RESPIRATORY EXAMINATION

×
Rating : Rate It:
 
Embed :   
 
seyed javad rekabpour    on Oct 13, 2012 Says :

thanks for your presentasion
denise    on Apr 19, 2010 Says :

great slides...it really helped me to understand respiratory assessment better...thankS!!!
Post a comment
    Post Comment on Twitter
Comments:  
4 Favorites
lonelyshams,   favourited this   4 Days ago.
Parvati,   favourited this   3 Years ago.
az khan860,   favourited this   3 Years ago.
dekram18,   favourited this   3 Years ago.
First Prev [1] Next Last



  Notes
 
 
Slide 1 : Respiratory Examination BY ASHRAF OKBA PROF. OF INTERNAL MEDICINE AIN SHAMS UNIVERSITY
Slide 2 :
Slide 3 :
Slide 4 :
Slide 5 :
Slide 6 :
Slide 7 :
Slide 8 : Personal History: Stress on the following points Occupation: e.g. – Silicosis may be complicated by pulmonary T.B. – Asbestosis may be complicated by mesothelioma Ask about the following: 1-Duration of exposure: several years needed for pneumoconiosis. 2-Adherence to safety measures as wearing special masks. Special Habits smoking cigarettes, shesha and goza.
Slide 9 : The six cardinal symptoms of chest diseases are:    1- Cough 2- Expectoration (sputum)      3- Hemoptysis 4- Chest pain     5- Dyspnea      6- Wheezes History of the present illness
Slide 10 :   Other symptoms of importance in chest diseases : 1- Symptoms of mediastinal syndrome as dysphagia and hoarseness of voice. 2-   Symptoms of toxemia as night fever, night sweats, loss of appetite and weight as in T.B. 3-  Symptoms of RVF as LLs edema and pain in the RUQ of the abdomen ( due to congested tender liver). 4-   Fever as in upper and lower resp. tract infections.     Finally any other symptoms related to other systems. History of the present illness2
Slide 11 : Attack or disease similar to the present one: e.g. - Asthma. - Recurrent pneumonia Allergic disorders: eczema, urticaria, angioedema and hay fever. Acute abdominal conditions. Admission in any hospital before and why? Bilharziasis: bilharzial cor pulmonale. Past History1
Slide 12 : Chest injuries and operations. Other Surgical Procedures. Coma , convulsions….may predispose to aspiration lung abscess Cardiac diseases and history of rheumatic fever.  Past History2
Slide 13 : Diabetes mellitus Hypertension. Cough may result from ACE inhibitors T.B and history of admission to a chest hospital for treatment of T.B. medicines, duration of the treatment and the adherence to it. Previous radiological examination: comparison with the current radiograph Past History3
Slide 14 :  Similar condition in the family. History of T.B. History of allergy as eczema and hay fever. History of DM Family and Social History
Slide 15 : Ask about the following: The frequency  The severity Dry or productive Time of occurrence Relation to posture Character of cough (better observed by the physician) Cough Analysis of Chest Symptoms1
Slide 16 : Sputum Analysis of Chest Symptoms2 Amount Color Character (seous, mucoid,purulent and mucopurulent) Odor Relation to posture What increases or decreases it Associated conditions
Slide 17 : Hemoptysis1: Analysis of Chest Symptoms3 The most important causes of hemoptysis are Mitral stenosis Pulm tuberculosis Pulm infarction Brochiectasis Bronchogenic carcinoma Bronchial adenoma Bleeding tendency
Slide 18 : Differentiate between hemoptysis and hematemesis Ask about : Type and Degree Frequency and Duration Ask about the preceding events e.g. DVT or chest infection Hemoptysis2: Analysis of Chest Symptoms4
Slide 19 : Type and Degree Hemoptysis3: Analysis of Chest Symptoms5 Frank hemoptysis Blood-stained sputum Blood streaked sputum Rusty sputum Frequency and duration
Slide 20 :   Chest pain: The onset.. Site. Character. Radiation. What increases the pain what relieves or decreases it. Associated symptoms. Analysis of Chest Symptoms6
Slide 21 : Wheeze What dose the patient mean by wheezing? differentiate between wheeze and stridor. Wheezing may be intermittent as in asthma or persistent as in chronic bronchitis. Wheezing may be diffuse as in asthma and chronic bronchitis or localized as in bronchogenic carcinoma. Analysis of Chest Symptoms7
Slide 22 : CHEST EXAMINATION
Slide 23 : Inspection of anterior chest wall 1) Ask the patient to lie supine. 2) Ask the patient to lower his gown to waist level. 3) Stand at the feet of patient. 4) Inspect the shape of the chest (ratio of antero-posterior and transverse diameters). 5) Inspect the symmetry of the patient’s chest on both sides with comparison.
Slide 24 :
Slide 25 :
Slide 26 : Chest wall Pectus carinatum Pectus excavatum
Slide 27 :
Slide 28 : Inspection of anterior chest wall 6) Inspect patient’s chest normal breathing movement. 7) Inspect patient’s chest for accessory muscle use. 8) Inspect patient’s chest for retraction of lower intercostal spaces. 9) Stand again to the right of patient and look tangentially for apical and epigastric pulsation. 10) Inspect the chest wall and skin for swelling, scars, skin eruption or engorged veins.
