Suggested examination items:
1: Pulmonary function tests.
Warm tips.
Children may be afraid of the test, so they should be reassured and guided before and during the test.
Normal values.
1. Bronchial excitation test without response of increased airway reactivity. The airway is open and gas enters and exits very easily.
2. Bronchial diastolic test test calculates the improvement rate of FEV1 less than 12% after inhalation as negative diastolic test.
Clinical significance
Abnormal results.
1. bronchial excitation test has increased airway reactivity, the diagnosis is likely to be atypical asthma.
2. Stop using short-acting β2 agonists within 12 hours and long-acting β2 agonists within 48 hours before the bronchial diastolic test; stop using theophylline extended-release tablets for 24 hours and atropine drugs for 8 hours; firstly, measure the subject’s basal FEV1, then nebulize the inhaled β2 agonists and repeat the measurement of FEV1 15-20 minutes after inhalation; calculate the improvement rate of FEV1 after inhalation as 12%. The above is a positive diastolic test can assist in the diagnosis of asthma. Suggests the presence of current airway spasm and minor asthma attack.
Population to be examined.
Children with problems with lung function and respiratory problems. Children with a cough that has not been treated with antibiotics for up to 1 month or children who have had 4 or more recurrent wheezing episodes in a year and have been treated for an acute asthma attack for a period of time without any coughing or wheezing symptoms.
Precautions.
Not suitable for: patients with cardiopulmonary insufficiency, hypertension, coronary artery disease, hyperthyroidism, pregnancy and other diseases.
Pre-test contraindications: no history of respiratory infection in the month prior to the test; asthma patients in symptomatic remission.
Requirements during the examination: children may be afraid of the examination, so they should be reassured and guided before and during the examination.
Examination procedure
Respiratory diseases in children, like those in adults, are also reflected in pulmonary function. The indications for pulmonary function tests are the same as those for adults, but children have their own characteristics. Attention should be paid when performing pulmonary function tests.
1.Exertion-dependent pulmonary function test
(1) Exertion-dependent spirometry (MEFV) is limited by the age of the child. The test requires the active cooperation of the subject, and the application of these pulmonary function tests is limited in children who are too young due to poor cooperation, such as inability to breathe quickly and forcefully, and poor repeatability.
(2) Testing of pulmonary function in children may require multiple tests as long as their expiratory flow rate curve is straight (flow rate change <0.251/s).
(3) Children’s lung function differs from that of adults in some respects because they are growing and developing. Children’s lung function indexes (such as FVC, FEV1, PEF, etc.) increase with age, height and weight. For the evaluation of children’s lung function, the lung function values of adults should not be referred to and projected based on the projected equations of adults, but only the normal values of lung function of the children’s group.
2. Uncooperative children
For some children who cannot cooperate with the pulmonary function test, or in some cases where the rate of change of pulmonary function needs to be continuously monitored, the highest expiratory flow velocity meter (peak velocity meter) can be used for peak expiratory flow velocity determination.
3. Infants and children (<3 years old) < span="">
Because they cannot actively cooperate, the current routine exertion-dependent pulmonary function tests cannot be applied. Non-exertion-dependent pulmonary function such as tidal volume, minute ventilation, functional residual air volume, pulmonary diffusion volume by repetitive breathing, and respiratory mechanics such as airway resistance and thoracopulmonary compliance can be applied to these children.
(1) Tidal breath flow rate volume loop (TBFV) measurement. This technique does not require subjective exertional cooperation from the subject, and only tidal breathing is required when the occluder is attached, and the spirometer can continuously record the flow rate volume loop.
(2) Pulse oscillation spectral analysis method to determine airway resistance. Through the pulse oscillation technique with an external signal source, the child only needs to breathe tidefully for several cycles with the mouthpiece attached, and the airway viscous resistance, elastic resistance and inertial resistance, as well as thoracic and bronchial compliance and other parameters can be evaluated.
4.Blood gas analysis
Blood gas analysis is an important component of pulmonary function and is the most important pulmonary function test for infants and children. It determines the gas exchange capacity of the child.
