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    Macloaed Only Examination

    Uploaded by

    Tahir Ali
    The document outlines steps for conducting a general examination of patients with breathlessness, including: 1. Measuring respiratory rate, checking for accessory muscle use, listening for stridor, and checking blood pressure and pulse. 2. Looking for tremors by having the patient hold out their arms or squeeze fingers, and checking lymph nodes in the neck. 3. Palpating the trachea, measuring distance between neck landmarks, and assessing chest expansion through palpation and observation. 4. Percussing the chest to identify abnormal lung areas. 5. Auscultating the lungs anteriorly, laterally, and posteriorly to assess breath sounds.

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    Macloaed Only Examination

    Uploaded by

    Tahir Ali
    27 views3 pages
    The document outlines steps for conducting a general examination of patients with breathlessness, including: 1. Measuring respiratory rate, checking for accessory muscle use, listening for stridor, and checking blood pressure and pulse. 2. Looking for tremors by having the patient hold out their arms or squeeze fingers, and checking lymph nodes in the neck. 3. Palpating the trachea, measuring distance between neck landmarks, and assessing chest expansion through palpation and observation. 4. Percussing the chest to identify abnormal lung areas. 5. Auscultating the lungs anteriorly, laterally, and posteriorly to assess breath sounds.

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    MACLOAED EXAMKINATION PART ONLY

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    The document outlines steps for conducting a general examination of patients with breathlessness, including: 1. Measuring respiratory rate, checking for accessory muscle use, listening for stridor, and checking blood pressure and pulse. 2. Looking for tremors by having the patient hold out their arms or squeeze fingers, and checking lymph nodes in the neck. 3. Palpating the trachea, measuring distance between neck landmarks, and assessing chest expansion through palpation and observation. 4. Percussing the chest to identify abnormal lung areas. 5. Auscultating the lungs anteriorly, laterally, and posteriorly to assess breath sounds.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    27 views3 pages

    Macloaed Only Examination

    Uploaded by

    Tahir Ali
    The document outlines steps for conducting a general examination of patients with breathlessness, including: 1. Measuring respiratory rate, checking for accessory muscle use, listening for stridor, and checking blood pressure and pulse. 2. Looking for tremors by having the patient hold out their arms or squeeze fingers, and checking lymph nodes in the neck. 3. Palpating the trachea, measuring distance between neck landmarks, and assessing chest expansion through palpation and observation. 4. Percussing the chest to identify abnormal lung areas. 5. Auscultating the lungs anteriorly, laterally, and posteriorly to assess breath sounds.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    General examination

    1. Measure the respiratory rate in all patients with breathlessness

    Note if the patient is breathless at rest and count the


    respiratory rate (breaths/min) for 3060 seconds while you
    feel the pulse and assess chest movements.

    2. Notice if the patient is using the accessory muscles of respiration.

    3. Ask the patient to cough and then breathe deeply in and out with
    the mouth wide open. Listen closely to the patients mouth, for
    stridor.
    4. Lips and tongue : Ask the patient to open his mouth and look at
    the lips and the underside of the tongue for a purplish blue
    discoloration in natural light .
    5. Measure blood pressure and check the pulse

    6. Ask the patient to hold out his arms with the hands extended at the
    wrists. Look for a jerky, flapping tremor (asterixis). Alternatively,
    ask the patient to squeeze your index and middle fingers and
    maintain this for 3060 seconds. Patients with a flapping tremor
    cannot maintain their grip.

    7. Look for enlargement of the cervical, supraclavicular and scalene


    lymph nodes
    8. Palpate the neck : Note the size and consistency of any palpable
    node and whether it is fixed to surrounding structures.
    9. Look for enlargement of the cervical, supraclavicular and scalene
    lymph nodes.
    10. Palpate the neck : Note the size and consistency of any palpable
    node and whether it is fixed to surrounding structures.

    Palpation
    1. With the patient looking directly forwards, look for any deviation
    of the trachea.

    2. Gently place the tip of your right index finger into the
    suprasternal notch and palpate the trachea (Fig. 7.15). This can
    be uncomfortable; be gentle and explain what you are doing.
    Slight displacement to the right is common in healthy people.

