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