Respiratory Examination

[Melehete]

I am very happy to see the vidoe Respiratory Examination from you, hopefully the others also are happy for You

[NganaJHone]

I am very happy to see the vidoe after you give this Respiratory Examination

[Ondelendo]

Steady I Really Like This Video Respiratory Examination

[bundawartini]

Nice Video That You Share , So Very Nice Thanks You providing online videos demonstrating core clinical skills common to a wide range of medical and health-based courses.

[Kricardose]

I Really Like The Video From Your is a project aimed at providing online videos demonstrating core clinical skills common to a wide range of medical and health-based course

[anakmudajaman]

Your Video The Clinical Skills Online (CSO) is a project aimed at providing online videos demonstrating core clinical skills common to a wide range of medical and health-based courses Is Very Useful Sharing

[paradigmata]

No doubt the patient is a racist.

[nvk1001]

youre swagggggggggggg, jk nice osce

[Michb3ck]

i need more videos where Dr. Ramachandren is talking. this is like a vacation you can listen to.

[tybeebeachbunny]

this is great! thanks :)

[daughertyjack1]

you are supposed to ask them to say 99 when palpating for tactile fremitus. you ask them to whisper it when auscultating for whispered pectoriloquy!

[mherieka]

@daughertyjack1 He is testing for Bronchophony, the sounds would be louder over any field of consolidation

[kotiya1]

I thought that you shouldn't ask them to say 99, you should ask them to whisper it. If they say it then you can hear it - and you're not supposed to be able to hear it unless they have pneumonia or something which makes the lung conduct the sound from the whispering larynx. In a respiratory examination I thought the point was that you were not supposed to hear the patient whispering 99 at all, let alone ask them to say it.

[IrishInferno88]

@rosieroserosie

*All you idiots, *obviously. You're in need of a spelling tutor.

[cowbeautiful]

@IrishInferno88 I'm a tooter

[RivJohnson101]

the patient looks like turk from scrubs lol

[narancauk]

Pronator drift for respiratory system?

[MaryWoods35504]

Thanx doc. I just started my Respiratory classes and I think these videos are very helpful and for all of you people that are cussing and saying stupid stuff- I really hope you didn't sign up for med school and if you are- what kind of college would accept students like that. We sure don't have any idiots like that in the RT program at my college.

[Mojoissimo]

Thanks for this - very useful to see the exam at full speed, without interruptions!

[TheBASTON17]

what the fuck are yu doin man....yu should explain what signs&symptoms ure looking for on the patient and how they come about.....that'll show us u know what ure doin...

[trequor]

The deep breaths sound like a steam engine.

[mammajama7]

i just knoticed he doesnt make the patient turn over on his side while listening, is their a reason why or did he forget to do that?

[IMAHMS]

lousy. it's a good examination I guees but what the point of us seeing it? evaluate you?! you should explain why and what you are doing so it would be an educational video

[abdull1989]

you did 2 mistakes: 1st he should sit on the side of the bed

2nd he should elevate his arms while doing the back test

thank you :)

[wirdo1988]

are'nt he sposed to be on the left side of the patient??

[xmen002]

@wirdo1988 NEVER always on the RIGHT SIDE of the bed

[hateliberals1]

more free medical care I pay for....

[sculli722]

@hateliberals1 Ah well, I hope one day you become sick and have to rely on the free healthcare that we all pay for. Maybe then you will appreciate it a bit more.

[sunilsiddiraj]

thankx doc :-)

[petergohayes]

Apex usually listened to with bell. only small  enough above clavicle, diaphragm too big

[Su9700]

Does anyone know why he is switching between the diaphragm and the bell when he moves down from the apexes on auscultation?

[Paullee000]

@Su9700 Switching to the bell allows you to hear lower frequency sounds better. I don't know much about lung sounds yet, but when listening to the pulse and the heart, there is can be a pretty big difference when you listen from the diaphragm or when you listen from the bell

[Su9700]

Does anyone know why he is switching between the diaphragm and the bell when he moves down from the apexes on auscultation?

[TheMrpalid]

what is the ninety nine for?

