Asthma (OSCE)

Clinical Assessment of Asthma

## ABC, Vitals

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* SaO2

## Inspection

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### Fingers

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* cyanosis

### Chest

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

### Work of Breathing

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* 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

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* ↓ 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

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

## Percussion

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* hyperresonance - percuss anteriorly and posteriorly, compare L and R
* ↓ diaphragmatic excursion (normal is 5 - 6 cm)
* inferior displacement of diaphragm due to hyperinflation

## Auscultation

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* 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

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* 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

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* v
* t
* e

Objective structured clinical examination

Acute Confusion \- Acute Coronary Syndrome Orders \- Anemia \- Arterial Blood Gasses \- Asthma \- Blood Pressure \- Chest pain \- Chest XRay \- CHF \- Coma \- COPD \- Cranial Nerves \- Diabetic History \- Diabetic Foot \- Dysphagia \- EKGs \- Gallbladder and Liver \- Liver Disease \- Gait and Balance \- Headache \- Hematemesis \- Hypertension \- Jugular Venous Pulses \- Knee Exam \- Lymph Nodes \- Community Acquired Pneumonia \- Parkinson Disease \- Peripheral Arterial Insufficiency \- Pneumonia Examination \- Precordial Exam \- STD's \- Spleen \- Swollen Leg Exam \- Thyroid Exam \- Upper vs Lower Motor Neuron Lesions \- Urinary Incontinence
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