Archive:COPD Examination

1. Knock on the door, walk in and introduce yourself. Wash hands and make sure the patient is comfortable then begin the examination.

2. General

ABCs
- as a general rule, if the patient can talk to you their airway and breathing are okay
LOC
Pulse rate
Respiratory rate, rhythm and depth
Effort of breathing
- Use of accessory muscles - sternocleido mastoid, pec minor
  - arms braced on knees or table
- speaking in full sentences
- Pursing of lips
- Nasal flaring
- Paradoxical abdominal breathing
- Sweating
- Tracheal tug

3. Inspection

Look for cyanosis
- Central - look at lips, oral mucosa and tongue
- Peripheral - nails, hands and feet
Look at fingers for nicotine stains and clubbing of fingernails
Shape of chest
- Chest wall deformities or trauma
- Asymmetries of shape or movement
- Barrel chest has increased AP diameter - common in COPD
Look for intercostal, subcostal and supraclavicular indrawing

4. Palpation

Feel for tracheal position and presence of a downward tug
Feel for range and symmetry of movement on inspiration - decreased range with hyperinflated lungs of COPD
Feel for tactile fremitus - decreased in COPD

5. Percussion

Percuss anterior and posterior, comparing left to right - hyperresonance with COPD
Estimate diaphragmatic excursion by noting the difference in the level of dullness on percussion with inspiration and expiration - normal is 5-6cm, but is decreased with hyperinflated lungs of COPD

6. Auscultation

7. Make diagnoses