DOCSLIB.ORG

How to Perform Chest Auscultation and Interpret the Findings

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
How to Perform Chest Auscultation and Interpret the Findings Copyright EMAP Publishing 2020 This article is not for distribution except for journal club use Clinical Practice Keywords Chest/Auscultation/ Interpretation/Assessment Practical procedures This article has been Chest auscultation double-blind peer reviewed How to perform chest auscultation and interpret the findings lthough the first stethoscope Fig 2. Location of the lung Authors Jaclyn Proctor is respiratory for auscultation was invented lobes (anterior chest) advanced nurse practitioner at in 1816 by René-Théophile- Warrington and Halton NHS Hyacinthe Laennec, the use of A Right lung Left lung Foundation Trust; Emma Rickards is auscultation dates back to Hippocrates, respiratory nurse consultant at who would place his ear to his patient’s Horizontal Liverpool Heart and Chest Hospital chest and listen for sounds. fissure NHS Foundation Trust and Knowsley Auscultation is an important part of an Community Respiratory Service. assessment of the respiratory system and Superior is also used for cardiac and gastrointes- lobe Superior Abstract Chest auscultation is tinal examination. The procedure should lobe frequently used in the clinical always form part of an holistic assessment examination of patients. This article Middle and must be viewed alongside the patient’s lobe explains the clinical procedure for chest clinical history (Box 1). Inferior auscultation and provides a guide to The Nursing and Midwifery Council lobe Inferior interpreting findings. (2018) has included chest auscultation and lobe Oblique fissure interpretation of findings in the Standards Citation Proctor J, Rickards E (2020) of Proficiency for Registered Nurses, and stu- How to perform chest auscultation and dent nurses now learn this skill as under- interpret the findings. Nursing Times graduates. transmitted to the trachea and bronchi. [online]; 116: 1, 23-26.. To undertake a thorough assessment of These sounds are audible when ausculta- the chest, including auscultation, it is tion is performed using a stethoscope. Box 1. essential to understand the anatomy and Chest auscultation involves listening to IPPA assessment physiology of the respiratory system. Fig 1 these internal sounds to assess airflow A commonly used acronym in clinical illustrates the anatomy of the lungs and through the trachea and the bronchial tree examination of the chest is IPPA: Fig 2 highlights the location of the lung (Sarkar et al, 2015). Inspection lobes from an anterior chest perspective. Familiarity with the normal vesicular Palpation Cedar (2018) provides further information breath sounds found at specific locations Percussion on the physiology of breathing. on the chest enables health professionals Auscultation to identify abnormal sounds, which are This is an example of a systemic What is chest auscultation? often referred to as adventitious. It is not assessment tool but other tools are Vesicular breath sounds occur when the always possible to determine from which available (Simpson, 2015) vocal cords vibrate during inspiration and lobe of a lung a sound is emanating. Using expiration, when the vibrations are the four chest X-ray zones can, therefore, be helpful: Fig 1. Anatomy of the lungs l Apical zone: above the clavicles; l Upper zone: below the clavicles and Respiratory bronchioles, Large airways: above the cardiac silhouette; with alveoli and Trachea l Mid zone: level of the hilar structures; pulmonary circulation Right bronchus l Lower zone: bases. Left bronchus Equipment The bell of the stethoscope is generally Smaller airways: used to detect high-pitched sounds – at the - dichotomous apex of the lungs above the clavicle; its dia- branches phragm is used to detect low-pitched Pleural sounds in the rest of the chest (Dougherty membranes – and Lister, 2015). Fig 3 illustrates parts of Outer parietal the stethoscope. Inner visceral Infection prevention Diaphragm The stethoscope is an important tool for PETER LAMB clinical assessment, but can become Nursing Times [online] January 2020 / Vol 116 Issue 1 23 www.nursingtimes.net Copyright EMAP Publishing 2020 This article is not for distribution except for journal club use Clinical Practice Practical procedures Fig 3. Parts of the stethoscope Fig 4a. Anterior chest auscultation Eartips Binaurals Brace Tubing Chestpiece Bell Starting at the top of the chest (first intercostal space), Diaphragm use a ‘stepladder’ approach to listen to breath sounds on the anterior chest finishing at the seventh intercostal space contaminated by micro-organisms Positioning the patient 6. Position the patient comfortably so you (Longtin et al, 2014). Adherence to local The optimal position for chest ausculta- can access their chest. infection prevention and control policies, tion is sitting in a chair, or on the side of including the cleaning of equipment the bed. However, the patient’s clinical 7. Remove or rearrange the patient’s between