Slide 29 : Palpation of anterior chest wall 1) Stand to the right of the patient. 2) Ask the patient to lie supine. 3) Palpate upper lung zone to confirm the movement by placing the palms in the infraclavicular fossa and the two thumbs in the midline at the level of suprasternal notch. Let the patient inspire deeply and let your thumbs follow chest movement. 4) Palpate middle lung zone by putting the palm in the middle part with tips of thumbs in the midline. Let the patient inspire deeply and let your thumbs follow chest movement.
Slide 30 :
Slide 31 : Palpation of anterior chest wall 5) Palpate lower lung zone by putting the palm in the lower part with tips of thumbs in the midline. Let the patient inspire deeply and let your thumbs to follow chest movement. 6) Palpate for palpable rhonchi, pleural rub or chest wall tenderness by putting the palm on various areas of chest wall. 7) Palpate for Tactile vocal fremitus a) Place the palm of hand over various area of chest wall in the direction of bronchial tree away from midline with comparison. b) Ask the patient to repeat the words “44” in arabic
Slide 32 : TVF2
Slide 33 : Tracheal examination: a) Stand to the right of the patient. b) Ask the patient to sit up with the head straight. c) Inspect for tracheal position “Trill’s sign”. d) Tracheal shift: Insert the index finger in horizontal position in the pouch between the medial end of sternomastoid and the lateral aspect of trachea with comparison. e) Check the cricosternal distances. This is the distance between the cricoid cartilage and the suprasternal notch. If it is less than 3 finger breadths, this indicates hyperinflation of the lung. f) Tracheal descent: place the tip of the index finger on the thyroid cartilage during inspiration to observe its descent.
Slide 34 :
Slide 35 : Percussion technique Place left hand on chest wall, palm downwards with fingers separated 2nd phalanx over area of intercostal space Right middle finger strikes the 2nd phalanx producing hammer effect Entire movement comes from wrist
Slide 36 :
Slide 37 : Percussion of the chest anterior chest wall 1- Stand to the right of the patient. 2- Ask the patient to lie supine. 3- Use light percussion. 4- Krönig’s isthmus: Percuss both areas right and left from dullness to resonance (start from the neck) with comparison. 5- Percuss both clavicles directly (over medial third) 6- Percuss the infraclavicular regions. 7- Percuss both parasternal lines right and left, from the second space to the sixth space with comparison. 8- Spare bare area to be percussed late with special areas percussion. 9- Percuss both midclavicular lines right and left, from the second space to the sixth space with comparison. 10-Comment on dullness found.
Slide 38 : Percussion of the lateral chest wall 1-Stand to the right of the patient. 2-Ask the patient to lie supine and raise his hands above his head. 3-Use light percussion. 4-Percuss both anterior axillary lines right and left, from the fourth space to the eighth space with comparison. 5-Percuss both middle axillary lines right and left, from the fourth space to the eighth space with comparison. 6-Percuss both posterior axillary lines right and left, from the fourth space to the eighth space with comparison. 7-Comment on dullness found.
Slide 39 : Upper border of the liver 1- Stand to the right of the patient. 2- Ask the patient to lie supine. 3- Use heavy percussion. 4- Start in the right midclavicular line from second space down to the first dullness. 5- Decide the upper border of the liver.
Slide 40 : Bare area of the heart 1- Stand to the right of the patient. 2- Ask the patient to lie supine. 3- Place the left hand in the left 4th and the 5th spaces between midline and parasternal line. 4- Percuss lightly with right hand. 5-Comment.
Slide 41 : Tidal percussion 1- Stand to the right of the patient. 2- Ask the patient to sit. 3- After percussing the back using heavy percussion if any infrascapular dullness was found, fix the left hand over it and ask the patient to take a deep breath and hold it then percuss again. 4- Comment on whether it changed to be resonant or not and explain.
Slide 42 : Percussion of the lateral chest wall 1- Stand to the right of the patient. 2- Ask the patient to lie supine and raise his hands above his head. 3- Use light percussion. 4- Percuss both anterior axillary lines right and left, from the fourth space to the eighth space with comparison. 5- Percuss both middle axillary lines right and left, from the fourth space to the eighth space with comparison. 6- Percuss both posterior axillary lines right and left, from the fourth space to the eighth space with comparison. 7- Comment on dullness found.
Slide 43 : Kronig’s isthmus 1- Stand to the right of the patient. 2- Ask the patient to sit and stand behind him. 3- Use light percussion. 4- Percuss both areas right and left from dullness to resonance with comparison. 5- Comment on dullness found.
Slide 44 : Auscultation of the chest anterior chest wall 1) Stand to the right of the patient 2) Ask the patient to lie supine. 3) Auscultate both midclavicular lines right & left, from the second space to the sixth space with comparison. 4) Ask the patient to say ‘ 44 ’ and auscultate both midclavicular lines right & left, from the second space to the sixth space with comparison
Slide 45 : Anterior Auscultation
