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0. Preparing patient.(5)
- Gain verbal consent,
- perform hand hygeine.
- Ask for exposure from waist up.
- Bed at 45 degrees.
- Approach from right.
1. General inspection from head of bed. (12)
- pallor, cough, SOB,
- sweating, distress, cyanosis,
- body habitus,
- accessory muscle straining,
- barrel chest, pigeon chest
- stridor, hoarseness
2. Looking around the bed (5)
- mobility aids
- sputum pot
- oxygen aides
3. Examine nails and hands. (8)
- clubbing, peripheral cyanosis,
- tobacco staining, yellow nails
- fine salbutamol/theophylline tremor
- steroid treatment thin skin
- raised nontender firm subcutaneous nodules
6. Examine neck (6)
- Raised JVP, 'cannon a waves'
- Kussmaul's sign, carotid pulse
- trachela deviation, tracheal drag
7. Examine face (1)
Examine eyes for ptosis/partial ptosis (Horner's syndrome)
8. Examine chest (3)
- chest drain
- deformity e.g. kyphoscoliosis, pigeon chest
9. Examine back (10)
- Check expansion of chest, Ask for cough
- Percuss back, and apices.
- Auscultate back.
- whispering petriloquoy
- pitting oedema
- Percuss front and axilla
- Auscultate front and briefly listen to heart
10. To finish examination (4)
- Peak flow rate
- General obs (RR, HR, BP, temp)
- bloods for respiratory acidosis