Respiratory Assessment

 

Emergency

 

Hx

Ex

Ix

Mx

 

Index

 

  

 

Respiratory History

 

HPI

PMH

 

Social

 

Family

 

 

  

Respiratory History of Presenting Illness (HPI)

 

- Cough: COPD (bronchitis), pneumonia, PE, ACEI

- Sputum

-  Blood: bronchiectasis, lung cancer, TB

-  Pink frothy: pulmonary oedema

-  Dry: URTI, ACEI

-  Productive: pneumonia (green, rusty), bronchitis (white), asthma (white)

-  Nocturnal: asthma

-  Chest pain

-  Pleuritic: PE, pneumonia, rib #, pneumothorax

-  Dyspnoea

-  APO

-  Pneumonia, asthma, COPD

-  Fever: pneumonia, COPD infective exacerbation, PE

-  Weight loss: TB, COPD, lung cancer

-  Sweating: TB, pneumonia

-  Sleeping: OSA

 

 

 

  

Respiratory Past Medical History (PMH)

 

- Atopy/allergies: hay fever, asthma, eczema

- Sleep

- Day time somnolence, snoring, dry mouth, morning headaches: OSA

- Insomnia: depression, pain

- Immunisations: pneumococcus, influenza

 

 

 

  

Respiratory Social & Personal History

 

-  Occupation

-  Dust exposure: pulmonary fibrosis

-  Smoking: COPD, lung cancer

-  Current, past, passive

-  Pack years (1 pack = 20 ciggarettes)

-  Quit attempts

-  Alcohol: aspiration pneumonia

-  Drugs

-  ADLs, exercise tolerance

-  Pets: atypical pneumonia

 

 

 

  

Respiratory Family History

 

- CF, atopy

- COPD: alpha 1 antitrypsin def.

- Smokers: COPD, lung Ca

- Occupation: silicosis, asbestos: restrictive lung disease

 

 

 

 

Respiratory Examination

 

General

 

Head

 

Arm

 

Chest

Abdo

Leg

 

 

 

  

General Respiratory Examination

 

-  Cough: dry, productive, bovine

-  Sputum: haemoptysis, color

-  Profuse: CF

-  Foul smelling: bronchiectasis

-  Respiratory distress

-  Ability to talk in single words, short sentences

-  Pink puffer: COPD (emphysema)

-  Blue bloater: COPD (chronic bronchitis +/- cor pulmonale)

-  Confusion: CO2 retention

-  Wasting/weakness: COPD, restrictive lung disease, lung Ca, CF

-  Cushingoid: chronic steroids: asthma, COPD

 

 

 

  

Respiratory Head & Neck Exam

 

-  Horners syndrome: Pancoast tumour

-  Cyanosis (tongue, lips)

-  Hoarse voice: recurrent laryngeal nerve path

-  Maxillary tenderness: sinusitis

-  Nasal flaring: asthma

-  Difficulty speaking (words, sentences): asthma

-  Accessory muscle use

-  Tonsils: pharyngitis, tonsilitis

-  Crowded pharynx: OSA

-  Ear Exam

-  Nose Exam

-  Polyps: CF

-  Pembertons Sign: Pancoast tumour

-  Tracheal deviation

-  Pneumothorax: ipsilateral

-   Contralateral: tension pneumothorax

-  Tumour: ipsilateral

-  Atelectasis: ipsilateral

-  Tracheal tug

-  COPD, asthma

-  Lymph nodes

-  JVP elevation

-  Hypervolaemia

-  R heart failure

 

 

 

  

Respiratory Upper Limb Exam

 

-  Clubbing: CF, bronchiectasis, lung Ca

-  Cyanosis

-  Wrist pain: HPOA

-  Intrinsic hand muscle wasting: T1 nerve compression (Pancoast tumour..)

-  Asterixis: CO2 retention

-  DDx tremor from B agonists: asthma, COPD

-  Nicotine (tar) staining: smoking

-  Pulse: pulsus paradoxus

-  Resp rate

 

 

 

  

Respiratory Chest Exam

 

Sequence of Resp Chest Exam 

-  Post chest

-  Inspect

-  Palpate: expansion, tactical fremitus

-  Percuss: intercostal

-  Auscultate: intercostal, vocal resonance

-  Ant chest

-  Inspect

-  Palpate: tacticle fremitus, apex beat, bony tenderness/crepitus

-  Percuss: apicies, intercostal, axilla

-  Auscultate: apicies, intercostal, axilla, vocal resonance

 

General Inspection

-  Uneven rise & fall

-  Pneumothorax

-  Pneumonia

-  Atelectasis

-  Flail chest: rib #

-  Scars

-  Deformity

-  Pectus excavatum/carinatum: obstructive lung disease

-  Kyphoscoliosis

 Barrel chest: COPD

-  Intercostal recession: asthma, COPD

 

Pectus

 

Palpation

-  Chest expansion

-  Tacticle Fremitus: consolidation

-  Apex beat

-  Bony tenderness/crepitus: bony metastasis

 

Percussion

-  Intercostal spaces, axilla & apicies

-  Dullness = collapse/consolidation

-  Pneumonia

-  Atelectasis

-  Hyper-resonant

-  Pneumothorax

-  Resonance: normal

 

Auscultation

-  Intercostal spaces, axilla & apicies

-  Stridor

-  Decreased air entry

-  Bronchial breath sounds

-  Vesicular breath sounds

-  Crepitatiions

-  Crackles

-  Fine

-  Coarse

-  Velcro

 

Lung Auscultation

 

 

 

  

Respiratory Abdominal Exam

 

-  Paradoxical breathing: diaphragm paralysis

-  Liver ptosis: hyper-expansion: asthma, CF

 

 

 

  

Respiratory Lower Limb Exam

   

-  Calf tenderness: DVT

-  Pedal oedema: R heart failure

 

 

 

 

Respiratory Investigations

 

Path

Imaging

Proc

Micro

 

 

 

 

Respiratory Management

 

General

 

Meds

Surgery

Proc