Name: checking breathing distress by exam
Uploaded: 2023-04-30T06:34:27.000Z
Duration: 9 min 59 s
Channel: JoVE

K12 Standards

new-york-state-science-learning-standards

New York State Science Learning Standards

High School

Life Science

Structure and Function

HS-LS1-3.

respiratory-exam-i-inspection-and-palpation

Respiratory Exam I: Inspection and Palpation

1. Preparation for exam
<ol>
	<li>Before examining the patient, wash hands thoroughly with soap and water or clean them with antibacterial wash.</li>
	<li>Explain to the patient that you are going to perform a lung examination.</li>
</ol>
2. Positioning the patient
<ol>
	<li>Make sure the patient is undressed down to the waist (females keeping on underwear and exposing each hemithorax one at a time).</li>
	<li>Position the patient on the examination table at a 30- to 45-degree angle and approach the patient from the right side. Examining the posterior of the lung requires that the patient be leaning forward or sitting on the edge of the bed.</li>
</ol>
3. General observation
<ol>
	<li>Have a general look at the patient first. By this time, the patient's vital signs should have already been obtained. Pay particular attention to the patient's respiratory rate and oxygen saturation.</li>
	<li>Note the signs of obvious respiratory distress. These include:
	<ol>
		<li>Fast respiratory rate (normal respiratory rate is around 14-20 breaths per minute)</li>
		<li>Cyanosis (blue or purple coloration of the skin or mucous membranes)</li>
		<li>Unusual posturing to maximize air entry (patient may lean forward on outstretched arms [tripod position])</li>
		<li>Breathing using accessory muscles (scalene, sternocleidomastoid, and trapezius muscles) in addition to the diaphragm</li>
		<li>Inward movement of intercostal muscles (intercostal retractions)</li>
	</ol>
	</li>
	<li>Note if the patient is coughing. If the patient is producing sputum, this can also provide an important diagnostic clue that there is an underlying respiratory infection.</li>
	<li>Note if the patient's voice sounds hoarse when speaking. A hoarse voice may be a sign of upper airway inflammation, infection, or malignancy.</li>
	<li>Note if wheezing is present.</li>
	<li>Observe carefully for any other specific abnormal breathing patterns.</li>
</ol>
4. Peripheral examination
<ol>
	<li>Hand examination
	<ol>
		<li>Ask the patient to stretch out the arms and extend the wrists. Assess for flapping tremor (asterixis), sometimes caused by carbon dioxide retention). Note that patients can also exhibit tremors if they've just received bronchodilator therapy.</li>
		<li>Note if nicotine staining on the nails is present.</li>
		<li>Ask the patient to put both thumbnails side-by-side. Note if a diamond-shape is formed on the inside. If clubbing (a decrease in angle between the nail and nail bed) is present, this doesn't happen. This can be a sign of pulmonary fibrosis, cystic fibrosis, or bronchogenic carcinoma.</li>
		<li>Examine the skin for erythema nodosum (red, painful, tender lumps or nodules associated with sarcoidosis).</li>
		<li>Palpate the radial pulse at the wrist. A bounding or abnormally strong pulse can be a sign of carbon dioxide retention.</li>
	</ol>
	</li>
	<li>Head examination
	<ol>
		<li>Inspect for a facial flushing, a potential indication of carbon dioxide retention.</li>
		<li>Inspect the nose for nasal polyps or evidence of epistaxis. Ask the patient to tilt head upwards and look into each nostril, using a flashlight.</li>
		<li>Ask the patient to open mouth and stick out the tongue. The color of the tongue should be pink/red. If it is a bluish discoloration, this indicates central cyanosis.</li>
		<li>Inspect the throat for pharyngitis or tonsillar inflammation. Ask the patient to phonate by saying, "Ahhhhh". Using a flashlight, look at the back of the patient's throat. You may use a tongue depressor to get a good view of the back of the mouth.</li>
		<li>Observe patient's face for the signs of Horner's syndrome (the triad of miosis (constricted pupil), ptosis, and hemifacial anhidrosis (decreased sweating on that side of the face). Horner's syndrome can be caused by brachial plexus compression from a Pancoast (apical lung) tumor.</li>
	</ol>
	</li>
	<li>Assess for lymphadenopathy
	<ol>
		<li>Palpate the cervical lymph nodes with both hands, one on each side of the patient's face.</li>
		<li>Start at the preauricular glands and then work down, palpating with the ends of your fingers: jugulodigastric, submandibular, submental, anterior cervical, supraclavicular, posterior cervical, posterior auricular, occipital lymph nodes.</li>
		<li>Assess for axillary lymphadenopathy by holding the patient's arm near the elbow with one hand and palpating in the axilla with your other hand.</li>
	</ol>
	</li>
</ol>
5. Chest inspection
