![]() ![]() From here, second order neurons pass out of the spinal chord, out over the apex of the lung, and then up alongside the carotid artery, to the superior cervical ganglion. The arrangement of sympathetic nerves in this area – the sympathetic chain! – 1 st order neurons travel from the brain, to the spinal chord between levels C8 and T2.Thus in this case, there is no sympathetic, so the pupil is always constricted – however – as the parasympathetic is still active, you may be able to constrict the pupil even further by shining a light into it – this does not mean that Horner’s is not present! Sympathetic nerves cause dilation of the pupil.This is a common symptom of an upper lung tumour. no sweating on the affected side of the face. for anaemia, jaundice, xanthelasma and Horner’s sign – consists of: constricted pupils, a droopy eyelid and reduced sweating – all on the same side of the face – e.g. check for cyanosis on the underside of the patient’s tongue.Check the BP – or at least say you would check it.Fine tremor – there is a fine tremor often present in respiratory patients that is caused by β 2– agonists – i.e.Splinter haemorrhages (endocarditis) – although they are very commonly caused by trauma (manual labour).They are horizontal ridges in the nail – a bit like rings in a tree trunk. Beau’s lines – sign of serious illness in the past 3 months (nails take 3 months to grow fully).Leukonychia – white nailsa as a result of hypoalbuminaemia – liver disease.Other signs that show CO2 retention include warm sweaty palms (due to vasodilation), and a bounding pulse – always check the pulse!.If there is a flapping tremor (a ‘coarse flap’) this suggests a retention of carbon dioxide. Ask the patient to hold out their arms and bend their wrists so that their palms are vertical pointing away from them. Respiratory causes of clubbing include: Empyema, Bronchiectesis, Non-small cell carcinoma, Lung fibrosis, CF, Abscesses, suppurative diseases – diseases that produce a lots of pus!.Also look for a drip, any medications, sputum pots, nasal specs or masks.Ĭheck for signs of clubbing. as these are clues to possible respiratory disorders. is there oxygen, inhalers or a nebulizer etc. listen if there are any audible breathing sounds (normally there aren’t.).Normally expiratory time is shorter than inspiratory time, however, in lung diseases, often there is very short inspiration followed by prolonged expiration. look at the patient’s expiratory time.see if the patient is pursing their lips on breathing. ![]() This may be present if the patient suffers from COPD)
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