not use
home oxygen but has nebulisers at home. Gets
SOB on walking 20yards normally.
x smoker
28. ncreased work of breathing, accessory muscles
used.
arm sweaty hands
achycardic bounding pulse. RR 28
yperinflated barrel chest
35. Severity – Confusion, hypotension, low O2
all bad signs- Severe exacerbation of
COPD.
im
→Treat hypoxia, bronchospasm and infection.
36. BC
xygen - Venturi mask. Aim for oxygen greater
than 8. If concerned about hypoxia give high
flow oxygen initially then switch. Do repeat
ABGs
V Fluids
ntibiotics
37. Confusion (New AMT<8)
Urea >7mmol/L
Respiratory rate >30
BP <90mmHg systolic or 60mmHg diastolic
5 Age 65yrs or over
39. lick, confident examination = pass finals Practice!→
lues before even touch patient
now basic findings for common respiratory conditions.
nvestigations for common respiratory conditions- easy
ones first.
anagement- logical order, know why you are requesting
tests. Always say ABC. They don’t expect you to know
everything.
40. – Notes, Powerpoints, Videos, Podcasts and Practice
Questions. Community based so can share
information. Free.
astest or ONExamination for practice MCQs and
Extended Matching Questions.