<ol>
	<li>Inspect the chest wall for scars that would be evidence of a prior thoracotomy.</li>
	<li>Inspect the chest shape and look for any visible chest deformities. The anterioposterior diameter of the chest is normally smaller than its lateral diameter (Figure 1).</li>
	<li>A "barrel" chest (Figure 2) is a bulging chest with an abnormal increase in anteroposterior diameter and decreased movement in respiration, observed in COPD and emphysema.</li>
	<li>Also look for pectus excavatum (Figure 3) (sunken or caved-in chest, usually congenital) versus pectus carinatum (Figure 4) (a protruding or "pigeon" chest, again, usually congenital).</li>
	<li>Note if kyphoscoliosis (Figure 5), an outward and lateral curvature of the spine which can impair respiration, is present.</li>
	<li>Note if the chest movements are symmetrical with equal expansion of both hemithoraces.</li>
</ol>
<img alt="Human anatomy concept; torso with directional diagram indicating anterior and posterior orientation." src="/files/ftp_upload/10028/10028fig1.jpg" data-altupdatedat="1761830439000" data-alt="Figure 4"> 
Figure 1. Thorax of a normal adult. A transverse section of a thorax (left); a torso (right). The anteroposterior chest diameter is smaller than lateral diameter.
<img alt="Anatomical positioning diagram; human torso, anterior-posterior arrows indicate directionality." src="/files/ftp_upload/10028/10028fig2.jpg" data-altupdatedat="1761830439000" data-alt="Figure 4"> 
Figure 2. Barrel chest. A transverse section of thorax (left); a torso (right) with signs of barrel chest (increased anteroposterior diameter)
<img alt="Anatomical orientation diagram; anterior-posterior axis on torso illustration." src="/files/ftp_upload/10028/10028fig3.jpg" data-altupdatedat="1761830439000" data-alt="Figure 4"> 
Figure 3. Pectus Excavatum (funnel chest). A transverse section of thorax (left); a torso (right) with signs of pectus excavatum (depression of the lower portion of sternum)
<img alt="Heart anatomical diagram showing anterior-posterior orientation next to torso illustration." src="/files/ftp_upload/10028/10028fig4.jpg" data-altupdatedat="1761830439000" data-alt="Figure 4"> 
Figure 4. Pectus Carinatum (pigeon chest). A transverse section of thorax (left); a torso (right) with signs of pectus carinatum (increased anteroposterior chest diameter, anteriorly displaced sternum, and depression of the costal cartilages)
<img alt="Human anatomy diagram of scapula orientation; anterior and posterior views comparison." src="/files/ftp_upload/10028/10028fig5.jpg" data-altupdatedat="1761830439000" data-alt="Figure 4"> 
Figure 5. Thoracic Kyphoscoliosis. A transverse section of thorax (left); a torso (right) with signs of kyphoscoliosis (abnormal spinal curvatures and vertebral rotation).
6. Palpation
<ol>
	<li>Palpate the trachea
	<ol>
		<li>Position yourself in front of the patient.</li>
		<li>Place your right index finger in the sternal notch.</li>
		<li>Palpate the lateral borders of the trachea to determine if it is in normal (midline) position. A deviated trachea can indicate lung pathology either away or towards the side of deviation. The trachea will be deviated away from the side of an effusion or lung mass, and towards the side of a pneumothorax, collapsed lung, or atelectasis.</li>
	</ol>
	</li>
	<li>Palpate the chest wall.
	<ol>
		<li>Use the palm of your right or left hand to assess for any obvious point tenderness, masses, or rib deformities.</li>
		<li>Palpate at 4-5 levels up the chest anteriorly and posteriorly. Any differences between right and left can indicate abnormal underlying lung tissue.</li>
		<li>Note any evidence of subcutaneous emphysema, which feels like a crackly tactility under the skin. This is observed when air gets into the subcutaneous tissues, and is associated with lung collapse secondary to trauma or a ruptured bronchial tube.</li>
	</ol>
	</li>
	<li>Assess chest expansion
	<ol>
		<li>Place your hands, with thumbs touching, in the midline and extend your fingers to make contact with the lateral edges of the chest anteriorly, just below the level of the nipples.</li>
		<li>Ask the patient to take a deep breath. The thumbs should separate by approximately 5 cm or more in normal chest expansion (this technique can also be utilized posteriorly).</li>
	</ol>
	</li>
	<li>Assess tactile vocal fremitus. Typically, tactile vocal fremitus is increased over areas of consolidation and decreased over pleural effusion in the case of lung collapse.
	<ol>
		<li>Place your hands at the lower anterior part of the chest with the hypothenar (ulnar) sides of each hand touching the chest at the same level on the right and left.</li>
		<li>Ask the patient to say "99" or "1-2-1". The vibration felt against your hand should be the same in each hand.</li>
	</ol>
	</li>
</ol>

Look first and foremost for any signs of respiratory distress in a patient and unique breathing pattern. Severe underlying pulmonary illnesses will often be apparent from simply glancing at patients. Conditions such as COPD and emphysema can reveal themselves in a patient&#39;s appearance and body habitus. These patients can loosely be classified as either &#34;pink puffers&#34; or &#34;blue bloaters.&#34; &#34;Pink puffers&#34; are usually thin and have emphysema. They have a hyper-infla...

respiratory exam i: inspection and palpation

Source: <a href="https://www.jove.com/author/Suneel_Dhand">Suneel Dhand</a>, MD, Attending Physician, Internal Medicine, Beth Israel Deaconess Medical Center
Disorders of the respiratory system with a chief complaint of shortness of breath are among the most common reasons for both outpatient and inpatient evaluation. The most obvious visible clue to a respiratory problem will be whether the patient is displaying any signs of respiratory distress, such as fast respiratory rate and/or cyanosis. In a clinical situation, this will always require emergent attention and oxygen therapy.
Unlike pathology in other body systems, many pulmonary disorders, including chronic obstructive pulmonary disease (COPD), asthma, and pneumonia, can be diagnosed by careful clinical examination alone. This starts with a comprehensive inspection and palpation. Keep in mind that in non-emergency situations the patient&#39;s complete history will have been taken already, gaining important insight into exposure histories (e.g., smoking), which could give rise to specific lung diseases. This history can then confirm physical findings as the examination is performed.

Source: Suneel Dhand, MD, Attending Physician, Internal Medicine, Beth Israel Deaconess Medical Center
Disorders of the respiratory system with a chief ...

Disorders of the respiratory system with a chief complaint of shortness of breath are among the most common reasons for both outpatient and inpatient evaluation.The air we breathe in travels through our trachea into our lungs through the bronchi. Inside the lungs, it passes through the bronchioles to ultimately enter the specialized air sacs called alveoli. The alveoli are surrounded by blood capillaries, which allow diffusion of inhaled oxygen into our blood stream and facilitate excretion of carbon dioxide; thus maintaining our system's homeostasis.Dysfunctioning of lungs, which occurs in diseases like asthma, emphysema or chronic obstructive pulmonary disorder, commonly known as COPD, can be diagnosed with the help of a simple respiratory exam. This assessment involves inspection, palpation, percussion and auscultation. This presentation will focus on the inspection and palpation aspect only; the rest will be covered in another video of this collection.First, let's briefly review what to look for during inspection and palpation of the respiratory system. Unlike pathology in other body systems, many pulmonary disorders can be diagnosed by careful inspection alone. For example, simply by checking the respiration rate, one can diagnose respiratory distress. Similarly, observing the muscles used in respiration can also provide some insight. Normal or quiet breathing is accomplished just by the use of diaphragm and external intercostal muscles, while forced expiration involves the internal intercostal and abdominal muscles. Other than these primary muscles, there are accessory muscles for inspiration, such as scalene, sternocleidomastoid, pectoralis minor and trapezius. A constant use of these muscles, which can be observed during inspection, indicates difficulty in breathing.Another parameter that can be inspected is the chest's anteroposterior diameter, which is normally smaller than its lateral diameter. Therefore, a "barrel" chest, which is indicated by bulging chest with an abnormal increase in anteroposterior diameter, is indicative of conditions such as COPD and emphysema. Some chest deformities like pectus excavatum signified by sunken or caved-in chest, or pectus carinatum, which refers to a protruding or "pigeon" chest, are due to congenital defects. By inspection, one can also detect kyphoscoliosis, which is an outward and lateral curvature of the spine; this can severely impair respiration.Coming to palpation, palpating the lateral borders of the trachea via the sternal notch helps in determining if the trachea is in normal, midline position or not, as a deviated trachea can indicate lung pathology. Other major areas of palpation include all of the head, neck and axillary lymph nodes. Lymphadenopathy, which is abnormal number or size of lymph nodes, can indicate a respiratory tract infection.Taken together, careful inspection and palpation can provide great deal of information regarding the physiology and pathophysiology of a patient's respiratory system.After reviewing what to look for during a respiratory exam, let's walk through the detailed steps of general observations and inspection. Before every examination, wash your hands thoroughly with soap and warm water. Enter the room, where the patient is already seated. Introduce yourself and briefly explain the exam you are going to perform. Make sure that the patient is undressed down to their waist. Females should keep their underwear on and expose one hemithorax at a time as requested. Position the patient on the examination table at a 30-45? angle and approach them from their right side.First, note the signs of obvious respiratory distress. These include: hoarse voice, fast respiratory rate, unusual posturing to maximize air entry like tripoding, breathing using accessory muscles, inward movement of intercostal muscles, coughing with sputum, wheezing, and cyanosis. Next, ask the patient to stretch out their arms and extend the wrists. Inspect for the presence of tremor and also note if nicotine staining of nails is present. Ask the patient to put their two thumbnails side by side. Note if a diamond-shape is formed on the inside. If clubbing is present, this doesn't happen, and it can be a sign of pulmonary fibrosis, cystic fibrosis, or bronchogenic carcinoma.Examine the skin on the anterior tibial surface for erythema nodosum, which is inflammation of the skin, or panniculitis that typically causes painful red nodular areas. Inspect the patient's face for obvious facial flushing, and for the signs of Horner's syndrome, which includes the triad of miosis, ptosis, and hemifacial anhidrosis-that is decreased sweating on one side of the face. Ask the patient to tilt their head upwards and look into each nostril with the help of a flashlight. This is to inspect for nasal polyps or evidence of epistaxis. Next, instruct the patient to open their mouth and stick out their tongue. The color of the tongue should be noted-pink or red represent normal, while bluish discoloration suggests central cyanosis. Then, ask the patient to phonate by saying, "Ahhhhh", and using a tongue depressor, inspect the throat for pharyngitis or tonsillar inflammation.After this, move to the chest region and inspect the chest wall for scars that would be an evidence of a prior thoracotomy. Also inspect the chest shape and look for any visible deformities.Now, let's review the palpation steps of the respiratory physical exam. Start with palpating the radial pulse. A bounding or abnormally strong pulse can be a sign of carbon dioxide retention. Next, assess for lymphadenopathy in the cervical region. Palpate the nodes with on both sides simultaneously. Start at the preauricular glands followed by jugulodigastric, submandibular, submental, anterior cervical, supraclavicular, posterior cervical, posterior auricular, and occipital lymph nodes. Assess for axillary lymphadenopathy by holding the patient's arm near the elbow with one hand and palpating in the axilla with your other hand. Next, feel the trachea by placing the right index finger in the sternal notch. Palpate the lateral borders of the windpipe to determine if it is in the normal, midline position.Following that, palpate the chest wall by using the palm of your hand to assess for any obvious point tenderness, masses, or rib deformities. Perform the palpation at four to five different levels anteriorly and posteriorly, and any differences between the right and left sides can indicate abnormal underlying lung tissue. Next, assess chest expansion, place your hands just below the level of the nipples, with thumbs touching in the midline and fingers extended to make contact with the lateral edges. Ask the patient to take a deep breath. The thumbs should separate by approximately 5 cm or more in normal chest expansion. This technique can be also utilized posteriorly.Lastly, to assess tactile vocal fremitus, place the hypothenar sides of your hands at the lower anterior part of the chest. Then ask the patient to say "99" every time you change the position. The vibration felt against your hand should be the same for each position on both sides. Same test can be performed on the posterior surface.You've just watched JoVE's video on inspection and palpation during a respiratory exam. Severe pulmonary illnesses will sometimes be apparent from simply glancing at the patient. Gaining important clues related to smoking and other exposure history could further aid in the diagnosis of specific lung disease. In addition, careful inspection and palpation can help detect disorders that are not apparent and therefore one should take the time to go through this entire process on every patient with a respiratory complaint. As always, thanks for watching!

Education

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Clinical Skills

Physical Examinations I

checking breathing distress by exam

Respiratory exam starts with looking for breathing distress and feeling the chest. Shortness of breath is a common reason for both outpatient and inpatient evaluation. Early inspection can reveal fast breathing or cyanosis, which is a bluish color change that can signal low oxygen.

If a patient shows respiratory distress, the situation needs urgent attention and oxygen therapy. In many cases, careful clinical examination can help identify lung problems without relying only on tests. This is especially useful for conditions such as chronic obstructive pulmonary disease, asthma, and pneumonia.

The exam begins with inspection and palpation. Inspection means observing the patient for visible signs of trouble. Palpation means using the hands to feel the chest and confirm findings.

A complete history is also important in non-emergency situations. Information such as smoking exposure can point toward specific lung diseases. The history then helps support the physical findings as the respiratory exam continues.

Checking Breathing Distress by Exam

general approach to the physical exam

Why Physical Exams Still Matter

Physical examination remains an important part of medicine. Doctors have used the body exam for centuries to connect changes in body function with disease. Even with modern imaging and lab tests, the bedside exam still helps clinicians understand what may be happening in the patient. Physical examination is not a replacement for tests, and it does not answer every question. Some maneuvers that were once highly valued may have limited usefulness. Still, many conditions can only be found through...

observation and inspection

Clinical Observation in Physical Exam

Clinical observation is the starting point of a physical examination and begins at the first contact with a patient. Observation is a broad term for using the senses carefully to gather information. Inspection is a narrower term. It refers to what can be seen with the eyes, especially on the surface of the body, rather than to behavior. Skilled clinicians use more than sight when they examine a patient. They also rely on touch, through palpation and percussion, and on hearing, through...

