Hi there my name is Andrew, one of the final year medical students. Could I just check your name and date of birth, please? 自我介紹
Sure it's James Alexander 30th of December 1989. - Nice to meet you, James. 確認患者姓名和年齡
Today I've been asked to examine your chest. This will involve looking from the end of the bed. 解釋檢查
Feeling different parts of the chest and then listening with the stethoscope at the end. 呼吸系統檢查 請查看GEEKYMEDICS.COM上的書面指南
Would that be okay? - That sounds fine. Billiant. 洗手
Have you any pain anywhere at alL? - No. Have you any questions about the exam? - No, I don't. Okay. 獲得同意
Okay, James. We can start the exam now, and I'm just going to start by having a look from the end of the bed. 獲得同意
James I'd like to start by looking at your hands. If you could just bring them up in front of you, please. 普通檢查
And if you could turn them over. 注意任何周圍性紫紺
Fantastic, and if you could bring two fingernails together, like this, for me. 從床尾檢查： - 床上的治療 -發紺 -呼吸急促 -咳嗽 -哮 -喘鳴 -惡病體質
And again if you could just bring your arms out in front of you. I'm just going to assess the temperature of your arms. 杵狀指
Now if you could bring your arms out in front of you like this, and keep them there. 評估和比較溫度
And cock your wrists back, James, and keep them there. 瘀傷或皮膚變薄 長期使用類固醇 焦油染色 抽煙
And relax. 檢查手
I would now like to feel the pulse in your wrist. 評估撲翼樣震顫 二氧化碳滯留
Could you just turn your head to the left for me? 評估呼吸頻率 正常=每分鐘12-20次呼吸
And bring your head back. 評估頸靜脈壓力 患者在45度 位於胸鎖乳突肌的兩頭之間 在肺心病中升高
James, I'm now gonna have a look at your face and eyes, okay? If you could just look straight ahead for me. 觸診橈動脈脈搏 評估心博速率
And I'm now gonna pull down on your lower eyelid. 檢查中心紫紺 判斷是否缺氧
If you could just open your mouth for me. 結膜蒼白 貧血
And lift your tongue to the roof of the mouth. 檢查口腔 角性口炎 中央紫紺
That's great. 檢查臉部
I'd now like to more closely inspect the chest. Schamroth's window test 细缝消失（杵狀指）
If you could just lift your right arm up for me? 檢查疤痕 中央胸部 - 胸骨切開術和胸廓切開術 鎖骨起搏器 中腋 - 胸腔引流
And your left arm? 檢查疤痕 側開胸
I'm now just going to feel the position of your windpipe. Let me know if it's too uncomfortable. 檢查胸部 胸壁畸形 傷疤
I'm now going to assess the expansion of the chest. 評估氣管位置
This will just involve me placing my hands around the chest, quite tightly, then asking you to take a deep breath in. 評估胸部擴張
Deep breath. 減少胸部擴張 肺塌陷 肺炎
And out. 評估環狀軟骨和胸骨之間的距離 正常= 3-4個手指
And in. 觸診心尖搏動 第五肋間隙 鎖骨中線
And out. I would now like to tap on the chest. 使用β2 Agonist
James, I am now gonna listen to the chest if you could just take some deep breaths in and out through your mouth. 注意心臟濁音
This time, James, every time I place my stethoscope on the chest could you say ninety nine for me? 小泡呼吸 正常
Ninety nine. 吸氣喘鳴 上呼吸道阻塞
Ninety nine. 粗糙的爆裂聲 肺炎和肺水腫
Ninety nine. 叩诊肺野 共振打擊是正常的
Ninety nine. 增加聲樂共鳴 合併 腦葉崩潰 瘤 聲音共鳴減少 胸腔積液
Ninety nine. 評估聲音共鳴 觸覺發音障礙是一種替代測試
Ninety nine. 哮 哮喘和慢性阻塞性肺病
Ninety nine. 聽診肺野
Ninety nine. 精細的爆裂聲 肺纖維化
Ninety nine. 沉悶的打擊樂音符： 合併 坍方 積液
Ninety nine. James, if you could now sit forward for me. I'd like to examine for any glands in the neck. 積液
I'm just going to more closely look at you back now. 淋巴結病的原因 感染 惡性腫瘤 結節病
Like before, James, I'd like to examine for chest expansion now. 檢查後胸壁
So this will just involve me putting my hands tightly around the chest again and asking you to take a deep breath in. 觸診淋巴結
Deep breath. 單方面減少胸部擴張 肺萎陷 肺炎
And out. And in. 評估後胸部擴張
And out. James, I'm now gonna tap on your back. If you could just fold your arms for me. 評估後胸部擴張
James, I am now gonna listen to your back. If you could just keep your arms folded. 打擊樂音符類型： 共振：正常 沉悶：實質化或塌陷 石沉悶：胸腔積液 超共振：氣胸
And breathe in and out through your mouth for me. 叩诊後胸壁
And now if you could say ninety nine for me. 粗糙的爆裂聲 肺炎和肺水腫
Ninety nine. 小泡呼吸 正常
Ninety nine. 細緻的爆裂聲 肺纖維化
Ninety nine. 吸氣喘鳴 上呼吸道阻塞
Ninety nine. 聽診後胸壁
Ninety nine. 增加聲音共鳴： 肺實質化 肺葉塌陷 腫瘤 聲音共鳴減弱： 胸腔積液
Ninety nine. 哮 哮喘和慢性阻塞性肺疾病
Ninety nine. 評估聲音共鳴
Ninety nine. And I'm now just gonna press on your lower back. 評估聲音共鳴
Let me know if you have any pain in your calves. 評估腳蹬水腫 右心室衰竭
James, that completes the examination. Thank you very much, you can now get dressed. 評估深靜脈血栓
In summary, I performed a respiratory exam on James, a 27 year old male. 感謝患者
James had no peripheral stigmata or respiratory disease, his pulse was regular, and he had a normal respiratory rate. 總結調查結果
James had a normal and symmetrical percussion note on the front and back of the chest. 評估骶骨水腫
On auscultation James had normal vesicular breathing with no added sounds. This was a normal respiratory exam. 洗手
To complete the respiratory exam, 洗手
I'd like to measure James's oxygen saturations, And also send off a sputum sample. 完成檢查