[petitfutemievre]

@TheMrpalid

I believe he's checking for Tactile Vocal Fremitus. This is pathologically increased over areas of consolidation and decreased or absent over areas of pleural effusion or pneumothorax (where there is liquid or air instead of usual lung). - wiki

[12thaveforeal]

he trying so hard not to be gay lol

[MrDemenuel]

Dr. R., I didn't get to see the posterior view of the patient. Your next video on this should let the viewers know where you place your hands at the back of the patient during a respiratory examination. Thanks.

[888rdls]

he did not do pamberton;s sign and the lateral chest wall ;p but its all good...wat do u check for n da legs??

[redcowDKJ]

@888rdls Agree with u abt the Pemberton's. I assume he's checking for clubbing of toes and differential cyanosis in toes and also pedal oedema. Right heart failure due to pulmonary hypertension can cause pedal oedema. In a bed bound patient, should also check for sacral oedema.

[cygnusx555]

that guy from Sicko I believe.......the documentary by the fat guy

[looker768]

why is he examining his hans?

[smbled21]

@looker768 to test blood circulation

[BrockenSpecter]

@smbled21 Also to check for clubbing, capillary refill, tar staining, etc.

[fornow100000]

as for a teacher it would have been helpful if you actully said what you were looking for evertime you asked the pt to do something.. No worries. Im sure you will do better next time. Please see cardiovascular examination by your female collegue. She was brllliant

[TheFitz741]

lol

[BrockenSpecter]

Just realized looking at the shoulders was probably to check for vaccination scars...

[BrockenSpecter]

Immediately following checking the centrality of the trachea, Dr. Ramachandren looks to the left and then to the right, as if observing both shoulders. What could this be for? Perhaps to check for symmetry? Excellent instructional video, incidentally.

[sweetestperfection90]

this is very useful, it has a little bit more flow than the talley and o'connor DVD!

[sadia6655]

God this guy is takin so classical deep breaths...i wish every patient could take such deep breaths....in practice one hardly find patients like dis:(

[sillydillydokieo]

most relaxing thing to watch

[Irvgott1]

the examiner seems more uncomfortable than the patient..

[evermrod]

he missed tactile vocal fremitus altogether

[ronjonsilver]

@evermrod but he did vocal resonance....you only do one or the other

[shehperpk1]

Resp exam should be completed from back as whole and front should be used only for trachea, apex beat, percussion and auscultation (if command is whole resp sys). He did examined for pedal edema, camera never caught it. chest movement above nipple from the front should be done as he did. Type 2 resp failure produces flapping tremors. he examined hands for sweating in case of horner's. Make pt comfortable as u may. tactile fremitus may be skipped for vocal resonance.

[idahosux]

What is he doin at :50 when he runs his fist down the patients hand?

[noodle080]

not sure? maybe looking for weakness or atrophy in wrist from Pancot's tumour?

[jsmed07]

checkin for asterixis on the pulmonary exam?....umm.....most think of "liver" (ie. abdominal exam) w/ hepatic encephalopathy

[MrHarmsworth]

Asterixis is due to a strain on the brain cells. Many times it is metabolic. Thus we think of liver disease due to the liver's inability to convert ammonia to urea.

However, this can occur in carbon dioxide toxicity, such as when the patient is in Type II Respiratory Failure (as the name suggests, a respiratory condition).

Other causes include: Willson's disease, in which copper accumulates in the tissues, among which the brain but also the liver; Azotemia which may be pre-renal and renal.

[noodle080]

Youc an also get an asterixis from hypercapnewia

[jsmed07]

@noodle080 true:)....although I've only seen it in ur typical hepatic encephalopathic pt.

If you don't mind me asking, are you studying/practicing med in Australia? Im in the US. I can't imagine you have to take step 2CS, right? So glad to be done w/ that....utter waste of cash.

