Walk tests are practical, simple ways to assess cardiopulmonary function commonly used in rehabilitation and pre- and postoperative settings. The 2002 American Thoracic Society guidelines that standardize the 6-minute walk test continue to predict clinical outcomes in most patients with COPD.60,61 The test is easy to administer and requires only a 100-foot hallway. It measures "the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes" and provides a global evaluation of the pulmonary and cardiovascular systems, neuromuscular units, and muscle metabolism. Review the specifics of testing, which should be done on two occasions and include taking the clinical history and vital signs. This test as well as shorter tests continue to be evaluated.
Forced Expiratory Time.
This test assesses the expiratory phase of breathing, which is typically slowed in obstructive pulmonary disease. Ask the patient to take a deep breath in and then breathe out as quickly and completely as possible with mouth open. Listen over the trachea with the diaphragm of a stethoscope and time the audible expiration. Try to get three consistent readings, allowing a short rest between efforts, if necessary.
Identification of a Fractured Rib.
Local pain and tenderness of one or more ribs raise the question of fracture. By AP compression of the chest, you can help to distinguish a fracture from soft-tissue injury. With one hand on the sternum and the other on the thoracic spine, squeeze the chest. Is this painful, and where?
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