prof. mridul m. panditrao discusses the bedside assessment of the Pulmonary Function, various tests with help of Photographs etc.

1. BEDSIDE ASSESSMENT
OF
PULMONARY FUNCTION
Prof. M M PANDITRAO
Consultant
Dept. Anesthesiology & ICU
Rand memeorial Hospityal
Freeport, Bahamas

2. INTRODUCTION
 ASSESSMENT
Simple/ Bedside
Advanced
 MANAGEMENT
Surgical
Non-Surgical

3. PRINCIPLES & PRACTICES
PRINCIPLES
 In-depth History Taking
 Developing Rapport
 Precise, Pertinent and Optimum
 General Physical & Systemic

4. PRINCIPLES & PRACTICES (Contd.)
PRACTICES
Clinical assessment of Pulmonary Function
Inspection
Palpation
Percussion
Auscultation

5. INSPECTION
o Tachypnea
o Stridor
o Retraction- suprasternal / intercostal
o Dis-coordination- Abdomen & chest
o Flared Nostrils
o Airway sputum / Oedema
o Prolonged expiration
o Pursed Lip Breathing
o Breathless during speech

6. 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

7. 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

8. 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

9. PALPATION
• Neck : Deviation of Trachea, Crepitus
• Hemi thorax
• Dis-cordinate Breathing
PERCUSSION
• Hyper-resonance
• Dullness
• Tympanicity of upper abdomen

10. AUSCULTATION
“STETHOSCOPIC EXAMINATION IS
SIN 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

11. PERI-OPERATIVE PULMONARY TESTING
 Upper Abdominal & Thoracic Surgery
 G. A.
Factors:
Age
Obesity
Smoking
Pre-existing Pulmonary Disease
Pre-op evaluation helps in Peri-op period

12. “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”

13. “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

14. 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)

15. Bedside P F T s
Breath-Holding test of Sebrasez
Match Blowing Test
Valsalva Test
Single Breath Count
Ascultation over Trachea
Cough test

16. Breath Holding Test

17. Match Blowing Test

18. Valsalva Test

19. Valsalva Test (contd.)

20. Single Breath Count

21. Auscultation over Trachea

22. Cough Test

23. Conclusion
Bedside Pulmonary Function assessment
Start with Basics
Learn to be observant
Good preparation of surgical pt.
Bedside PFTs good guides
Post-op follow up is as essential