[rajiv117]

he didn't check for tactile resonance, did he even count the respiratory rate? why was the patients arm extended at the time of pulse examination, wouldn't it be more comfortable to rest the patient's hand on his abdomen, and count both respi and pulse rate while in this position, didn't see him check for pedal edema, as part of the general examination. chest expansion for the upper zone was wrong, the hands should move apart and not up and down, to localise which part is affected

[SupaAmi]

I'm not sure if there are any errors in this video, we just started practicing this today. I did like this examination though, I thought he did it well and was very considerate and respectful. But yeah, like some of you have said, he should have explained things during.

[num1jmca]

Please disregard my rowdy page. I'm a serious student!! But yea, I think I see a couple things too. Can anybody tell my why he touches the patients knee at the end of the film?

[astromas]

@num1jmca I think he want to check pedal edema

[anatabone]

shouldnt respiratory exam be done from the back only? or it does not make such a difference?

[Endrawnia]

theres more um..gods if i could remember the correct term, lobes? the front of your body has more lobes in the lungs, where as the back has only two, i think. correct me if im wrong please

[MrHarmsworth]

@Endrawnia The right lung is composed of 3 lobes, the left lung of 2. However, posteriorly the lung fields are mainly occupied by the lower lobes of both lungs.

[Endrawnia]

thank you for the correction :)

[pinkPINK99967]

ok man this has some mistakes on it if i ddnt introduce myself first n take permission i wont even finish the exam and never touch the patient while inspection at first touch inspection is over

[CTreyO182]

I'm sorry, but at certain points of this video...the black dude looks as if he's saying ''um, dude you seriously need to get the hell away from me"

[jamalfadil1]

he must explain the purpose behined very step he is doing during examination,for exampel why han lessen over the trachea med bell of stethoscop or why and where he is doing percussion,otherwise it will be just like TV drama eller presentation.

[SupaAmi]

Lol... what is up with you mixing English and Swedish words in the same sentence? Seriously, it made me laugh. But yeah, you got a good point.

[darkprince1190]

Tack bro !

[bawain]

i wish he'd explain why he did wat ever he did

[TomSaunders89]

I like this doc a lot but I do think he should wear a tie clip

[Harrehz]

i like him too. and really, i couldnt care less about his tie

[TomSaunders89]

But what about transmitting infections? I mean, you can see him having to hold it away from the patient in places so he's obviously at least aware of the potential annoyance to the patient.

I hate to seem like a stickler for procedure but I do think it's important.

[joshimaru100]

a doctor wants to check whether the patient has any sputum..

[Mowgligrl]

What the hell is he looking for! Explain what and why you are doing all these things, this vid isn't great for OSCE skills

[Harrehz]

your mum said otherwise hahahaha

[CarlaLR74]

What is a doctor looking for or listening for when he or she asks a patient to cough?

[bonnhew]

cough

[romanholiday]

I would like to see the doctor/HCP thinking aloud. Tell the audience why you are doing certain things e.g. what are you looking for when your patient repeats the number 99.  That way I am going to learn more. Thanks, RH

[SnowyDae]

That Doc is hot!

[mitziblair]

I think this is a little bit over acted. When the guys breathing in and out lol. Maybe just me but thats what I think. Erm the exam was well performed and I think the doctor done well.

[timmo2k]

Dr who????

[Urbanebula]

Dr. Nathin Ramachandren

[IrishInferno88]

@Urbanebula

Dr Nathin Ramalamadingdong is what he said. Are you deaf?

[SatinWorship]

@IrishInferno88 Are you stupid?

[IrishInferno88]

@SatinWorship

Nope, Are you a retarded cunt? I think so. Cunt

[SatinWorship]

@IrishInferno88 Ooops, there we go, I'm right again.

[IrishInferno88]

@IrishInferno88

You win a minor argument on a youtube comment section, congrats. Shame you have that pathetic existence known as your reality you have to deal with. =/

[StigRossi]

@Urbanebula

its Dr. Navin Ramachandran. A simple google search would have cleared your error up :)

[trigeminal77]

he examined only right eye for anemia.... i think both eyes should be examined

[musicalmedic88]

our consultant made fun of us... sarcastically asking about unilateral anaemia!