palpation

How Hand Position Guides Palpation

Palpation uses touch to collect diagnostic information during the physical exam. It is one of the ways a healthcare provider uses the senses to learn more about a patient. The part of the hand used for palpation changes depending on the body area being examined. Finger pads are best for fine detail. Their dense sensory nerves help the examiner feel small features, such as the borders of masses or lymph nodes. The back of the hand, also called the dorsal surface, gives a rough sense of relative...

percussion

Clinical Percussion and Body Sound

Clinical percussion uses tapping to create sound and help assess what lies beneath the body surface. It is a simple bedside technique that depends on the way sound changes when it travels through different tissues. The method began with Leopold Auenbrugger, an Austrian inn-keeper's son, who found that tapping beer barrels could help him take inventory. He later applied the same idea to patients in Vienna and published the first description of its diagnostic use in 1761. Jean-Nicolas Corvisart...

auscultation

Stethoscope Sounds in Clinical Exam

Auscultation is a clinical exam method that lets a provider listen to sounds inside the body. Doctors use it to gather important diagnostic information from the chest, heart, abdomen, and blood vessels. For many years, auscultation meant immediate auscultation. In that method, the examiner placed an ear directly on the patient's skin. This approach was used for centuries, but it became less useful in nineteenth-century France because of social norms and poor diagnostic yield. René Laënnec...

proper adjustment of patient attire during the physical exam

proper-adjustment-of-patient-attire-during-the-physical-exam

Draping for a Better Physical Exam

Draping is an important part of a careful physical exam. It helps the provider examine the right body area while also protecting patient modesty. Good draping takes practice because the examiner must balance exposure with comfort. Correct technique also improves the accuracy of the exam. Skin lesions can be missed if inspection is done through clothing. Lung crackles may be reported by mistake when the chest is examined through a T-shirt, and subtle heart findings can be missed when...

blood pressure measurement

Manual Blood Pressure Reading Steps

Blood pressure reading uses an indirect method to measure the pressure of blood against vessel walls. Blood pressure, or BP, is a vital sign that is checked routinely in hospital and outpatient settings. It is one of the most common medical assessments performed around the world. The indirect method is non-invasive, safe, and easily reproducible, so it is used most often. BP can be measured automatically by oscillometry or manually by auscultation. Auscultation uses a sphygmomanometer, which...

measuring vital signs

Vital Sign Ranges and Patient Status

Vital signs are objective measurements that show a patient’s clinical status. The commonly accepted vital signs are blood pressure, heart rate, temperature, respiratory rate, and oxygen saturation. In many practices, pain is also treated as the sixth vital sign and is documented with the others. Pain is different from the other vital signs because it is a subjective measurement. That means the pain scale can vary from one patient to another. A vital signs assessment includes heart rate, blood...

Respiratory exam starts with looking for breathing distress and feeling the chest. Shortness of breath is a common reason for both outpatient and inpatient evaluation. Early inspection can reveal fast breathing or cyanosis, which is a bluish color change that can signal low oxygen. If a patient shows respiratory distress, the situation needs urgent attention and oxygen therapy. In many cases, careful clinical examination can help identify lung problems without relying only on tests. This is...

respiratory exam ii: percussion and auscultation

respiratory-exam-ii-percussion-and-auscultation

Respiratory Exam: Lung Sounds and Percussion

Respiratory exam skills include percussion and auscultation of the lungs. These techniques help identify lung problems during a physical exam. Percussion uses tapping to assess the chest, and auscultation uses a stethoscope to listen for breath sounds. Percussion is a useful skill that is often skipped in routine clinical practice. When it is done correctly, it can help a physician detect underlying lung pathology. Auscultation can also give an almost immediate clue to several acute pulmonary...

cardiac exam i: inspection and palpation

Cardiac Exam I: Checking the Chest First

Cardiac exam inspection and palpation are the first steps in a careful heart assessment. These steps help a physician gather useful information before using a stethoscope. They are part of the core examination performed when a patient is first seen. Heart and circulatory disorders are common reasons for hospital admission. They can include conditions such as myocardial infarction and congestive heart failure. Because of this, learning a complete cardiac examination is important for any...