    3. Measure the distance between the suprasternal notch and


    cricoid cartilage, normally 34 finger breadths; any less suggests
    lung hyperinflation.

    4. Stand behind the patient and assess expansion of the upper


    lobes by watching the clavicles during tidal breathing.
    5. Assess expansion of the lower lobes by placing your hands
    firmly on the chest wall. Extend your fingers around the sides of
    the patients chest (Fig. 7.16). Your thumbs should almost meet
    in the midline and hover just off the chest so they can move
    freely with respiration.

    6. Ask the patient to take a deep breath. Your thumbs should move
    symmetrically apart by at least 5 cm.

    7. With the patient supine, look for paradoxical inward movement


    of the abdomen during inspiration.

    Percussion

    1. Place the palm of your left hand on the chest, with your fingers
    slightly separated (Fig. 7.18C).
    2. Press the middle finger of your left hand firmly against the chest,
    aligned with the underlying ribs over the area to be percussed.
    3. Strike the center of the middle phalanx of your left middle finger
    with the tip of your right middle finger, using a loose swinging
    movement of the wrist and not the forearm.
    4. Remove the percussing finger quickly so the note generated is not
    dampened.
    5. Percuss the lung apices by placing the palmar surface of your left
    middle finger across the anterior border of the trapezius muscle,
    overlapping the supraclavicular fossa and percussing downwards.
    6. Percuss the clavicle directly over the medial third, as percussing
    laterally is dull over the shoulder muscles.
    7. Ask the patient to fold the arms across the front of the chest,
    moving the scapulae laterally and percuss the upper posterior chest.
    Do not percuss near the midline, as solid structures of the thoracic
    spine and paravertebral musculature produce a dull note.
    8. Map out abnormal areas by percussing from resonant to dull.
    Percuss each side alternately and compare the note.
    9. Place the palm of your left hand on the chest, with your fingers
    slightly separated (Fig. 7.18C).
    10. Press the middle finger of your left hand firmly against the chest,
    aligned with the underlying ribs over the area to be percussed.
    11. Strike the centre of the middle phalanx of your left middle finger
    with the tip of your right middle finger, using a loose swinging
    movement of the wrist and not the forearm.
    12. Remove the percussing finger quickly so the note generated is not
    dampened.
    13. Percuss the lung apices by placing the palmar surface of your left
    middle finger across the anterior border of the trapezius muscle,
    overlapping the supraclavicular fossa and percussing downwards.
    14. Percuss the clavicle directly over the medial third, as percussing
    laterally is dull over the shoulder muscles.
    15. Ask the patient to fold the arms across the front of the chest,
    moving the scapulae laterally and percuss the upper posterior chest.
    Do not percuss near the midline, as solid structures of the thoracic
    spine and paravertebral musculature produce a dull note.
    16. Map out abnormal areas by percussing from resonant to dull.
    Percuss each side alternately and compare the note.

    Auscultation
    1. Listen with the patient relaxed and breathing deeply through his
    open mouth. Avoid asking him to breathe deeply for prolonged
    periods, as this causes giddiness and even tetany. Auscultate each
    side alternately, comparing findings over a large number of
    equivalent positions to ensure that you do not miss localized
    abnormalities.
    2. Listen: anteriorly from above the clavicle down to the sixth rib
    laterally from the axilla to the eighth rib posteriorly down to the
    level of the 11th rib.
    3. Assess the quality and amplitude of the breath sounds. Identify any
    gap between inspiration and expiration, and listen for added sounds.
    Avoid auscultation within 3 cm of the midline anteriorly or
    posteriorly, as these areas may transmit sounds directly from the
    trachea or main bronchi.
    4. Listen with the patient relaxed and breathing deeply through his
    open mouth. Avoid asking him to breathe deeply for prolonged
    periods, as this causes giddiness and even tetany. Auscultate each
    side alternately, comparing findings over a large number of
    equivalent positions to ensure that you do not miss localized
    abnormalities.
    5.

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