![]() ![]() Pectus carinatum: prominent sternum from lung hyperinflation while the bony thorax is still developing eg. Exercise intolerance is the main symptom (from heart compression). Associations: scoliosis, Marfans, E-D syndrome. Pectus excavatum: Often asymptomatic but can cause displacement of the heart to the left and restricted vent capacity with or without mild air trapping. SVCO- prominent veins on the arms, neck and upper chest. ![]() Assymetry of chest wall expansion: ask pt to take deep breath.Access muscle use: SCM, platysma, infrahyoid, scalenus, trapezius.phrenic nerve crush, median sternotomy, ant. COPD/asthma, scoliosis (lateral bending), kyphosis (forward bending, humpback, increased AP thoracic spine curvature). pectus excavatum (funnel or sunken chest)/carinatum (pigeon chest), barrel chest (AP diameter bigger, tracheal descent and chest expansion reduced) in chronic hyperinflation eg. NB: a protuberant abdomen and abnormal posture may indicate ankylosing spondylitis Enlarged due to chest malignancy/TB.īack: kyphoscoliosis, evidence of ankylosing spondylitis, scars on back. Lymph nodes from behind in fluid movement with patient sat forward: submental, submandibular, pre and post auricular, occipital, ant and post cervical chain, ant and post triangles, supraclavicular, axillary. Mouth: central cyanosis, oral candida, microstomia (systemic sclerosis) pancoasts tumour)įace: Lupus pernio, malar rash, flushed, cushingoid, scleroderma features, facial swelling of SVCO obstruction photosensitive skin rash, neck sizeĮyes: Conjunctival pallor, Horners (ptosis, miosis, anhydrosis, enopthalmus eg. JVP (increased in cor pulmonale) and neck eg. 3 min, the cause may be a long lung-to-brain circ time eg, in chronic pul oedema or reduced CO. Caused by brainstem lesions or compression eg. Cheyne-Stokes breathing: breaths get deeper and deeper then shallower in cycles with episodic apnoea.Hyperventilation syndrome: panic attacks etc.Neurogenic hyperventilation due to pontine lesions.Kussmaul respiration: deep sighing breaths in severe metabolic acidosis (helps to blow off CO2).Eg.NB: the anxious patient in A+E with hyperventilation and resp alk may actually be presenting with aspirin OD. May cause resp alkalosis,hence paraesthesiae with or without muscle spasm (reduced Ca2+). Hyperventilation may be fast (tachypnoea >20) or deep (hyperpnoea, increased tidal vol).RR: time for 30 secs (N= 14-16) and pattern of breathing (if not assessed already at the end of the bed) Radial Pulse: rate and rhythm and character. Lung Carcinoma (especially SCC, usually not small cell).Look for evidence of Rheumatoid arthritis including nodules, scleroderma, dermatomyositis (gottrans papules).Ideally I would like to hold this for 30secs” CO2 retention flap (asterixis): wrists dorsiflexed and fingers spread “hold arms out for me and spread fingers.Wasting of intrinsic muscles (T1 lesions eg.Paradoxical respiration: abdomen sucked in with insp in diaphragmatic paralysis.Intercostal, subcostal, sternal recession.Descent of trachea with insp limiting airflow. Tracheal tug (pulling of thyroid cartilage towards sternal notch in insp).Signs of resp distress (occurs if high negative intrapleural pressures needed to generate air entry): Inspect the surroundings: sputum pots, inhalers, nebulisers, oxygen tubing, peak flow meters, spacers, antibiotics, steroids Take RR from end of bed and breathing pattern.Ask them to do this several times if unsure whether movement is assymetrical or not. Ask patient to take deep breath in: is chest wall movement symmetrical.Patient: well/unwell, in pain?, distressed/comfortable at rest, breathless, colour, cachectic, access muscle use, chest wall and spine deformity, stridor/wheeze/cough, Cushingoid, pursed lips, scars of past surgery/chest drain/radiotherapy, chest drain, photosensitive skin rash.WIPER Q (wash hands, introduce yourself, seek permission to examine, expose the patient adequately to waist, reposition the patient to 45 degrees, ask if the patient is comfortable/has any pain)Įyeball the patient from the end of the bed: ![]()
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