Identify features of the physician's physical examination consistent with his admitting diagnosis. Describe the pathophysiology that might be responsible for each physical finding

Question

What will be an ideal response?

Answer 1

Increased respiratory rate:
• Emphysema damages the elasticity of the airway and destruction of the alveolar wall occurs.
• Thus, airways collapse during expiration, which causes air to become trapped.
• The lungs and chest wall hyper-expand in an attempt to compensate.
• This increases the overall work of breathing and requires more breaths due to this inefficiency.
Jugular distention: Due to the decreased amount of oxygen available, widespread vasoconstriction and increased pulmonary artery pressure occur.
1+ pitting edema of the extremities:
• When the heart (R ventricle) has to work harder in response to the decreased overall oxygen saturation, over time the increased pressures are transmitted to the venous circulation.
• This results in peripheral edema.
Harsh inspiratory breath sounds: This is due to the trapping of air and the prolonged expiration.
Absent inspiratory breath sounds/hyperresonance of the left chest: This is due to the collapsed lung caused by the tension pneumothorax.

Use of accessory muscles: It is typical for a patient with emphysema to develop use of the accessory muscles (and form a barrel chest) in order to assist with the expiration of air.