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Respiratory Exam
- Introduction, Consent & Explain procedure
- 1. Inspection
- Note: Relaxced/distressed
- Resp Rate: norm= 8-12/min
- Hands: Peripheral Cyanosis
- Clubbing
- Palmar creases/Erythemma
- Radial pulse
- Flapping tremor (?)
- Face: Central Cyanosis - lips & tongue
- Pallor of conjunctiva (anaemia)
- Chest: shape (kyphosis, scoliosis, barrel)
- Symmetry
- Scars
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Resp Exam Cont.
- 2. Palpation
- Position of Trachea - Central
- Apex beat - 5th intercost, mid clavicular
- Chest Expansion (2 @ front, 3 @ back) Thumbs @ midline
- Vocal Fremitus (111, diminished vibration on pathology)
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Resp Exam Cont.
- 3. Percussion
- Tap Clavicles
- intercostals & axillae
- Dull over liver & heart
- 4.AuscultationDeap Breaths THRU THE MOUTH
- Listen for crackles, wheeze, bronchial breaths
- normal = vesicular
- Vocal Resonance (111, louder on pathology)
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Resp Exam Cont.
Continue onto back and do same
- Examine lymph nodes (cervical and supraclavicular)
- for malignancy
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Cardiovascular Exam
- 1. Inspection
- General: unwell/breathless/uncofortable
- Hands: Tar stains
- Cyanosis
- Clubbing
- Anaemia (pale creases)
- Splinter Haemorrhages (Infect. Endocarditis)
- Face: Mallor flush (red cheeks)
- Conjuctiva - pale, anaemia
- Eyelids - Xanthalasma (hyperlipidaemia)
- Corneal Arcus
- Tongue for Central Cyanosis
Pulse & B.P
Right internal jugular vein, indicates RH fail - estimate height from sternum
- Antagonise w. hepatojugular reflux
- Chest: Scars
- Visible Pulsations
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CV Exam Cont.
- 2. Palpation
- Apex Beat - norm 5th midclavicular
- RV Heave - @ L. sternal edge, during expiration
- Thrills - Palpable murmur (aortic stenosis)
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CV Exam Cont.
- 3. Auscultation
- Over 4 valve areas, use diaphrag then bell
- Apex - Mitral Area
- L. Lower Sternal edge - Tricuspid
- 2nd Int on L. Side - Pulmonary
- 2nd Int on R. Side - Aortic
- S1 = Mitral & Tricuspid closing (APEX)
- S2 = Aortic & Pulmonary closing (A & P)
Carotid (Bruits)
Amplify by turning patient on left side/leaning forward
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