every patient contact, is essential. condition and comfort needs to be consid- clothing as necessary to enable you to see Nurses are advised to have a stethoscope ered during the examination and some the chest. for their own use, as sharing equipment patients may only tolerate lying at a 45° may increase infection risk and main- angle. Both these positions will facilitate 8. See whether the stethoscope feels cold. taining clean ear tips can be difficult. the assessment (Ferns and West, 2008). Warm it between your hands if necessary Non-sterile gloves are not required rou- You may need help to support the patient before applying it to the chest to avoid dis- tinely for this procedure. Nurses need to in a comfortable position during the comfort for the patient. assess individual patients for the risk of examination. exposure to blood and body fluids (Royal 9. Position the ear tips in your ears so they College of Nursing, 2018) and to be aware The procedure point slightly forward towards the nose; of local policies for glove use. 1. Ensure your stethoscope has been this will help to create a seal and will cleaned following local infection preven- reduce external noise. Preparing the environment tion and control guidance. and patient 10. Holding it between the index and Listening to a patient’s chest to establish 2. Discuss the procedure with the patient middle finger of your dominant hand, breath and any other sounds requires a quiet and gain informed consent. place the chest piece of the stethoscope area, so that health professionals can fully flat on the patient’s chest using gentle appreciate what they hear and interpret 3. Check that the patient is kept warm and pressure. their clinical relevance (Sarkar et al, 2015). the area is free from drafts. Chest auscultation requires the chest 11. Using a ‘stepladder’ approach (Fig 4a) and back to be exposed, so measures should 4. Screen the bed to maintain patient pri- listen to breath sounds on the anterior be taken to ensure the patient’s privacy and vacy and dignity. chest. This technique allows you to com- dignity is maintained at all times. A chap- pare one side of the chest with the other erone should be offered for the assessment 5. Decontaminate your hands according to in a systematic manner and detect any PETER LAMB if this is considered appropriate. local policy. asymmetry. The stethoscope should be in Nursing Times [online] January 2020 / Vol 116 Issue 1 24 www.nursingtimes.net Copyright EMAP Publishing 2020 This article is not for distribution except for journal club use Clinical Practice Practical procedures Fig 4b. Posterior chest auscultation Fig 4c. Right lateral chest auscultation Start at the first intercostal space of the posterior chest Move from the peak of the axilla to between the seventh moving downwards, avoiding the scapula, to the seventh or eight rib on the right and left. intercostal space contact with the chest for a full cycle of 19. Record findings in the patient’s notes often louder than usual breath sounds and inspiration and expiration at each point on (Box 2). in some patients it is audible from some the stepladder (Ferns and West, 2008). distance or when the patient breathes Interpreting findings through the mouth. With a stethoscope 12. Use the step ladder approach for the There are several adventitious sounds but you may also be able to hear a wheeze over posterior chest (Fig 4b); avoid the scapula the main ones to be aware of are crackles, the patient’s trachea (Sarkar et al, 2015). as lung sounds cannot be heard through wheeze and absent breath sounds. Wheeze is often referred to as a musical bone (Ferns and West, 2008). sound and is sometimes considered to be a Crackle precondition for conditions such as air- 13. Ask the patient to move their right arm Crackles are generated within the small flow obstruction (Simpson, 2015). to the side so the right lateral chest can be airways; they predominantly occur during Clinical conditions such as asthma are assessed (Fig 4c). Starting with the upper the inspiratory phase but can happen on associated with a high-pitched musical lobe move to the middle lobe, and finally expiration. Clinical conditions where wheeze that may be more evident on expi- the lower lobe at the bottom (Ferns and crackles maybe present include pneu- ration. An inspiratory wheeze (stridor) West, 2008). monia, pulmonary fibrosis, chronicusually results from an upper airway obstructive pulmonary disease (COPD), obstruction such as laryngeal oedema or 14. Repeat on the left side where the lung is lung infection and heart failure. the presence of a foreign body. A wheeze made up of an upper lobe and lower lobe. Crackles can be categorised as coarse or on both inspiration and expiration could fine; distinguishing between these can be be due to secretions in the airways (Welch 15. Replace the patient’s clothing and make significant – coarse crackles may indicate and Black, 2017) and the patient may need them comfortable. pneumonia, while fine crackles may sug- to be advised how to clear their chest gest pulmonary oedema.
