osce learning points

Dec 7 2023

OSCE questions

1. What are bronchial breathsounds how to differentiate it from vesicular breath sounds 
I have learnt how to identify bronchial breath sounds clinically 
Brochial breath sounds

It is loud, hollow, and high pitch

Expiratory phase is longer than inspiratory phase

There is distinct pause between inspiration and expiration due to absent alveolar phase

Vesicular breathsounds

Soft, low pitched, and rustling in quality

  a) Inspiratory phase remains  longer than the            expiratory phase 

  b)   Inspiration is higher pitch than expiration

   c) No pause between inspiration and expiration

What are crepitations? How they occur ?

Crepitations are adventitious breath sounds. 

Crepitations are made either by air passages and alveoli (air sacs) opening up during inspiration or by air bubbling through fluid. They are not normally heard in healthy lungs.

During expiration alveoli stick together while during inspiration the alveolar walls are seperated with difficulty and only at the end of inspiration 

Crepitations is silight crackling sound that can be  imitated by  rubbing a strand of hair.

 Ventilator weaning criteria 

Subjective assesment 

Adequate cough 

No neuromuscular blocking agents 

Absence of extra tracheobronchial secretions 

Reversal of underlying cause for respiratory failure

No continous sedative infusion 

Objective measurments

Stable cardiovascular status

Heart rate <140 beat/min

No active myocardial ischemia

Adequate hemoglobin level >8g/dl

Systolic blood pressure 90-160mmHg

Afebrile 

Adequate oxygenation 

Tidal volume >5ml/kg

Vital capacity >10ml/kg

Proper inspiratory effort

Respiratory rate <35/min.

Pao2 >60 and paCo2<60mmHg

No significant respiratory acidosis pH>7.30

O2 saturation >90%on FIO2<0.4 




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