What is normal RR?
12-15 breaths/min at rest
What are some abnormalities of the chest wall?
- Barrel chest
- Asthma or emphysema
- Pigeon chest
- Severe childhood asthma
- Sternal depression
- Congenital
What are the 4 different percussion notes and what could they indicate?
- Hyper-resonance
- More air than normal, emphysema, pneumothorax
- Dull or impaired
- Less air, lung collapse, consolidation or fibrosis
- Stony dullness
- Fluid present, large pleural effusion
- Upper border liver dullness
- Usually 5th intercostal space mid-clavicular line, lower than normal when emphysema is present
In what conditions can breath sounds be diminished?
- Abnormally thickened chest wall
- Emphysema
- Poor chest movement due to pain
- Fluid or air in pleural cavity
- Pleural thickening
- Total obstruction of large airway
When can breath sounds be increased?
Through thin chest wall
What can cause the expiratory phase of breathing to be prolonged?
- Narrowing of airway
- Bronchitis, asthma
What are examples of added sounds and what do they indicate?
- Wheezes
- Expiration, in asthma
- Crackles
- End of inspiration
- Fine - reopening of airways that have become blocekd in expiration such as in pulmonary oedema
- Course - air bubbling through secretions, bronchitis or COPD
- Pleural friction rub
- Pneumothorax or pulmonary embolism
What does increased or decreased vocal resonance indicate?
- Increased
- Consolidation or cavity formation
- Decreased
- Fluid in cavity or reduced ventilation in lung due to bronchail narrowing or lobar collapse due to tumour
Fine tremor?
Overuse of B-agonists
Normal crico-sternal distance?
2-3 fingers
What is crico-sternal distance reduced in?
COPD
What do you comment on in auscultation?
- Breathing vesicular or bronchial
- Loudness of sounds
- Added sounds
- Abnormalities in inspiration or expiration
What do you comment on in vocal resonance?
Loudness and clarity of sound
By how much can PEFR be below expected?
Males - 100L/min
Females - 85L/min
What are the different kinds of inhalers?
Pressurised metered-dose inhaler
Dry powder device
How long should breath be held using inhalers?
10 seconds
How long should be waited between inhaler doses?
30-60 seconds (unless DPI)