Load more

Recommended publications
  • The Stethoscope: Some Preliminary Investigations
    695 ORIGINAL ARTICLE The stethoscope: some preliminary investigations P D Welsby, G Parry, D Smith Postgrad Med J: first published as on 5 January 2004. Downloaded from ............................................................................................................................... See end of article for Postgrad Med J 2003;79:695–698 authors’ affiliations ....................... Correspondence to: Dr Philip D Welsby, Western General Hospital, Edinburgh EH4 2XU, UK; [email protected] Submitted 21 April 2003 Textbooks, clinicians, and medical teachers differ as to whether the stethoscope bell or diaphragm should Accepted 30 June 2003 be used for auscultating respiratory sounds at the chest wall. Logic and our results suggest that stethoscope ....................... diaphragms are more appropriate. HISTORICAL ASPECTS note is increased as the amplitude of the sound rises, Hippocrates advised ‘‘immediate auscultation’’ (the applica- resulting in masking of higher frequency components by tion of the ear to the patient’s chest) to hear ‘‘transmitted lower frequencies—‘‘turning up the volume accentuates the sounds from within’’. However, in 1816 a French doctor, base’’ as anyone with teenage children will have noted. Rene´The´ophile Hyacinth Laennec invented the stethoscope,1 Breath sounds are generated by turbulent air flow in the which thereafter became the identity symbol of the physician. trachea and proximal bronchi. Airflow in the small airways Laennec apparently had observed two children sending and alveoli is of lower velocity and laminar in type and is 6 signals to each other by scraping one end of a long piece of therefore silent. What is heard at the chest wall depends on solid wood with a pin, and listening with an ear pressed to the conductive and filtering effect of lung tissue and the the other end.2 Later, in 1816, Laennec was called to a young characteristics of the chest wall.
    [Show full text]
  • HEENT EXAMINIATION ______HEENT Exam Exam Overview
    HEENT EXAMINIATION ____________________________________________________________ HEENT Exam Exam Overview I. Head A. Visual inspection B. Palpation of scalp II. Eyes A. Visual Acuity B. Visual Fields C. Extraocular Movements/Near Response D. Inspection of sclera & conjunctiva E. Pupils F. Ophthalmoscopy III. Ears A. External Inspection B. Otoscopy C. Hearing Acuity D. Weber/Rinne IV. Nose A. External Inspection B. Speculum/otoscope C. Sinus areas V. Throat/Mouth A. Mouth Examination B. Pharynx Examination C. Bimanual Palpation VI. Neck A. Lymph nodes B. Thyroid gland 29 HEENT EXAMINIATION ____________________________________________________________ HEENT Terms Acuity – (ehk-yu-eh-tee) sharpness, clearness, and distinctness of perception or vision. Accommodation - adjustment, especially of the eye for seeing objects at various distances. Miosis – (mi-o-siss) constriction of the pupil of the eye, resulting from a normal response to an increase in light or caused by certain drugs or pathological conditions. Conjunctiva – (kon-junk-ti-veh) the mucous membrane lining the inner surfaces of the eyelids and anterior part of the sclera. Sclera – (sklehr-eh) the tough fibrous tunic forming the outer envelope of the eye and covering all of the eyeball except the cornea. Cornea – (kor-nee-eh) clear, bowl-shaped structure at the front of the eye. It is located in front of the colored part of the eye (iris). The cornea lets light into the eye and partially focuses it. Glaucoma – (glaw-ko-ma) any of a group of eye diseases characterized by abnormally high intraocular fluid pressure, damaged optic disk, hardening of the eyeball, and partial to complete loss of vision. Conductive hearing loss - a hearing impairment of the outer or middle ear, which is due to abnormalities or damage within the conductive pathways leading to the inner ear.
