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Clinical Examination Respiratory System F Y BAMS


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Title: Clinical Examination Respiratory System F Y BAMS

Examination of Respiratory System
  • Dr. Lalit. V. Vithalani
  • M.D.(Kriya-Sharir)
  • B.S.Ayurved college, Sawantwadi

A- Respiratory Rate (RR)(Ideally Rate, depth,
Rhythm and Type Should be examined)
  • Aim- To determine Respiratory Rate of Given
  • (The respiration rate is the number of breaths a
    person takes per minute.)
  • 2. Instrument- Subject
  • 3. Normal rate in adult person - At rest ranges
    from 12-20 breaths /min

  • 4. Procedure for Counting Rate-
  • The RR is usually measured when a person is at
    rest and simply involves counting the number of
    breaths for one minute by counting how many times
    the chest rises.
  • Respiratory rate should be counted
    surreptitiously (hidden/sneaky) while keeping the
    finger on the radial pulse.
  • Observe RRPR 14 (Normally)

  • 5. Respiratory Rate Before and after exercise-
  • RR increases after exercise so as to fulfil
    the increased demand of oxygen at cellular level.
  • ______________________________
  • ______________________________

6.Types of Breathing
  • Depends on Age and Sex-
  • Thoracic breathing- In Women
  • The movements of the chest are greater than
    those of abdomen.
  • b)Abdominal Breathing- In Male
  • (Diaphragm is more freely used than
    intercostal muscles)
  • Children- Abdominal breathing
  • (Various combinations- thoraco-abdominal,

7.RR increased in conditions (Tachypnea)
Tachypnea (tak-ip-NE-a tachy- rapid -pnea
breath - Rapid breathing
  • Normal RR Quoted 12-20 breaths/min
  • RR greater than 20/min Tachypnea
  • (Children have higher RR)
  • Physiological Tachypnea-
  • Exercise Exertion
  • labour during pregnancy

  • Patho-physiological causes of tachypnea-
  • Pain, Fever, Obesity, Matabolic acidosis
  • CO poisoning Oxygen delivery to the
    tissues and organs is blocked.
  • Lung diseases- COPD, Tuberculosis, Pneumonia
  • heart diseases- Myocardial Infarction
  • Anemia Anxiety
  • Various Poisoning
  • Shock Dehydration
  • Hyperthyrodism

8.RR decreased in conditions (Bradypnea)
  • Bradypnea (Greek) Bradys- Slow, Pnoia-Breath
  • Abnormally slow breathing rate.
  • Causes -
  • Aging, Alcohol Abuse
  • Hypothyrodism, Electrolyte Imbalance,
  • Degeneration of heart tissue because of
    aging, sleep apnoea, Medications- such as drugs
    for heart diseases, psychosis(sleeping pills).
  • Brain Tumours etc.

  • _________________________________________________

B) Examination of Breath Sounds
  1. Aim- Auscultation for determination of
    characteristic of various breath sounds and their
    clinical interpretation.
  2. Instruments- Stethoscope, Subject
  3. Procedure for auscultation- Auscultation is done
    all over the lungs front, axillary regions and
    back. Sounds at corresponding points on the two
    sides are compared.

3.Procedure cont...
  • Since breath sounds during quiet breathing are
    insufficient for study, the patient is asked to
    breath deeply through open mouth.
  • (best to show the patient how to do it.)
  • Adopt zigzag pattern for auscultation

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Order of auscultation
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a)Type and character of breath sounds
  • Whether vesicular or bronchial
  • Vesicular breath sounds
  • -Produced by passage of air in the medium
    and large bronchi
  • - they get filtered and attenuated while passing
    through millions of air filled alveoli before
    reaching the chest wall.

Vesicular breath sounds cont
  • -Heard both during inspiration and expiration.
  • Inspiratory sound-
  • Low pitched, rustling in character.
  • always longer than expiratory sound.
  • Expiratory sound-
  • Softer and shorter, flows without a pause,
  • heard during early part of expiration.

  • I E
  • Vesicular breath sounds.

  • Normally, breathing over most areas of the chest
    is vesicular.
  • Most typically so in the axillary and
    infrascapular region.

2.Bronchial Breath Sounds
  • Bronchial breath sounds originates probably in
    the same medium and large bronchi.
  • They replace vesicular sounds when the lung
    tissue between them and the chest wall becomes
    airless as a result of consolidation (as in
    pneumonia), tuberculosis, carcinoma and fibrosis.
  • There is no filtration and attenuation of sound
    as they dont pass through air filled alveoli.

Bronchial breath sounds cont.
  • Bronchial breath sounds are loud, clear, hollow
    or blowing in character and of high frequencies.
  • Inspiratory sound becomes inaudible just before
    the end of inspiration
  • Expiratory sound is heard throughout the

Areas where the bronchial sound can normally be
  • Trachea and larynx- harsher , louder sounds
  • Interscapular regions and apex of right lung-
  • more bronchial element than vesicular because
    trachea and bronchi come near to the surface.
  • Right infraclavicular, over the lower cervical

  • I E
  • Bronchial breath sounds.

B. Intensity of breath sound
  • Whether diminished or absent

C. Added or adventitious sounds.
  • Crepitations-(or moist sounds)
  • discontinuous bubbling or crackling sounds
    produced by passage of air through fluid in small
    airways. Crepitations may be fine or coarse.
    (Fine creps- rub hair)
  • Ronchi- dry sounds- produced by the passage of
    air through narrowed or partially blocked
    respiratory passages.

Added or adventitious sounds cont....
  • Pleural Rub- (friction sound)
  • creaking or rubbing sound produced by friction
    between two layers of inflamed or roughened
  • Produced mainly during deep inspiration.
  • It disappears when there is accumulation of fluid
    in pleural cavity.