Interpretation

Some interpretation is found in examination page. This page adds onto that and doesnt replace that!

• Note the patient’s general appearance and demeanour

............................................................................................................... • Note any bedside clues.

............................................................................................................... • Ask the patient to undress to the waist and sit comfortably at 45°. • Measure the patient’s respiratory rate and breathing pattern. • Some practitioners like to do this whilst pretending to feel the patient’s radial pulse. In this way, the patient does not become self-conscious and breathes as they normally would.

............................................................................................................... • Examine the hands. • Note staining, cyanosis, clubbing, radial pulse • Assess for tremor.

............................................................................................................... • Examine the JVP.

............................................................................................................... • Look in the nose, mouth, and eyes.

............................................................................................................... • Feel for cervical, supraclavicular, and axillary lymph nodes.

............................................................................................................... • Inspect the chest.

• Deformity: any asymmetry of shape? Remember to check the spine for scoliosis or kyphosis. • Surgery: TB patients from the 940s and 950s may have had operations resulting in lasting and gross deformity (thoracoplasty). • Barrel chest: a rounded thorax with i AP diameter. Hyperinflation, a marker of chronic obstructive lung disease. • Pectus carinatum: also called ‘pigeon chest’. Sternum and costal cartilages are prominent and protrude from the chest. Can be caused by i respiratory effort when the bones are still malleable in childhood—asthma, rickets. • Pectus excavatum: also called ‘funnel chest’. Sternum and costal cartilages appear depressed into the chest. A developmental defect, not usually of any clinical significance. • Surgical emphysema: air in the soft tissues will appear as a diffuse swelling in the neck or around a chest drain site and will be ‘crackly’ to the touch.

............................................................................................................... • Assess mediastinal position and chest expansion, front and back.

............................................................................................................... • Percuss front and back, comparing sides.

• Normal lung sounds ‘resonant’. • ‘Dullness’ is heard/felt over areas of i density (consolidation, collapse, alveolar fluid, pleural thickening, peripheral abscess, neoplasm). • ‘Stony dullness’ is the unique extreme dullness heard over a pleural effusion. • ‘Hyper-resonance’ indicates areas of d density (emphysematous bullae or pneumothorax). • COPD can create a globally hyper-resonant chest. Normal dull areas • There should be an area of dullness over the heart which may be diminished in hyperexpansion states (e.g. COPD or asthma). The liver is manifested by an area of dullness below the level of the 6th rib anteriorly on the right. This will be lower with hyperinflated lungs.

............................................................................................................... • Auscultate front and back, comparing sides.

............................................................................................................... • You may wish to consider other bedside tests such as PEFR or simple spirometry.

............................................................................................................... • Thank the patient and help them re-dress if necessary

Go trhough page 153 tally and connor entire section for short case basis