    [Show full text]
  • Advanced Interpretation of Adult Vital Signs in Trauma William D
    Advanced Interpretation of Adult Vital Signs in Trauma William D. Hampton, DO Emergency Physician 26 March 2015 Learning Objectives 1. Better understand vital signs for what they can tell you (and what they can’t) in the assessment of a trauma patient. 2. Appreciate best practices in obtaining accurate vital signs in trauma patients. 3. Learn what teaching about vital signs is evidence-based and what is not. 4. Explain the importance of vital signs to more accurately triage, diagnose, and confidently disposition our trauma patients. 5. Apply the monitoring (and manipulation of) vital signs to better resuscitate trauma patients. Disclosure Statement • Faculty/Presenters/Authors/Content Reviewers/Planners disclose no conflict of interest relative to this educational activity. Successful Completion • To successfully complete this course, participants must attend the entire event and complete/submit the evaluation at the end of the session. • Society of Trauma Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Vital Signs Vital Signs Philosophy: “View vital signs as compensatory to the illness/complaint as opposed to primary.” Crowe, Donald MD. “Vital Sign Rant.” EMRAP: Emergency Medicine Reviews and Perspectives. February, 2010. Vital Signs Truth over Accuracy: • Document the true status of the patient: sick or not? • Complete vital signs on every patient, every time, regardless of the chief complaint. • If vital signs seem misleading or inaccurate, repeat them! • Beware sending a patient home with abnormal vitals (especially tachycardia)! •Treat vital signs the same as any other diagnostics— review them carefully prior to disposition. The Mother’s Vital Sign: Temperature Case #1 - 76-y/o homeless ♂ CC: 76-y/o homeless ♂ brought to the ED by police for eval.
    [Show full text]
  • Central Venous Pressure Venous Examination but Underestimates Ultrasound Accurately Reflects the Jugular
    Ultrasound Accurately Reflects the Jugular Venous Examination but Underestimates Central Venous Pressure Gur Raj Deol, Nicole Collett, Andrew Ashby and Gregory A. Schmidt Chest 2011;139;95-100; Prepublished online August 26, 2010; DOI 10.1378/chest.10-1301 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/139/1/95.full.html Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright2011by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692 Downloaded from chestjournal.chestpubs.org at UCSF Library & CKM on January 21, 2011 © 2011 American College of Chest Physicians CHEST Original Research CRITICAL CARE Ultrasound Accurately Refl ects the Jugular Venous Examination but Underestimates Central Venous Pressure Gur Raj Deol , MD ; Nicole Collett , MD ; Andrew Ashby , MD ; and Gregory A. Schmidt , MD , FCCP Background: Bedside ultrasound examination could be used to assess jugular venous pressure (JVP), and thus central venous pressure (CVP), more reliably than clinical examination. Methods: The study was a prospective, blinded evaluation comparing physical examination of external jugular venous pressure (JVPEXT), internal jugular venous pressure (JVPINT), and ultrasound collapse pressure (UCP) with CVP measured using an indwelling catheter. We com- pared the examination of the external and internal JVP with each other and with the UCP and CVP.
