RESPIRATORY EXAMINATION
1.Introduce,consent
2.Patient sitting,shirt off
3.General inspection incl count RR,sputum pot, use of accessory muscles, dyspnoea ,breathing
4.Askl patient to cough.If there is hoarseness,ask to say a few words [recurrent laryngeal nerve damage]
5.Hands -clubbing,cyanosis,nicotine staining,wasting etc
6.Spread fingers, test for abduction and adduction, which are weaken if brachial plexus is involved in lung ca.
7.Hepatic flap in CO2 narcosis
8.Pulse - irregular irregular pulse in AFib is common in chronic lung disease
9.Face
10.Neck - JVP in RVF caused by lung problems [cor pulmonale]
11.Start with the back,ask patient to sit at edge of bed
-inspection
-palpation - cervical lymph nodes
1.submental 2.submandibular 3.ant cervical 4.deep cervical 5.supraclavicular 6.pre auricular 7.post auricular 8.occipital
- chest expansion, tactile vocal fremitus [use palms]
- percussion [8 spots - 4 between scapula,2 below scapula at midline,2 at axilla]
- auscultation - 8 spots, then vocal resonance
12.Front of chest
13.Check hepatomegaly for RVF
14.Ankle oedema for RVF
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