Bronchiectasis physical examination and management

Bronchiectasis physical examination and managementCreated OnMay 29, 2020Last Updated OnMay 29, 2020byadmin You are here: Main Clinical Examination Bronchiectasis physical examination and management < All Topics Table of Contents Physical examination: General examination Observation Assess the level of consciousness – Indicate the severity Note the build of the patient, thin build, muscle wasting may suggest malignancy (Mesothelioma(rare), secondary metastasis) or Tuberculosis Note whether patient can speak in words/ phrases/ sentences/ couldn’t speak Dyspnea, count respiratory rate Observe for any signs of distress Pleuritic chest pain Respiratory distress Diaphoresis Cyanosis Current oxygen therapy – Nasal prongs/ Simple face mask/ High flow mask/ Venturi mask, connected to oxygen (how many litre/min) Bedside Sputum culture container – suspected TB Often copious sputum(may contain blood) Waste bin to look for hemoptysis Low BMI Hand Peripheral cyanosis/ Pallor Pulse (Rate, rhythm) – Tachycardia Blood pressure Pulse oximetry Face Cyanosis (polycythemia) Pursed lips breathing Cachexia Any facial puffiness? Jaundice – Liver pathology Central cyanosis Temperature – Elevated in case of infection Finger Clubbing HPOA Tobacco staining Neck Look for lymphadenopathy Any increase in JVP Leg Pedal oedema – Congestive cardiac failure Skeletal muscles Wasting weight loss Right sided Inspection Decreased movement at the right side of chest Palpation Tracheal central, trachea tug Apex beat absent/present Chest expansion reduced bilaterally Vocal fremitus reduced Percussion Hyperresonant if obstructive, dull if restrictive Auscultation Reduced air entry Bronchial with prolonged expiration wheeze, inspiratory crepitation Investigation: sputum culture chest x ray ( cystic shadow, thickened bronchial wall, tramline and ring shadow 3. spirometry (often obstructive pattern) 4. CT scan to confirm diagnosis (honeycomb appearance) 5. bronchoscopy (to locate site of hemotypsis, exclude obstruction and obtain samples for culture) 6. Sweat test (cystic fibrosis) 7. Immunoglobulin test 8. Aspergillus precipitant/skin-prick test Management: Supportive treatment Smoking cessation Chest physiotherapy Avoidance of second-hand smoke Adequate nutritional intake with supplementation, if necessary Immunizations for influenza and pneumococcal pneumonia Confirmation of immunizations for measles, rubeola, and pertussis Oxygen therapy is reserved for patients who are hypoxemic with severe disease and end-stage complications, such as cor pulmonale. Antibiotic treatment Oral/IV ciprofloxacin Long term antibiotic if exacerbation >3 times/year According to culture Bronchodilator Corticosteroids Surgical resection Reduction of acute infective episodes Reduction of excessive sputum production Massive hemoptysis (Alternatively, bronchial artery embolization may be attempted for the control of hemoptysis.) Foreign body or tumor removal Consideration in the treatment of MAC or Aspergillus species infections Lung transplant consider patients with CF and bronchiectasis for lung transplantation when FEV1 falls below 30% of the predicted value Common short case questions for bronchiectasis What is the role of vitamin D deficiency in...

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