5.Airway responsiveness measurement
In older children, the method of airway responsiveness measurement is mostly referred to that of adults. Zheng Jinping and others reported that the airway reactivity measurement (inhalation histamine bronchial excitation test) in older children (11-14 years old) was performed with the same method and criteria as adults, and the results were similar to those of adults. The exercise excitation test is also used in clinical practice.
6.Airway diastolic test
In infants and young children, the development of β receptors in the airway may be immature, and thus the responsiveness to β receptor stimulants may be poor. In contrast, M receptors are relatively more developed and may respond better to M receptor antagonists, so it may be better to use M receptor antagonists (such as ipratropium bromide) in infant and child airway diastolic test.
Unsuitable groups
Unsuitable groups: patients with cardiopulmonary insufficiency, hypertension, coronary artery disease, hyperthyroidism, etc.
Adverse reactions and risks
Generally no complications and hazards.
2.Exertional spirometry (FVC)
Force spirometry (FVC) is also known as time spirometry. This index refers to the ability to exhale the gas from the measured lung volume in the most rapid manner. This index refers to the ability to exhale the gas from which the lung volume is measured with the quickest possible exhalation. The exhaled volume in the first second is the forced expiratory volume in one second (FEV1.0), which is widely used in clinical practice and is often expressed as FEV1.0/FVC%.
Normal value
1s0.83.
2s0.96.
3s0.99.
Clinical significance
In practice it is often expressed as a percentage of the whole lung volume in the 1st second, called the 1-second rate. In normal individuals, it is greater than 80% and below 80% indicates the presence of obstructive airway ventilation disorders, such as asthma. The severity of bronchial asthma is also judged medically by the presence of less than 80% and 60%.
Possible diseases with low results.
Bronchial asthma, asthma, pediatric asthma
Precautions
1. Before the examination, the subject should be given a detailed explanation of the examination methods and essentials, and adaptation training should be done.
2.Exertional spirometry and maximum mid-expiratory flow are affected by the degree of forceful exhalation during the examination, with the former having a greater impact.
3, the subject’s gender, age, height and muscle strength can affect the above examination results.
4, when exhaling as hard as possible to exhale the air, so as not to affect the results of the examination.
5, contraindications: ① serious cardiopulmonary disease, physical weakness. ②Mental abnormalities or those who cannot cooperate well.
Examination process
Inhale completely, then exhale forcefully, quickly and completely. Explosive exhalation is required, without hesitation at the beginning, and the degree of force can be slightly reduced in the middle and later stages of exhalation, but there is no interruption in the whole exhalation process until the exhalation is complete, avoiding coughing or double inhalation; the exhalation time should be extended as much as possible according to the requirements of the instructor, and in general, the adult exhalation requirement is more than 6s.
Unsuitable groups
Contraindications.
①Severe cardiopulmonary disease, weakness.
②People with mental abnormalities or who cannot cooperate well.
Adverse effects and risks
This test is a non-invasive test and generally does not bring complications and hazards.
3.Provocation test
Provocation test is a test to determine allergens by simulating natural conditions and causing a mild allergic reaction with a small amount of allergens. It is mainly used for type I allergic reactions, and sometimes also used for the examination of type IV allergic reactions, especially when the skin test or other tests cannot obtain positive results, this method can exclude the false positive reactions and false negative reactions in the skin test.
Warm tips.
This test is not performed in patients with respiratory tract infection or significantly reduced lung function.
Normal value
Negative reaction.
Clinical significance
The excitation test or is divided into specific excitation test and non-specific excitation test. Non-specific excitation is to do a mist inhalation with histamine or methacholine to observe the patient’s sensitivity to type I allergic reaction, so as to carry out etiological analysis or efficacy determination; specific excitation is to do the test with antigen, which is of certain value to clarify the allergens. Depending on the location of the patient’s disease, the excitation test of different organs can be performed, often bronchial excitation test (BPT), nasal mucous membrane excitation test and conjunctival excitation test.
Precautions
Before the test: Patients should stop using β-agonists and phosphodiesterase inhibitors at least 12 hours before the test, stop using sodium cromoglycate 24 hours before, stop using antihistamines 48 hours before, and stop using hydroxyzine 96 hours before.
At the time of examination: after inhalation of allergen infusion should be observed for at least 30 minutes, and 24 hours if possible, to facilitate the detection of delayed reactions and biphasic reactions.
