Asthma: Difference between revisions
wikademia>Koppertone New page: '''Clinical Assessment of Asthma''' ==ABC, Vitals== *SaO2 ==Inspection== ===Fingers=== *clubbing *cyanosis ===Chest=== *↑AP diameter (barrel chest) *asymmetry of shape and movement ===... |
wikademia>Wikademia m moved Asthma (OSCE) to Asthma |
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==ABC, Vitals== | ==ABC, Vitals== | ||
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==Inspection== | ==Inspection== | ||
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==Other OSCE Modules== | ==Other OSCE Modules== | ||
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[[Category: | [[Category:OSCE]][[Category:Clinical Skills]] | ||
[[Category:Respiratory medicine]] | |||
Latest revision as of 05:17, 23 April 2009
Clinical Assessment of Asthma
ABC, Vitals
- SaO2
Inspection
Fingers
- clubbing
- cyanosis
Chest
- ↑AP diameter (barrel chest)
- asymmetry of shape and movement
Work of Breathing
- RR, HR
- POSTURE (tripoding)
- level of comfort, speaking full sentences, diaphoresis
- accessory muscle use (SCM, shoulder elevation), nasal flaring, pursed lips
Signs of RESPIRATORY EXHAUSTION or impending FAILURE
- ↓ LOC, ↓ amplitude of pulse
- central cyanosis (tongue, oral mucosa)
- intercostals, subcostal, and supraclavicular indrawing
- pulsus paradoxus (> 18 mm Hg drop with inspiration suggests very severe asthma)
- paradoxical movement of the diaphragm
Palpation
- tracheal tug
- symmetrically ↓ chest expansion
- ↓ tactile fremitus (due to hyperinflation)
Percussion
- hyperresonance - percuss anteriorly and posteriorly, compare L and R
- ↓ diaphragmatic excursion (normal is 5 - 6 cm)
- inferior displacement of diaphragm due to hyperinflation
Auscultation
- listen to each lobe, compare L and R
- major fissure: T3 posteriorly → 4th ICS MAL → 6th rib MCL
- minor fissure: 5th ICS MAL → 4th ICS parasternal
- ↓ AE
- prolonged expiratory phase
- forced expiration with bell on trachea (normal < 5 s, abnormal > 6 s)
- wheezing
- may be absent in severe asthma
- consolidation
- suggests pneumonia as trigger for acute attack
Special Tests
- peak expiratory flow rate (PEFR): normal male 600, female 400, sick < 150
- PFT - obstructive pattern (↓ flow rates, ↑ volumes)
- ABG - pH < 7.3, PO2 < 60, PCO2 > 45
Other OSCE Modules
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence