For a detailed walk-through of the respiratory exam, please see this Respiratory Exam article

INTRODUCTION
  • Wash hands
  • Check patient name/DOB/hospital number
  • Introduce- My name is…”
  • Consent
  • “Is it ok if I have a look and feel of your head, neck, chest and hands?”
  • Chaperone
  • Confidentiality
  • Position – 45
  • Exposure – Chest
INSPECTION
  • General: Comfortable at rest? Look around bedside for Oxygen, Nebulisers, Medication
  • Hands: Clubbing, Tar staining, Peripheral cyanosis, Flapping tremor, Pulse- character &rate
  • Mouth: Central cyanosis
  • Neck: JVP, Lymph Nodes
  • Chest: Scars, Deformities, Use of accessory muscles, Resp rate
PALPATION
  • Tracheal Deviation
    • Warn the patient this may be uncomfortable.
    • Best Technique:Single finger in sternal notch
  • Chest Expansion 
  • Vocal Fremitus is rarely helpful
PERCUSSION
  • Chest: Start at the apices above the clavicle, include the 3 lung zones (Upper/ Mid/ Lower) and the axilla
  • Compare right to left
AUSCULTATION
  • Upper/ Mid/ Lower Zones
  • