Source: Suneel Dhand, MD, Attending Physician, Internal Medicine, Beth Israel Deaconess Medical Center
Disorders of the respiratory system with a chief complaint of shortness of breath are among the most common reasons for both outpatient and inpatient evaluation. The most obvious visible clue to a respiratory problem will be whether the patient is displaying any signs of respiratory distress, such as fast respiratory rate and/or cyanosis. In a clinical situation, this will always require emergent attention and oxygen therapy.
Unlike pathology in other body systems, many pulmonary disorders, including chronic obstructive pulmonary disease (COPD), asthma, and pneumonia, can be diagnosed by careful clinical examination alone. This starts with a comprehensive inspection and palpation. Keep in mind that in non-emergency situations the patient's complete history will have been taken already, gaining important insight into exposure histories (e.g., smoking), which could give rise to specific lung diseases. This history can then confirm physical findings as the examination is performed.
1. Preparation for exam
2. Positioning the patient
Look first and foremost for any signs of respiratory distress in a patient and unique breathing pattern. Severe underlying pulmonary illnesses will often be apparent from simply glancing at patients. Conditions such as COPD and emphysema can reveal themselves in a patient's appearance and body habitus. These patients can loosely be classified as either "pink puffers" or "blue bloaters." "Pink puffers" are usually thin and have emphysema. They have a hyper-infla
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