    [Show full text]
  • Monitoring Anesthetic Depth
    ANESTHETIC MONITORING Lyon Lee DVM PhD DACVA MONITORING ANESTHETIC DEPTH • The central nervous system is progressively depressed under general anesthesia. • Different stages of anesthesia will accompany different physiological reflexes and responses (see table below, Guedel’s signs and stages). Table 1. Guedel’s (1937) Signs and Stages of Anesthesia based on ‘Ether’ anesthesia in cats. Stages Description 1 Inducement, excitement, pupils constricted, voluntary struggling Obtunded reflexes, pupil diameters start to dilate, still excited, 2 involuntary struggling 3 Planes There are three planes- light, medium, and deep More decreased reflexes, pupils constricted, brisk palpebral reflex, Light corneal reflex, absence of swallowing reflex, lacrimation still present, no involuntary muscle movement. Ideal plane for most invasive procedures, pupils dilated, loss of pain, Medium loss of palpebral reflex, corneal reflexes present. Respiratory depression, severe muscle relaxation, bradycardia, no Deep (early overdose) reflexes (palpebral, corneal), pupils dilated Very deep anesthesia. Respiration ceases, cardiovascular function 4 depresses and death ensues immediately. • Due to arrival of newer inhalation anesthetics and concurrent use of injectable anesthetics and neuromuscular blockers the above classic signs do not fit well in most circumstances. • Modern concept has two stages simply dividing it into ‘awake’ and ‘unconscious’. • One should recognize and familiarize the reflexes with different physiologic signs to avoid any untoward side effects and complications • The system must be continuously monitored, and not neglected in favor of other signs of anesthesia. • Take all the information into account, not just one sign of anesthetic depth. • A major problem faced by all anesthetists is to avoid both ‘too light’ anesthesia with the risk of sudden violent movement and the dangerous ‘too deep’ anesthesia stage.
    [Show full text]
  • Practical Cardiac Auscultation
    LWW/CCNQ LWWJ306-08 March 7, 2007 23:32 Char Count= Crit Care Nurs Q Vol. 30, No. 2, pp. 166–180 Copyright c 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins Practical Cardiac Auscultation Daniel M. Shindler, MD, FACC This article focuses on the practical use of the stethoscope. The art of the cardiac physical exam- ination includes skillful auscultation. The article provides the author’s personal approach to the patient for the purpose of best hearing, recognizing, and interpreting heart sounds and murmurs. It should be used as a brief introduction to the art of auscultation. This article also attempts to illustrate heart sounds and murmurs by using words and letters to phonate the sounds, and by presenting practical clinical examples where auscultation clearly influences cardiac diagnosis and treatment. The clinical sections attempt to go beyond what is available in standard textbooks by providing information and stethoscope techniques that are valuable and useful at the bedside. Key words: auscultation, murmur, stethoscope HIS article focuses on the practical use mastered at the bedside. This article also at- T of the stethoscope. The art of the cardiac tempts to illustrate heart sounds and mur- physical examination includes skillful auscul- murs by using words and letters to phonate tation. Even in an era of advanced easily avail- the sounds, and by presenting practical clin- able technological bedside diagnostic tech- ical examples where auscultation clearly in- niques such as echocardiography, there is still fluences cardiac diagnosis and treatment. We an important role for the hands-on approach begin by discussing proper stethoscope selec- to the patient for the purpose of evaluat- tion and use.
    [Show full text]
  • Bates' Pocket Guide to Physical Examination and History Taking
    Lynn S. Bickley, MD, FACP Clinical Professor of Internal Medicine School of Medicine University of New Mexico Albuquerque, New Mexico Peter G. Szilagyi, MD, MPH Professor of Pediatrics Chief, Division of General Pediatrics University of Rochester School of Medicine and Dentistry Rochester, New York Acquisitions Editor: Elizabeth Nieginski/Susan Rhyner Product Manager: Annette Ferran Editorial Assistant: Ashley Fischer Design Coordinator: Joan Wendt Art Director, Illustration: Brett MacNaughton Manufacturing Coordinator: Karin Duffield Indexer: Angie Allen Prepress Vendor: Aptara, Inc. 7th Edition Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2009 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007, 2004, 2000 by Lippincott Williams & Wilkins. Copyright © 1995, 1991 by J. B. Lippincott Company. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appear- ing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia PA 19103, via email at [email protected] or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Bickley, Lynn S. Bates’ pocket guide to physical examination and history taking / Lynn S.
