Asthma (OSCE)
Clinical Assessment of Asthma
ABC, Vitals
[edit | edit source]- SaO2
Inspection
[edit | edit source]Fingers
[edit | edit source]- cyanosis
Chest
[edit | edit source]- ↑AP diameter (barrel chest)
- asymmetry of shape and movement
Work of Breathing
[edit | edit source]- 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
[edit | edit source]- ↓ 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
[edit | edit source]- tracheal tug
- symmetrically ↓ chest expansion
- ↓ tactile fremitus (due to hyperinflation)
Percussion
[edit | edit source]- hyperresonance - percuss anteriorly and posteriorly, compare L and R
- ↓ diaphragmatic excursion (normal is 5 - 6 cm)
- inferior displacement of diaphragm due to hyperinflation
Auscultation
[edit | edit source]- 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
[edit | edit source]- 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