![]() ![]() 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. ![]()
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