Special Techniques

Clinical Assessment of Pulmonary Function. A simple but informative way to assess the complaint of breathlessness in an ambulatory patient is to walk with the patient down the hall or climb one flight of stairs. Observe the rate, effort, and sound of the patient's breathing.

Forced Expiratory Time. This test assesses the expiratory phase of breathing, which is typically slowed in obstructive pulmonary disease. Ask the patient to take a deep breath in and then breathe out as quickly and completely as possible with mouth open. Listen over the trachea with the diaphragm of a stethoscope and time the audible expiration. Try to get three consistent readings, allowing a short rest between efforts if necessary.

Identification of a Fractured Rib. Local pain and tenderness of one or more ribs raise the question of fracture. By anteroposterior compression of the chest, you can help to distinguish a fracture from soft-tissue injury. With one hand on the sternum and the other on the thoracic spine, squeeze the chest. Is this painful, and where?

If the patient understands and cooperates in performing the test, a forced expiration time of 6 or more seconds suggests obstructive pulmonary disease.

An increase in the local pain (distant from your hands) suggests rib fracture rather than just soft tissue injury.

TABLE 6-1 ■ Chest Pain

Problem

Process

Location

Quality

Severity

Cardiovascular

Temporary myocardial

Retrosternal or across the

Pressing, squeezing,

Mild to moderate,

Angina Pectoris

ischemia, usually secondary to

anterior chest, sometimes

tight, heavy,

sometimes perceived

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