Asthma (OSCE)

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Clinical Assessment of Asthma

ABC, Vitals[edit]

  • SaO2

Inspection[edit]

Fingers[edit]

  • clubbing
  • cyanosis

Chest[edit]

  • ↑AP diameter (barrel chest)
  • asymmetry of shape and movement

Work of Breathing[edit]

  • 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]

  • ↓ 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]

  • tracheal tug
  • symmetrically ↓ chest expansion
  • ↓ tactile fremitus (due to hyperinflation)

Percussion[edit]

  • 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]

  • 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]

  • 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

Other OSCE Modules[edit]