Читать книгу Respiratory Medicine - Stephen J. Bourke - Страница 56

Be alert to clues to respiratory disease that may be evident from the moment the patient is first seen (Fig. 2.1) or that become apparent during history taking. These include the rate and character of breathing, signs of respiratory distress such as use of accessory muscles of respiration (e.g. sternocleidomastoids), the shape of the chest, spine and shoulders and the character of any cough. Hoarseness of the voice may be a clue to recurrent laryngeal nerve damage by a carcinoma. Wheeze may be audible. Stridor is most commonly picked up during history taking, rather than examination.

Avoid proceeding directly to examination of the chest; first pause and ask the patient to cough.