Teaching Tips: Pulmonary
- As with any physical sign, it is helpful to have the learner commit to an assessment before utilizing technology, such as radiography, ECG, or invasive monitoring.
- Talk aloud to describe the maneuver as it is being performed.
- To keep all participants interested, pose questions that learners can be thinking about (see case example) until it is their turn to examine patients.
- Ask the patient's permission before reviewing the sign as a group. Summarize to the patient when the exam is completed.
- There are different way to approach the exam depending upon the level of the learner:
- A finding may be simply demonstrated, or A brief patient history may be given and the learner asked to demonstrate appropriate exam maneuvers, or
- Demonstrate various maneuvers to detect an abnormality (e.g., ascites), and ask learners about the value (sensitivity and specificity) of each exam maneuver.
- Historical points are fun and enhance interest in the exam.
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The traditional descriptions of friction rub used correlations such as "leather rubbing together" (examples such as a saddle and leather pants). Now these are irrelevant since most of us don't even know what leather sounds like!
Better examples to convey the sound are:
- The crunching sound of walking on new snow with an icy top crust.
- Ask the learner to rub his/her thumb and index finger together right next to the ear
- this reproduces a similar sound
- Cover ear with hand and with fingernail of opposite hand, scratch along dorsal surface of hand that is covering the ear
Question: Why is a pleural friction rub loudest over the lower chest wall on the side of inflammation?