This is a draft cheat sheet. It is a work in progress and is not finished yet.
Preperation and Equipment :
W |
Wash Hands |
I |
Introduce Yourself + Patient's Identity |
P |
Permission |
P |
Patient Position (45°) + Pain |
E |
Explaination |
Must wash stethoscope before and after, usually a good idea to do during general inspection |
Let the patient know they will be required to remove their top
General Inspection:
•Normal Body Habitus |
Not Thin/Wasted or Obese |
•Patient's Colour |
Cyanosis/Pallor |
•Breathing Difficulty |
Posture, use of accessory muscles, Stridor/Wheeze, Dyspnea (SOB) |
•Alertness |
•Chest Deformity |
•Medical paraphernalia: |
Inhalers/Sputum Cup/Oxygen Tubing/Peak Flow Meter/Pulse Oximeter/Walking Aid |
Hands:
Temperature: |
Peripheral vasoconstriction/poor perfusion |
Warm hands+ Cyanosis = Respiratory problem not circulatory |
Peripheral Cyanosis: |
Bluish discolouration of nails |
O2 Sat <85% |
Clubbing: |
Place 2 fingernails together and look for Schamroth's sign |
Chronic low blood-oxygen levels |
Joint Swelling |
Nicotine Staining |
Pallor of the palmar creases: |
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Anaemia |
Wasting of the small muscles of the hand: |
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Possible apical lung tumour -> can erode into the brachial plexus |
Wrist Tenderness: |
Palpate for tenderness |
Anhydrosis: |
Does the patient notice that one side of their face is dryer then the other? |
Horner's Syndrome
Apical tumour has invaded the sympathetic chain |
Tremors: |
Stretch out hands and close eyes for 15 seconds |
•Coarse flapping tremor (Asterixis) - CO2 retention/hypercapnia
•Fine Tremor β2 agonist use - Salbutamol |
CO2 retention signs: (Mention at least 2)
•SOB
•Daytime Sluggishness
•Headache
•Asterixis
•Bounding pulse
Vitals:
Pulse: |
Take pulse rate and rhythm during examinaiton of the hands. |
Bounding Pulse =>CO2 retention |
Breathing Rate: |
After taking pulse continue straight to breathing rate without informing the patient |
Face/Neck:
Face: |
|
Pallor/Plethoric facies (Facial Swelling and Redness) |
Eyes: |
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Ptosis/Miosis (Horner's Syndrome)
Anaemia (Conjunctival Pallor)/Jaundice |
Mouth: |
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Postnasal Drip/Pursed Lips |
Tongue: |
Bluish discolouration of lips/inferior aspect of tongue |
Central Cyanosis |
Voice: |
|
Hoarseness |
Cervical Lymph Nodes: |
Palpate under jaw, base of neck |
Neck: |
Offer to check JVP
Look for distended veins
Palpate trachea - Tracheal tug
Inform patient that this may be uncomfortable, palpate either side of the trachea 3 finger breths below Adam's apple, place finger in midline of the trachea, ask patient to take a deep breath |
JVP elevated in pulmonary hypertention
Abnormal downward movement of the trachea - Can indicate a dilation or aneurysm of the aortic arch |
Chest Wall:
Inspection: |
•Pectus Excavatum (indent)/Carinatum (outward dent)
•Barrel Chest
•Incisions
•Spinal Curvature
•Asymmetry of Movement
•Scars |
Palpate for chest expansion |
Palpate for tactile fremitus: |
Use ulnar boarder of the hand
Anterior chest
+
Posterior chest - Ask patient to bear hug to move scapulas out of the way |
Air = less vibration
Solid = more vibration |
Percussion of chest wall: |
Including apexes and lateral chest wall
Compare both sides{{nl
Both front and back of chest |
Lungs = Resonant
Heart = Dull
|
Auscultation of chest: (using diaphragm) |
Ask patient to take a deep breath in and out through their mouth.
Including apexes and lateral chest wall
Compare both sides{{nl
Both front and back of chest |
May hear:
•Fine crackle
•Coarse crackle
•High-pitched wheeze
•Pleural friction rub |
Auscultate for vocal resonance: |
Will be on the same side as tactile fremitis if present |
Peripheral Oedema:
Sacrum: |
2 Thumbs on the sacrum while patient is sitting up |
Tibia/ankle: |
Two thumbs on the tibia/ankle bony portion |
While looking at legs: Bruising of varying ages on the shins = Sarcoidosis
-Immune disease
Conclusion:
Thank patient and explain that the examination is finished
Sanitise Hands and Stethoscope |
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