[grobanmania]

Artificial eye! :)

[grobanmania]

Actually he examines the sclera for jaundice "yellow discoloration", not anemia "pallor". He should have examined both eyes though! :)

[Grimz92]

He didn't have to check twice. They only use perfectly healthy people for videos like these, so he already knew that he didn't have to check the other one.

[boscowally]

This dudes really good, very quick and I assume he's thorough enough too

[baronvdw]

Thanks for the video, over here we check the apex beat too, to check for deviation. Cheers for the vid

[xingyimaster1987]

bloody brilliant, i have clinical skills exams in two weeks and i could learn it all from these videos. thanks.

[kotoreru]

Can anyone tell me why he brushed the patient's palms with the back of his fist?

[TAQMAN180360]

i guess checking for clubbing

[kotoreru]

Thanks Taqman180360, but I'm sure it's not that. He checks for clubbing by bending down level to the patient's outstretched hands, to check the curve of the nails.

Thanks, though.

[TAQMAN180360]

thanks. your probably right

[sonique32]

Hi kotoreru, He brushed palms to check for excessive sweating..

cheers..

[kotoreru]

Thanks sonique32, I wouldn't have thought of that. We're not taught to do that. We probably check for sweaty palms by visual inspection.

What's the point of checking for it? i.e. what does it mean if the palms are excessively sweaty?

[Ratznium]

thyrotoxicosis

anxiety (+/- panic attacks)

infection (in particular, respiratory infections like community acquired pneumonia)

[kotoreru]

Nice one, cheers :)

[sonique32]

it's a part of general examination really.. If there is excessive sweating at rest, there could be a dysfunction of the sympathetic nervous system.. Ratznium's comment is also correct indeed..

[marie8805]

i believe he was feeling for the temperature of the patient's hands. If too cold, the patient may have peripheral cyanosis/not good perfusion of the extremeties...

[SlifeRed23]

No wait.. if your talking abt at 1:20... i thnk he's checking his R/R... since its the only vital sign that CAN be controlled.. he needs a way to hold him still while counting his repirations(chest goes up and down).. thats how i was taught... i might be wrong though

[marie8805]

hey, no i was refering to the doc brushing the back of his fingers over the patient's palms

[SlifeRed23]

ohh... sry :)

[kotoreru]

Good thinking, though. I hadn't thought about why he was holding the guy's arm up. :)

[nashstruck]

no,

intially with his fingers straight out, he's checking for a fine finger tremor from long term B2 agonist over-use.

then he asked him to cock his wrists back to look for a flapping tremor, associated with co2 retention.

[jazmone1]

You need to explain what you are doing and what you are looking for in the exam, and not just simply do the motions.

[spindoc85]

what did he do with the legs in the end????

[ill0o0lli]

he is making sure no pitting oedema is there ...

[DrIyiola]

very good technique

[Graham1952]

very good examination - good clinical skills - established good doctor - patient repore.

[drwajahat9]

v good examination, but i think he missed auscultation of axillae. and ? palpation of apex.

[lockie84]

there are several ways of doing respiratory exams but whats important is to know how your examiners want it to be done.

it is ideal for the res year students to find a video with full commentary eg no sign of clubbing etc

[DrIyiola]

wat i need for osce

[Halibut]

Dr. Navin Ramachandran

[stridskuk87]

what was his name again? dr ...?

[CappsGrad]

Wut exactly is his occupation? Respiratory therapist?

[SkanRashke]

Possibly general practitioner.

[ne15ag]

One minor thing re communication/professionalism is that the doctor did not say he was going to lay his hands on the patient before he did so. When checking for tracheal deviation it's probably worth saying "this may feel a little uncomfortable" rather than "let me know if this is uncomfortable". Apart from that excellent!

[itsmemeDDP]

This is a good doctor, you did the procedure excellent and with professionalism. Residents pay attention this is text book how it's done. Great vid!

[mohsz]

Great job... very educational.

Keep up the good work.

God bless..

[mohsz]

I think the doctor is excellent, and by the way about what you said about him... it takes one to spot one.