    [Show full text]
  • 1- Assessing Pain
    Foundations of Assessing and Treating Pain Assessing Pain Table of Contents Assessing Pain........................................................................................................................................2 Goal:..............................................................................................................................................2 After completing this module, participants will be able to:..............................................................2 Professional Practice Gaps............................................................................................................2 Introduction............................................................................................................................................. 2 Assessment and Diagnosis of Pain Case: Ms. Ward..........................................................................3 Confidentiality..........................................................................................................................................4 Pain History: A Standardized Approach..................................................................................................4 Evaluating Pain Using PQRSTU: Steps P, Q, R, S T, and U..............................................................5 Ms. Ward's Pain History (P, Q, R, S, T, U)..........................................................................................6 Video: Assessing Pain Systematically with PQRTSTU Acronym........................................................8
    [Show full text]
  • Blood Pressure Year 1 Year 2 Core Clinical/Year 3+
    Blood Pressure Year 1 Year 2 Core Clinical/Year 3+ Do Do • Patient at rest for 5 minutes • Measure postural BP and pulse in patients with a • Arm at heart level history suggestive of volume depletion or • Correct size cuff- bladder encircles 80% of arm syncope • Center of cuff aligns with brachial artery -Measure BP and pulse in supine position • Cuff wrapped snugly on bare arm with lower -Slowly have patient rise and stand (lie them down edge 2-3 cm above antecubital fossa promptly if symptoms of lightheadedness occur) • Palpate radial artery, inflate cuff to 70 mmHg, -Measure BP and pulse after 1 minute of standing then increase in 10 mmHg increments to 30 mmHg above point where radial pulse disappears. Know Deflate slowly until pulse returns; this is the • Normally when a person stands fluid shifts to approximate systolic pressure. lower extremities causing a compensatory rise in • Auscultate the Korotkoff sounds pulse by up to 10 bpm with BP dropping slightly -place bell lightly in antecubital fossa • Positive postural vital signs are defined as -inflate BP to 20-30mmHg above SBP as determined symptoms of lightheadedness and/or a drop in by palpation SBP of 20 mmHg with standing -deflate cuff at rate 2mmHg/second while auscultating • Know variations in BP cuff sizes -first faint tapping (Phase I Korotkoff) = SBP; • A lack of rise in pulse in a patient with an Disappearance of sound (Phase V Korotkoff)=DBP orthostatic drop in pressure is a clue that the Know cause is neurologic or related or related to -Korotkoff sounds are lower pitch, better heard by bell medications (eg.
    [Show full text]
  • Chest Pain and Non-Respiratory Symptoms in Acute Asthma
    Postgrad Med J 2000;76:413–414 413 Chest pain and non-respiratory symptoms in Postgrad Med J: first published as 10.1136/pmj.76.897.413 on 1 July 2000. Downloaded from acute asthma W M Edmondstone Abstract textbooks. Occasionally the combination of The frequency and characteristics of chest dyspnoea and chest pain results in diagnostic pain and non-respiratory symptoms were confusion. This study was prompted by the investigated in patients admitted with observation that a number of patients admitted acute asthma. One hundred patients with with asthmatic chest pain had been suspected a mean admission peak flow rate of 38% of having cardiac ischaemia, pleurisy, pericardi- normal or predicted were interviewed tis, or pulmonary embolism. It had also been using a questionnaire. Chest pain oc- observed that many patients admitted with curred in 76% and was characteristically a asthma complained of a range of non- dull ache or sharp, stabbing pain in the respiratory symptoms, something which has sternal/parasternal or subcostal areas, been noted previously in children1 and in adult worsened by coughing, deep inspiration, asthmatics in outpatients.2 The aim of this or movement and improved by sitting study was to examine the frequency and char- upright. It was rated at or greater than acteristics of chest pain and other symptoms in 5/10 in severity by 67% of the patients. A patients admitted with acute asthma. wide variety of upper respiratory and sys- temic symptoms were described both Patients and methods before and during the attack. One hundred patients (66 females, mean (SD) Non-respiratory symptoms occur com- age 45.0 (19.7) years) admitted with acute monly in the prodrome before asthma asthma were studied.