After the examination: If the patient feels that the reaction is heavy, he/she should be treated promptly or inhale the tracheal antispasmodic in time.
Examination process
Abnormal results of different tests.
1. Bronchial provocation test (BPT).
The criteria for determining positive results are as follows ① obvious conscious symptoms, such as chest urgency and wheezing; ② croup is heard in the lungs; ③ FEV-1 decreases by 20% or more.
BPT is more specific than skin test and correlates better with the patient’s medical history, symptoms and allergen adsorption test. It is commonly used to determine the allergens of bronchial asthma, to test the antigenicity of new preparations, to evaluate the efficacy of asthma calming drugs and to observe the results of desensitization therapy.
The disadvantage of this method is that only one antigen can be tested at a time, requiring specialized equipment and techniques, and the cooperation of the patient.
2. Conjunctival excitation test.
The conjunctiva on the test side is congested, edematous, with increased secretion, itchiness, and even redness of the eyelid is a positive reaction.
This test is mainly used for allergen screening for ocular allergic diseases. Note that any irritant in the antigen solution can lead to false positives; those with more severe reactions should be flushed with saline immediately.
3. Nasal mucosal excitation test.
Can be performed by antigen inhalation method (powder) or drop-in method (liquid), mucosal edema and pallor appear after 15-20 min of exposure to antigen, and patients with symptoms such as nasal itching, runny nose, sneezing can be judged as a positive reaction.
It is mainly used to diagnose hay fever and allergic rhinitis. If a more serious reaction occurs, dilute norepinephrine can be used for nasal flushing, and if necessary, administered according to the acute onset of allergic rhinitis.
4. Oral excitation test.
Direct contact of allergens with the oral mucosa, positive reaction to the oral mucosa swelling and congestion. Mainly used for the examination of food, drugs or other allergens.
5. Genitourinary system test.
The antigen is fixed in the cervix with a suitable size of uterine cap and put into the vagina; or introduced into the urethra through a catheter. A positive reaction is manifested by mucosal cicatricial inflammation and eosinophils can be detected in the secretions. This test is mostly used to test the sensitivity to contraceptives, topical urogenital drugs and contrast agents.
6. Ice water test.
A test tube filled with ice water is placed upside down on the skin of the back, and a positive reaction is observed after 1 min of localized wind mass. This test has diagnostic significance for cold urticaria.
Not suitable for people
Unsuitable groups: The test should not be performed on people with respiratory tract infection or significantly reduced lung function.
Adverse effects and risks
There are no relevant complications and hazards.
4.Skin test
Skin test is the most commonly used specific test, including patch, scratch, prick and intradermal injection. Clinically, prick and intradermal tests are most commonly used, such as negative prick test; can be reviewed by intradermal test.
This antibody adheres to the IgE receptor on the surface of mast cells in the skin or submucosa, and when it meets with the allergen that enters the body again, it forms a bridge between one allergen and two IgE antibodies, resulting in a series of biochemical processes in the mast cells, releasing allergic mediators and producing a localized wind, redness or itching in the skin. Itching. After 15-20 minutes of skin test, observe the skin reaction, the size of the local air mass and redness, and compare with the control point.
Warm tips.
Patients should stop taking antihistamines and corticosteroids 24-48 hours before the skin test, but it is not necessary to stop using asthma medication.
Normal value
Negative without papules and erythema, or very slight erythema.
Clinical significance
The positive reaction of the prick test is dominated by redness and the positive reaction of the intradermal test is dominated by wind masses.
1. Negative without papules and redness, or very slight redness.
2. Suspected redness less than 0.5 cm.
3. Positive with redness of the wind mass 0.5; with redness of the wind mass 0.5-1.0cm; with redness of the wind mass greater than 1cm but without pseudopods; with redness of the wind mass greater than 1.5cm and with pseudopods.
Positive results were seen in allergic diseases.
Positive results possible diseases.
Chytridiomycosis, Schistosomiasis, contact dermatitis, erythematous aspergillosis, cutaneous leukoplakia, schistosome caecal dermatitis, milia, hyperplastic scars, pediatric food allergic reaction, body lice
Matters to note for skin test.