cardiac exam ii: auscultation

Listening for Normal and Abnormal Heart Sounds

Heart auscultation uses a stethoscope to listen to heart sounds and check for normal and abnormal patterns. For physicians, knowing how to hear these sounds and tell them apart is an essential skill. The sound heard at each spot on the chest relates to the closing of specific heart valves. The heart has two main sounds, called S1 and S2. S1 happens when the mitral and tricuspid valves, which are the atrioventricular valves, close after blood enters the ventricles. This marks the start of...

cardiac exam iii: abnormal heart sounds

Heart Murmurs and Gallop Sounds

Heart murmurs and gallop sounds are abnormal heart sounds that can be heard during auscultation, or listening to the heart with a stethoscope. A good understanding of normal heart sounds is the first step in telling normal sounds apart from abnormal ones. Murmurs usually have a swishing quality and point to turbulent blood flow across a heart valve. Murmurs can happen because a valve is too narrow, which is called stenosis, or because blood leaks backward across the valve, which is called...

peripheral vascular exam

Assessing PAD and Venous Signs

Peripheral vascular disease can affect blood flow in the arms and legs, and careful exam steps help reveal signs of disease. Peripheral artery disease (PAD) is linked to cardiovascular and cerebrovascular complications. Risk factors include diabetes, hyperlipidemia, hypertension, and tobacco use. Symptoms may appear as limb claudication, which is cramp-like muscle pain that gets worse with activity and better with rest. Chronic venous insufficiency (CVI) can cause lower extremity swelling,...

peripheral vascular exam using a continuous wave doppler

peripheral-vascular-exam-using-a-continuous-wave-doppler

Bedside Doppler for Leg Blood Flow Checks

Peripheral vascular disease affects the arteries and veins outside the heart, and it is common in older adults. History and physical exam can suggest the diagnosis, but Doppler ultrasound is now a routine part of the bedside vascular exam. This lesson focuses on bedside assessment of peripheral arterial disease and chronic venous insufficiency with a handheld continuous wave Doppler. A handheld Doppler is a simple tool that sends and receives ultrasound at the same time. It detects changes in...

physical examinations i

This collection provides a foundation for performing physical exams; with techniques ranging from measuring blood pressure or vital signs, to key pulmonary and cardiovascular physical examinations. 

Learn how respiratory distress, cyanosis, and chest palpation help identify lung problems such as asthma, COPD, and pneumonia during a clinical exam.

Checking Breathing Distress by Exam | JoVE K12

Suneel Dhand

Beth Israel Deaconess Medical Center

Overview

Inspection and Palpation: What to look for?

General Observations and Inspection Steps

Palpation Steps

Summary

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Molecular signals play a major role in the complex processes occurring during embryonic development. These signals regulate activities such as cell ...

bacterial-transformation-the-heat-shock-method

Bacterial Transformation: The Heat Shock Method

Transformation is the process that occurs when a cell ingests foreign DNA from its surroundings. Transformation can occur in nature in certain types of ...

an-introduction-to-saccharomyces-cerevisiae

An Introduction to Saccharomyces cerevisiae

Saccharomyces cerevisiae (commonly known as baker&rsquo;s yeast) is a single-celled eukaryote that is frequently used in scientific research.  S. ...

Cell Cycle Analysis

Cell cycle refers to the set of events through which a cell grows, replicates its genome, and ultimately divides into two daughter cells through the ...

An Introduction to Transfection

Transfection is the process of inserting genetic material, such as DNA and double stranded RNA, into mammalian cells. The insertion of DNA into a cell ...

Chromatin Immunoprecipitation

Histones are proteins that help organize DNA in eukaryotic nuclei by serving as &#8220;scaffolds&#8221; around which DNA can be wrapped, forming a complex ...

