BEDSIDE ASSESSMENT OF
PULMONARY FUNCTION
Prof. M M PANDITRAO Consultant
Dept. Anesthesiology & ICU
Rand memeorial Hospityal
Freeport, Bahamas
INTRODUCTION
ASSESSMENT Simple/ Bedside Advanced
MANAGEMENT Surgical Non-Surgical
PRINCIPLES & PRACTICES
PRINCIPLES
In-depth History Taking
Developing Rapport
Precise, Pertinent and Optimum
General Physical & Systemic
PRINCIPLES & PRACTICES (Contd.)
PRACTICES
Clinical assessment of Pulmonary Function
Inspection
Palpation
Percussion
Auscultation
INSPECTIONo Tachypneao Stridoro Retraction- suprasternal /
intercostalo Dis-coordination- Abdomen & chesto Flared Nostrilso Airway sputum / Oedemao Prolonged expirationo Pursed Lip Breathingo Breathless during speech
INSPECTION (contd.)
Tachypnea: RR > 30/min. counting for full one min. is
mandatory
Stridor: Def. stridor + tachypnea– very ominous flared nostrils & suggest resp.
distress retraction
INSPECTION (contd.)
Dis-cordinate Breathing: Def. Trauma victims G.A. A useful rule of Thumb :“Respiratory
distress is neither significant nor severe if the patient can carry out normal conversation without appearing breathless ( neither tachypnic nor stridourous)”
Oedema & airway obstruction
INSPECTION (contd.)
In ICU• Uncooperative, intubated patient---oral airway• Restrain to avoid unplanned extubation• Resistance 1 5 Radius• Check the appropriate size of Endo-tracheal
Tube secretions
PALPATION• Neck : Deviation of Trachea, Crepitus• Hemi thorax• Dis-cordinate Breathing
PERCUSSION
• Hyper-resonance• Dullness• Tympanicity of upper abdomen
AUSCULTATION“STETHOSCOPIC EXAMINATION ISSIN QUA NON OF PULMONARY
ASSESSMENT”Goals
To Verify air movement in each hemi-thorax
Intensity, quality and symmetry of sounds
Neither oeso nor endo-bronchial intubation
Sounds in all lung fields
Abnormal sounds -= diagnosis & treatment
Axillae are good areas
PERI-OPERATIVE PULMONARY
TESTING Upper Abdominal & Thoracic
Surgery G. A.Factors: Age Obesity Smoking Pre-existing Pulmonary DiseasePre-op evaluation helps in Peri-op
period
“DO”s & “DON’ T”s
Substitute PFTs for clinical evaluation
Beware of erroneous tests Awareness of drug profile of pt. “Stopping smoking” “Exercise in
futility” Simple tests outweigh
“sophisticated” “Rational Outlook”
“DO”s & “DON’ T”s (contd.)
Broncho-dilators as diagnostic
tools Decide “what” is “necessary” Post-op. pt.‘pain’ inhibits Pulm.
Function ” Drugs of
Anaesthesiologists ” on Ventilator check for
mode , degree of oxygenation,
criteria for weaning
Criteria for weaning(International Gold Standard)
Respiratory Muscle strength: PNP
Ventilatory Parameters: VC,VT, Cst.
ABG parameters: Pa CO2, pHa
FiO2 requirement
Dead space: Tidal Volume (VD/ VT)
Bedside P F T s
Breath-Holding test of Sebrasez
Match Blowing Test
Valsalva Test
Single Breath Count
Ascultation over Trachea
Cough test
Breath Holding Test
Match Blowing Test
Valsalva Test
Valsalva Test (contd.)
Single Breath Count
Auscultation over Trachea
Cough Test
Conclusion
Bedside Pulmonary Function assessment
Start with BasicsLearn to be observant
Good preparation of surgical pt.Bedside PFTs good guides
Post-op follow up is as essential