1. Ask the patient to stop taking antihistamines and corticosteroids 24-48 hours before the skin test, but it is not necessary to stop using asthma medication.
2. During the skin test, in addition to observing the local immediate reaction, the patient should also be observed for systemic reactions such as chest tightness, shortness of breath, pallor, cold sweat, itchy skin rash, etc. Once found, the patient should be treated promptly to avoid danger.
3. Ask the patient to go home and continue to observe for late reactions within 72 hours.
4. For those who are highly sensitive to suspected allergens, try not to do intradermal test to avoid accidents.
Examination procedure
Test method: In the patient’s inner forearm, sterilize routinely, then use an OT syringe and a No. 4 needle to inhale 0.02 ml of different allergen dip into the skin of the inner forearm, with a distance of 2.5 cm between the antigen points. 15-20 minutes after the skin test, observe the skin reaction, the size of the local air mass and redness, and compare with the control points.
Unsuitable people
No special contraindications.
Adverse effects and risks
There are no relevant complications and hazards.
5.Blood routine
Blood test is to detect and analyze the quantity and quality of the three systems of blood, namely red blood cells, white blood cells and platelets. These three systems, together with plasma, make up the blood, which flows constantly in the body’s circulatory system and participates in the body’s metabolism and every functional activity, so blood plays an important role in ensuring the body’s metabolism, functional regulation and the balance of the body’s internal and external environment.
Pathological changes in any of the organic components of blood can affect tissues and organs throughout the body; conversely, lesions in tissues or organs can cause changes in blood components, thus hematological analysis and its results can be of great help in understanding the severity of diseases.
Most hospitals use automated hematology analyzers to do routine blood tests (currently called hematology analysis). Only 0.1 ml (about two large drops of blood) of anticoagulated blood is used for each test, and more than 20 results can be tested and printed in as little as 30 seconds or one minute.
Included items.
Neutrophil Ratio (NEUT%), Lymphocyte Ratio (LY%), Neutrophil Count (NEUT), Mean Platelet Volume (MPV), Platelet Count (PLT), Platelet Volume Distribution Width (PDW), Red Blood Cell Pressure (HCT), Hemoglobin, Eosinophil Count (E), Basophil Count, Mean Red Blood Cell Hemoglobin Content ( MCH), lymphocyte count (LY), mean erythrocyte hemoglobin concentration (MCHC), mean red blood cell volume (MCV), red blood cell count (RBC), red blood cell distribution width (RDW), red blood cell deformability, red blood cell deformability, monocyte count (MONO).
Warm Tips.
The day before the blood draw, do not eat too fatty or high-protein food and avoid drinking a lot of alcohol.
Normal values
1.Red blood cell (RBC): 4.0X10^12~5.5X10^12/L for men and 3.5X10^12~5.OX10^12/L for women.
2, hemoglobin (HGB or Hb): 120 ~ 160g/L for men, 110 ~ 150g/L for women.
3, erythrocyte pressure volume (HCT.Hct, also known as erythrocyte specific volume, PCV): male 0.42-0.49L/L (42%-49%), female 0.37-0,43L/L (37%-43%).
4.Mean erythrocyte pressure volume (MCV): 80-100fL.
5, Mean erythrocyte hemoglobin content (MCH): 27-33pg.
6.Mean erythrocyte hemoglobin concentration (MCHC): 320-360g/L.
7.Mean erythrocyte diameter (MCD): 6-9um (average 7.2um).
8.Red blood cell volume distribution width (RDW): 11.5%～14.5%.
Clinical significance
Red blood cell count (RBC) (unit: 10^12/L)
Greater than normal, true erythrocytosis, severe dehydration, pulmonary origin heart disease, congenital heart disease, inhabitants of high mountain areas, severe burns, shock, etc.; less than normal, anemia, hemorrhage.
Erythrocyte pressure (HCT) (unit: %)
Greater than normal, true erythrocytosis; various causes of blood concentration such as dehydration, extensive burns, reference value for rehydration; less than normal, anemia, hemorrhage.