    [Show full text]
  • Auscultation of Abdominal Arterial Murmurs
    Auscultation of abdominal arterial murmurs C. ARTHUR MYERS, D.O.,° Flint, Michigan publications. Goldblatt's4 work on renal hyperten- sion has stimulated examiners to begin performing The current interest in the diagnostic value of ab- auscultation for renal artery bruits in their hyper- dominal arterial bruits is evidenced by the number tensive patients. of papers and references to the subject appearing in Stenosis, either congenital or acquired, and aneu- the recent literature. When Vaughan and Thoreki rysms are responsible for the vast majority of audi- published an excellent paper on abdominal auscul- ble renal artery bruits (Fig. 2). One should be tation in 1939, the only reference they made to highly suspicious of a renal artery defect in a hy- arterial murmurs was that of the bruit of abdominal pertensive patient with an epigastric murmur. Moser aortic aneurysm. In more recent literature, however, and Caldwell5 have produced the most comprehen- there is evidence of increased interest in auscultat- sive work to date on auscultation of the abdomen ing the abdomen for murmurs arising in the celiac, in renal artery disease. In their highly selective superior mesenteric, splenic, and renal arteries. series of 50 cases of abdominal murmurs in which The purpose of this paper is to review some of aortography was performed, renal artery disease the literature referable to the subject of abdominal was diagnosed in 66 per cent of cases. Their con- murmurs, to present some cases, and to stimulate clusions were that when an abdominal murmur of interest in performing auscultation for abdominal high pitch is found in a patient with hypertension, bruits as a part of all physical examinations.
    [Show full text]
  • BTS Guideline for Oxygen Use in Adults in Healthcare and Emergency
    BTS guideline BTS guideline for oxygen use in adults in healthcare Thorax: first published as 10.1136/thoraxjnl-2016-209729 on 15 May 2017. Downloaded from and emergency settings BRO’Driscoll,1,2 L S Howard,3 J Earis,4 V Mak,5 on behalf of the British Thoracic Society Emergency Oxygen Guideline Group ▸ Additional material is EXECUTIVE SUMMARY OF THE GUIDELINE appropriate oxygen therapy can be started in the published online only. To view Philosophy of the guideline event of unexpected clinical deterioration with please visit the journal online ▸ (http://dx.doi.org/10.1136/ Oxygen is a treatment for hypoxaemia, not hypoxaemia and also to ensure that the oxim- thoraxjnl-2016-209729). breathlessness. Oxygen has not been proven to etry section of the early warning score (EWS) 1 have any consistent effect on the sensation of can be scored appropriately. Respiratory Medicine, Salford ▸ Royal Foundation NHS Trust, breathlessness in non-hypoxaemic patients. The target saturation should be written (or Salford, UK ▸ The essence of this guideline can be summarised ringed) on the drug chart or entered in an elec- 2Manchester Academic Health simply as a requirement for oxygen to be prescribed tronic prescribing system (guidance on figure 1 Sciences Centre (MAHSC), according to a target saturation range and for those (chart 1)). Manchester, UK 3Hammersmith Hospital, who administer oxygen therapy to monitor the Imperial College Healthcare patient and keep within the target saturation range. 3 Oxygen administration NHS Trust, London, UK ▸ The guideline recommends aiming to achieve ▸ Oxygen should be administered by staff who are 4 University of Liverpool, normal or near-normal oxygen saturation for all trained in oxygen administration.
    [Show full text]