Respiratory Examination Inspection

• Observe the rate, rhythm, depth and effort of breathing.

• Listen for abnormal sounds with breathing such as wheezes.

• Observe for use of accessory muscles.

• Look for signs of asymmetry and deformity.

• Is the trachea central?

• Is there any evidence of tracheal decent?

PALPATION

• Identify any areas of tenderness or deformity by palpating the ribs and sternum.

• Assess expansion and symmetry of the chest by placing your hands on the patient's back, thumbs together at the midline, and asking them to breathe deeply.

• Check for tactile fremitus.

• Palpate for cervical lymphadenopathy.

PERCUSSION Posterior Chest

• Percuss from side to side and top to bottom.

• Compare one side to the other looking for asymmetry.

• Note the location and quality of the percussion sounds you hear.

• Find the level of the diaphragmatic dullness on both sides.

Diaphragmatic Excursion

• Find the level of the diaphragmatic dullness on both sides.

• Ask the patient to inspire deeply.

• The level of dullness (diaphragmatic excursion) should go down by 3-5 cm symmetrically.

Anterior Chest

• Percuss from side to side and top to bottom. Compare one side to the other, looking for asymmetry.

• Note the location and quality of the percussion sounds you hear.

Figure 1.3. Anterior chest examination.

Percussion notes and their meaning

Flat or dull

Pleural effusion or lobar pneumonia

Normal

Healthy lung or bronchitis

Hyperresonant

Emphysema or pneumothorax

Figure 1.4. Percussion note interpretation table.

Abnormal lung sounds

Crackles

These are high-pitched, discontinuous sounds similar to the sound produced by rubbing your hair between your fingers (also known as Rales)

Wheezes

These are generally high pitched and 'musical' in quality. Stridor is an inspiratory wheeze associated with upper airway obstruction (croup)

Rhonchi

These often have a 'snoring' or 'gurgling' quality. Any extra sound that is not a crackle or a wheeze is probably a rhonchi

Figure 1.5. Interpretation of abnormal lung sounds.

Figure 1.5. Interpretation of abnormal lung sounds.

AUSCULTATION Posterior Chest

• Auscultate from side to side and top to bottom (see Figures 1.2 and 1.3).

• Compare one side to the other, looking for asymmetry.

• Note the location and quality of the sounds you hear.

Anterior Chest

• Auscultate from side to side and top to bottom (see Figures 1.2 and 1.3).

• Compare one side to the other, looking for asymmetry.

• Note the location and quality of the sounds you hear.

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