Mean red blood cell volume (MCV) (unit: fL)
Greater than normal value, dystrophic megaloblastic anemia, alcoholic cirrhosis, extra-pancreatic insufficiency, acquired hemolytic anemia, hemorrhagic anemia after regeneration, hypothyroidism; less than normal value, small cell hypochromic anemia, systemic hemolytic anemia.
Erythrocyte distribution width (unit: %)
Greater than normal value, used for diagnosis and efficacy observation of iron deficiency anemia, differential diagnosis of small cell hypochromic anemia, classification of anemia; less than normal value, neater than normal human red blood cells, little clinical significance.
Possible diseases with low results.
Hepatobiliary damp fever, pediatric leukemia, pediatric autoimmune hemolytic anemia, anemia of chronic disease, primary thrombocytosis in the elderly, pediatric leukoid reaction, bacterial skin disease, nasal cancer.
Possible diseases with high results.
Middle East respiratory syndrome , pediatric secondary thrombocythemia , hemoglobin M disease , pediatric megaloblastic anemia.
Precautions
I. Precautions before blood sampling
1, the day before the blood draw do not eat too greasy, high-protein food, avoid drinking a lot of alcohol. The alcohol content in the blood will directly affect the test results.
2, the day before the physical examination after 8:00 p.m., should fast, so as not to affect the next day fasting blood sugar and other indicators of detection.
3, blood should be relaxed when drawing blood, to avoid the fear of causing vasoconstriction, increasing the difficulty of blood collection.
4.Please explain in advance if you have a history of needle sickness.
Second, after the blood draw should be noted
1.After blood sampling, local pressure should be applied to the needle hole for 3-5 minutes to stop bleeding. Note: Do not rub, so as not to cause subcutaneous hematoma.
2. The duration of pressure should be adequate. The clotting time varies from person to person, and some people need a slightly longer time to clot. So when the skin surface does not seem to bleed immediately stop compression, may not completely stop bleeding, and blood seepage to the subcutaneous cause bruising. Therefore, longer pressure is necessary to stop bleeding completely. If there is a tendency to bleed, the compression time should be extended.
3.After blood sampling, symptoms of dizziness such as dizziness, dizziness and weakness should be immediately laid down, drink a small amount of sugar water, and wait for the symptoms to be relieved before conducting physical examination.
4.If local bruising occurs, wet compress with warm towel after 24 hours can promote absorption.
Examination process
Venous blood collection mostly uses the superficial veins located on the body surface, usually the elbow vein, dorsal hand vein, internal ankle vein or femoral vein. The anterior elbow vein is the preferred site of blood collection for most people (except infants and children). It is generally more obvious, less painful, and easy to operate. In children, the external jugular vein can be used. The next choice is the femoral vein.
Method
1.Prepare all the materials, label the specimen container, and explain to the patient after checking the correctness to obtain cooperation. Expose the patient’s arm, select the vein, tie a tourniquet at about 4-6 cm above the venipuncture site, and ask the patient to clench his fist so that the vein is filled and revealed.
2, Routinely disinfect the skin and leave it to dry.
3.Below the puncture site, pull the skin tightly with the left thumb and fix the vein, hold the syringe with the right hand, the needle bevel upward and the skin into 15 degrees to 30 degrees, stab subcutaneously on or beside the vein, then stab the vein subcutaneously along the vein, see the return blood, put the needle slightly flat, slightly forward and fixed, draw blood to the required amount, relax the tourniquet, ask the patient to loosen the fist, dry cotton swab press the puncture point, pull out the needle quickly. and flex the patient’s forearm to compress for a moment.
4, remove the needle, slowly inject blood along the wall of the tube into the container, do not inject the foam to avoid hemolysis. When glass beads are placed inside the container, it should be shaken quickly to remove fibrinogen. If the tube is anticoagulated, it should be rotated and rubbed in both hands to prevent coagulation. If it is a dry tube, it should not be shaken; if it is a liquid medium, the blood should be mixed with the culture medium and the bottle should be disinfected with flame before and after the blood is injected into the culture bottle, taking care not to let the bottle stopper touch the blood.
The amount of blood to be drawn is determined by the content of the test and the number of items, usually around 5ml.
Unsuitable groups
Patients with hemophilia, severe coagulation factor deficiency.