Slide 46 : Auscultation of the lateral chest wall 1) Auscultate both midaxillary lines right & left, from the fourth space to the eighth space with comparison 2) Ask the patient to say ‘ 44 ’ and auscultate both midaxillary lines right & left, from the fourth space to the eighth space with comparison Comment on : a) Breath sounds (character, intensity) b) Adventitious sounds (wheeze, crepitations) c) Type of wheeze if present ( inspiratory or expiratory, localized or generalized ) d) Type of crepitations if present (fine or coarse, change with cough) e) Vocal resonance
Slide 47 : Breathing Patterns
Slide 48 : Examination of posterior chest wall
Slide 49 : Inspection of posterior chest wall 1) Stand behind the patient in a midline position. 2) The patient should be sitting with the posterior thorax exposed. 3) Inspect the cervical, thoracic and upper lumbar spine for deformity. 4) Assess for costovertebral tenderness by placing the ball of one hand in the costovertebral angle and strike it with the ulnar surface of your fist 5) Inspect for scars.
Slide 50 :
Slide 51 : Palpation of posterior chest wall 1) Stand behind the patient in a midline position. 2) The patient should be sitting with the posterior thorax exposed. 3) Assess extent and symmetry of lower thoracic expansion by a) Place your thumbs at the level of the 10th ribs with your fingers loosely grasping the rib cage and gently slide them medially. b) Ask the patient to inhale deeply and observe whether your thumbs move apart symmetrically. 4) With palms of hands, assess symmetry of fremitus throughout lung fields.
Slide 52 :
Slide 53 : Percussion of the posterior chest wall 1-Stand to the right of the patient. 2-Ask the patient to sit and his hands folded across the anterior chest wall. 3-Use heavy percussion. 4-Percuss suprascapular area with comparison 5-Percuss both scapulae directly. 6-Percuss both infrascapular areas to the 10th space comparing right and left sides. 7-Percuss interscapular area on the right and left sides with comparison 8-Comment on dullness found.
Slide 54 : Auscultation of the posterior chest wall 1) Stand to the right of the patient. 2) Ask the patient to sit and his hands folded across the anterior chest wall 3) Auscultate both scapular lines right & left, from the apex to the tenth space with comparison. 4) Ask the patient to say ‘44 ’ and auscultate both scapular lines right & left, from the apex to the tenth space.
Slide 55 : Posterior Auscultation
Slide 56 : Interpretation of findings Pleural effusion reduced tactile vocal fremitus reduced chest expansion stony dull reduced air entry no added sounds reduced vocal resonance Consolidation increased tactile vocal fremitus reduced expansion dull percussion bronchial breathing coarse creps increased vocal resonance whispering pectoriloquy
Slide 57 : Interpretation of findings Pneumothorax deviated trachea reduced tactile vocal fremitus hyper-resonance reduced air entry reduced vocal resonance Collapse deviated trachea reduced tactile vocal fremitus dull percussion reduced air entry +/- creps
Slide 58 : Technique of Auscultation1 Patient relaxes and breathes normally with mouth open, auscultate lungs, apices and middle and lower lung fields posteriorly, laterally and anteriorly. Alternate and compare both sides at each site. Listen at least one complete respiratory cycle at each site. Listen to quiet respiration. If sounds are inaudible, then ask him take deep breaths. First describe the breath sounds and then the adventitious sounds.
Slide 59 : Technique of Auscultation2 Note intensity of breath sounds and compare with opposite side. Assess length of inspiration and expiration. Listen for a pause between inspiration, expiration and the quality of pitch of sound compare intensity of breath sounds between upper and lower chest in upright position. Compare intensity of breath sounds from dependent to top lung in decubitus position. Note the presence or absence of adventitious sounds.
Slide 60 : Normal Breath Sounds1 The normal breath sounds over lung tissue are vesicular breathing. The vesicular breathing is lower pitched and softer than bronchial breathing. Expiration is shorter (I > E) and no pause between inspiration and expiration. The breath sounds are symmetrical and louder in intensity in bases compared to apices in erect position and dependent lung areas in decubitus position. No adventitious sounds are heard.
Slide 61 : Normal Breath Sounds2 The breath sounds over tracheobronchial tree are bronchial breathing. only place where tracheobronchial trees are close to chest wall without surrounding lung tissue are Trachea right sternoclavicular joints posterior right interscapular space. These sites where bronchial breathing can be normally heard. bronchial breath sounds have a higher pitch, louder, inspiration and expiration are equal and pause between inspiration and expiration.
Slide 62 : prolonged expiratory phase (E > I) indicates airway narrowing, as in: Vesicular breathing with prolonged expiration Bronchial asthma. Chronic bronchitis

 


Related 

 
Free Powerpoint Templates
Add as Friend okba100@yahoo.com     4 Years ago.
11754 Views, 5 favourite
METHODS OF CLINICAL EXAMINATION OF A CASE WITH CHEST PROBLEMS- Slides
More By User

Flag as inappropriate





Browse | Powerpoint Templates | Tags | Contact | About Us | Privacy | FAQ | Blog

© Slideworld