An Overview of Epigenetics

Since the early days of genetics research, scientists have noted certain heritable phenotypic differences that are not due to differences in the ...

community-dna-extraction-from-bacterial-colonies

Community DNA Extraction from Bacterial Colonies

Source: Laboratories of Dr. Ian Pepper and Dr. Charles Gerba - The University of Arizona
Demonstrating Author: Luisa Ikner
Traditional methods of analysis ...

Cytogenetics

Cytogenetics is the field of study devoted to chromosomes, and involves the direct observation of a cell&#8217;s chromosomal number and structure, ...

embryonic-stem-cell-culture-and-differentiation

Embryonic Stem Cell Culture and Differentiation

Culturing embryonic stem (ES) cells requires conditions that maintain these cells in an undifferentiated state to preserve their capacity for self-renewal ...

DNA Gel Electrophoresis

DNA gel electrophoresis is a technique used for the detection and separation of DNA molecules. An electric field is applied to a gel matrix comprised of ...

Enzyme Assays and Kinetics

Enzyme kinetics describes the catalytic effects of enzymes, which are biomolecules that facilitate chemical reactions necessary for living organisms. ...

DNA Ligation Reactions

In molecular biology, ligation refers to the joining of two DNA fragments through the formation of a phosphodiester bond.  An enzyme known as a ligase ...

explant-culture-for-developmental-studies

Explant Culture for Developmental Studies

Explant culture is a technique in which living cells or tissues are removed from an embryo for continued development outside of the organism. This ex vivo ...

DNA Methylation Analysis

Methylation at CpG dinucleotides is a chemical modification of DNA hypothesized to play important roles in regulating gene expression. In particular, the ...

Expression Profiling with Microarrays

Microarrays are important tools for profiling gene expression, and are based on complementary binding between probes that are attached to glass chips and ...

Density Gradient Ultracentrifugation

Density gradient ultracentrifugation is a common technique used to isolate and purify biomolecules and cell structures. This technique exploits the fact ...

F&#246;rster Resonance Energy Transfer (FRET)

F&#246;rster resonance energy transfer (FRET) is a phenomenon used to investigate close-range biochemical interactions. In FRET, a donor photoluminescent ...

detecting-environmental-microorganisms-with-polymerase-chain-reaction

Detecting Environmental Microorganisms with the Polymerase Chain Reaction and Gel Electrophoresis

Source: Laboratories of Dr. Ian Pepper and Dr. Charles Gerba - Arizona University
Demonstrating Author: Bradley Schmitz
Polymerase chain reaction (PCR) is ...

Gel Purification

Gel purification is used to recover DNA fragments after electrophoretic separation. DNA recovery from an agarose gel includes three basic steps: binding, ...

Detecting Reactive Oxygen Species

Reactive oxygen species are chemically active, oxygen-derived molecules capable of oxidizing other molecules. Because of their reactive nature, there are ...

Gene Silencing with Morpholinos

Morpholino-mediated gene silencing is a common technique used to study roles of specific genes during development. Morpholinos inhibit gene expression by ...

development-and-reproduction-of-the-laboratory-mouse

Development and Reproduction of the Laboratory Mouse

Successful breeding of the laboratory mouse (Mus musculus) is critical to the establishment and maintenance of a productive animal colony. Additionally, ...

Genetic Crosses

To dissect genetic processes or create organisms with novel suites of traits, scientists can perform genetic crosses, or the purposeful mating of two ...

drosophila-melanogaster-embryo-and-larva-harvesting-and-preparation

Drosophila melanogaster Embryo and Larva Harvesting and Preparation

Drosophila melanogaster embryos and larvae are easy to manipulate and develop rapidly by mechanisms that are analogous to other organisms, including ...

Construct an explanation based on evidence for how the structure of DNA determines the structure of proteins which carry out the essential functions of life through systems of specialized cells.

HS-LS1-1.

Checking Breathing Distress by Exam

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