Adverse effects and risks
Blood or needle sickness: During blood sampling, the lack of blood supply to the brain due to emotional stress, fear, vagus nerve excitation and blood pressure drop may cause blood sickness or dizziness.
6. Pulmonary ventilation
Pulmonary ventilation refers to the amount of gas entering and leaving the lungs per unit of time. Generally refers to the dynamic volume of the lungs, which reflects the ventilation function of the lungs. Pulmonary ventilation can be divided into ventilation per minute, maximum ventilation, ineffective lung volume and alveolar ventilation. Ventilation per minute refers to the product of tidal volume and respiratory rate, which is the volume of air inhaled or exhaled by the lungs per minute. Inadequate ventilation and hypoxia are often seen in patients with shallow breathing in clinical practice. When resuscitating a patient with sudden respiratory arrest, artificial respiration is used to keep the lungs ventilated by expanding and narrowing the patient’s chest. However, care should be taken not to exert too much force to prevent damage to the ribs, but also to pay attention to the magnitude so that alveolar ventilation achieves sufficient effect.
Warm tips.
Inappropriate people: severe cardiopulmonary disease and hemoptysis are contraindicated.
Normal values
Resting ventilation per minute.
The tidal volume of calm breathing is about 25% from the contraction of intercostal muscles and 75% from the diaphragm movement. Therefore, tidal volume is not only related to gender, age, height and body surface area, but also influenced by thoracic and diaphragmatic movements. The calculated values are subject to BTPS
The calculated values must be corrected by BTPS.
Maximum ventilation volume.
Normal values are about 104±2.71 L for men and 82.5±2.17 L for women, and are usually determined as a percentage of the expected value, with values below 80% of the expected value being considered abnormal.
Clinical significance
Abnormal results.
VE below 3 L indicates hypoventilation and above 10 L is hyperventilation. It should be noted that a normal value of this value is not equal to normal respiratory function.
Decreased MVV is seen in ① airway obstruction and decreased elasticity of lung tissue, such as obstructive emphysema; ② decreased respiratory muscle strength and respiratory insufficiency; ③ thoracic, pleural, diffuse interstitial lung disease and large parenchymal lung disease, such as pulmonary atelectasis, which limits lung diastole and contraction.
Need to check the population Commonly used in the evaluation of pulmonary function status of patients before thoracic surgery and occupational disease work capacity identification.
Possible diseases with low results.
Pediatric asthma, croup, renal cough
Precautions
Pre-examination contraindications: maintain a quiet state for a period of time.
Attention during the examination: stand in the body position and cooperate with the doctor.
Examination procedure
1. Minute ventilation (VE) is the volume of air in and out of the lungs per minute at rest, which is equal to tidal volume (VT) × respiratory rate (RR)/minute.
Preparation and measurement: The spirometer and the tube are first flushed with air and then filled with air about 1/2 of the barrel volume, and the speed of the paper is adjusted to 30 mm/min. The subject rests quietly in bed for 15 minutes until the breathing is stable, and then the spirometer is connected to the spirometer to start the measurement. The respiration was repeated for 2 minutes, and the respiratory curve and automatic oxygen consumption were recorded at the same time. The VE was calculated by selecting a minute when the respiratory curve was stable, the baseline was horizontal and the oxygen uptake curve was uniform.
2. maximal voluntary ventilation (MVV) is the amount of ventilation obtained by repetitive breathing for one minute with maximum voluntary effort at the fastest respiratory rate and the deepest possible respiratory amplitude.
Measurement method: there are two types of closed and open, the latter is suitable for grassroots mass screening census. The subject takes an upright position, connected to the swelling meter, and breathes calmly for 4~5 times and then continues to repeat breathing for 12 or 15 seconds with the fastest breathing rate and maximum breathing amplitude, requiring 10~15 times of breathing. After 10 minutes of rest, repeat the procedure again. In order to make the measurement successful, it is necessary to explain to the subject fully beforehand, and to give timely instructions and continuous guidance and encouragement to the subject during the measurement in order to obtain the best results.
Calculation: Select a section of the curve with uniform respiratory rate and consistent amplitude for 12 or 15 seconds, and multiply the exhaled or inhaled air volume by 5 or 4 to obtain the maximum ventilation per minute. The difference between the two measurements should be <8%, and the maximum value should be selected as the actual value.