[4bizu]

yeh really if ur gonna be dissin on gays then just go jump in a manhole

[SGUSOMUSA]

This was a cursory exam at best, which, I recognise, is all we will be able to execute in the wards due to time constraints. Some things that were missed: tactile fremitus, whispering pectoriloquy, diaphragmatic excursion, and listening to an adequate number of positions over the chest. Also, Id like to add that clubbing is best seen when the fingernails are symetrically apposed.

[amerenio]

doctor what?????????

[timmo2k]

LOL. Totally agree. i listened over and over, bit by bit, and this is what i get:

Dr Navaramachangranm

God knows, his ancestors are retards for using this as a name LOL

[Mrster]

Well maybe his name actually means something.

[besos13]

Where as you are just a retard? Simply because you are unable to say something, it does not make the thing you cannot say stupid. When you turn round and insult it it makes you pathetic.

[Pilar2086]

Very very good=)

[michaelatm2603]

I'd like to know. Why he has to check his hands?

[VinayWa]

To see wether or not there is clubbing of the fingers or peripheral cyanose. The way he is looking it's more to see if there's clubbing of the fingers.

[sabbarah]

also palmar erythema is an important sign

flapping tremors (asterexis) can be caused by respiratory failure

[ruheir]

dont you think he's doing it too fast? tomorrow is the big day for all of the first year students in RCSI cause there's a clinical skill examination. everybody is absolutely nervous.ahhhhhhhhhhhhhhhhhhhhh­hhhhhhhh

[wimthehof]

good speed: to be "complete"

- wrist tenderness -> HPO

- ab/adduction of fingers against resistance

-> weakness: lung cancer inv. brachial plexus

- palpate maxillary, frontal sinuses for tenderness -> sinusitis

- Pemberton's sign -> SVC obstruction

[mraff1983]

Not a great idea doing Pembertons sign in an exam... nothing likely to pass if your patient passes out

[wimthehof]

I agree Pemberton's shouldn't be done say in a 5 min OSCE station as you'll blow valuable time. However, if you are doing a "complete" assessment, you don't want to be missing SVC obstruction "on exertion" as opposed to say in 6 months when eg. an apical lung cancer starts compressing the SVC, trachea etc. "at rest" - then you will have a problem

[CyberDragonZero]

You sure do like to post that dont you? Same thing over and over

[anatlus1987]

flapping tremor occurs when there is retention of CO2 such as in patients with severe respiratory failure.

[timmo2k]

so basically its the opposite of a panic attack? i have panic attacks because my body sometimes removes too much CO2 from my blood stream.

[anatlus1987]

flapping tremor occurs when there is retention of CO2 such as in patients with severe respiratory failure.

[Kriyn]

but it's totally what u need to do for osces...it's so fake!!! :(

[timmo2k]

I know he explains lightly, but what is he looking for in the hand and why? what on earth is a ''flapping tremor'' (if i heard correctly) indicative of?

[hillmie87]

Not so sure about the flapping tremor. But looking at the hand, or maybe more precisely fingers allows you to observe for finger clubbing and nicotine staining. This gives you the basic idea of the lungs condition.

[zchaai3]

A flapping tremor is indicative of carbon dioxide retention (or a sign of liver disease in abdo exam). A very slight tremor/vibration of hands is common if patient on salbutamol

[timmo2k]

thankyou

[angchoonseong]

thanks

[alfares94]

very good>>>>>>>>>>>

[lampie161091]

what is the 99 all about

[freyman1976]

the vibrations when patient repeats 99 helps to check if the lungs are ok (f.e. if there aren't any fluids in them)

[zchaai3]

its called vocal fremitus. If consolidation e.g.pneumonia, vibration is increased

[camilaustral]

si se puede hacer 30 segundos, despues lo multiplicas por 2.

[deepun]

although u didnt let me into your med school

[deepun]

the video is really good apart from that

[deepun]

i think its 30 seconds to measure your heart rate not respiratory rate.

[freyman1976]

not exactly - usually you tell patient that you're gonna check his pulse, but really you're checking his respiratory rate, because if you would tell him "I'm gonna check your breathing" he most probably would concentrate his mind on it and wouldn't keep his natural respiratory rate