Not suitable for
Severe cardiopulmonary disease and hemoptysis are not suitable for this test, as exertional exhalation can aggravate the condition.
Adverse effects and risks
The test is non-invasive and does not cause serious complications or other hazards.
7. Tactile sensation
Tactile sensation (thigmesthesia) is performed by gently touching the patient’s skin or mucous membranes with a cotton swab and asking the patient to answer whether there is a light itching sensation or to count the number of times the patient is touched. When examining the extremities, the direction of stimulation should be parallel to the long axis, and the direction of examination of the chest and abdomen should be parallel to the rib cage. The order of examination is face, neck, upper extremities, trunk, and lower extremities. A variety of diseases have loss or hyperalgesia of pain, temperature and touch, such as after cerebrovascular accident and spinal cord injury. Diabetic neuropathy, neuritis, post-herpetic neuralgia, Raynaud’s disease, and fascicular myelopathy often present with abnormal sensation or sensory dullness.
Warm tips.
Before the examination, you should prepare the cotton wool or feather to be used, the texture of the feather should be soft.
Normal values
Normal people are sensitive to light touch.
Clinical significance
Abnormal findings: Tactile disorders are seen in posterior cord lesions.
People who need to be examined: Patients with tactile disorders.
Precautions
Pre-examination contraindications: the cotton wool or feathers to be used should be prepared before the examination, and the texture of the feathers should be softer.
Requirements during the examination.
1, the examination requires closed eyes.
2. The patient should answer whether he/she feels something touching the skin during the examination.
Examination process
Ask the patient to close his eyes, touch his skin with cotton wool or feather, and ask him to answer whether he feels anything or not, and if he does not feel anything, he is tactile.
Unsuitable people
The test is not suitable for patients with severe skin loss.
Adverse reactions and risks
None at this time.
8.Expiratory flow rate
Expiratory flow rate measurement is an index that mainly reflects the degree of airway obstruction. It is more sensitive and objective than clinical symptoms to reflect the degree of airway obstruction and changes in the condition of asthma patients.
Monitoring expiratory flow rate can help detect early signs of deterioration before symptoms appear.
Warm Tips.
If the patient is nervous, strenuous exercise, crying, etc., the measurement should be taken after stabilization.
Normal values
No airway obstruction.
Clinical significance
Abnormal findings: reversible narrowing of the airway and leading to dyspnea, it is clinically manifested by shortness of breath, coughing, sputum production, dyspnea, and croup can be heard in the lungs, especially the croup is more pronounced during expiration.
People who need to be examined: people with suspected symptoms of asthma.
Possible diseases with positive results.
Idiopathic pulmonary fibrosis, bronchial asthma in the elderly, pediatric asthma, pediatric chronic bronchitis, upper airway obstruction, combined asthma in pregnancy, idiopathic pulmonary fibrosis in the elderly, mixed chronic plateau disease, allergic asthma, fungal allergic asthma
Precautions
Pre-examination contraindications: pay attention to normal living and eating habits, pay attention to personal hygiene.
Requirements during the examination.
1. The rate of breathing will be affected by consciousness, so it is not necessary to tell the patient when measuring.
2. If the patient is nervous, strenuous exercise, crying, etc., the measurement should be taken after stabilization.
3. Patients with irregular breathing and infants should be measured for 1 minute.
Examination procedure
Expiratory flow rate is the maximum exhalation done after the subject inhales forcefully to the total lung volume. The highest expiratory flow rate that can be achieved in the first 10 milliseconds.2 Expiratory flow rate varies diurnally in both normal and asthmatic subjects, with the lowest value in the morning and the highest value in the afternoon. The predicted value of expiratory flow rate is corrected for height and age, while the measured value of expiratory flow rate depends mainly on the individual’s exertion and the strength of respiratory muscles. Therefore, it is recommended that the value of expiratory flow rate used to evaluate treatment should be the patient’s personal best value. Consistently maintaining an expiratory flow rate above 80% of the personal best value indicates good asthma control.
Inappropriate population
Not suitable for: None.
Adverse effects and risks
None.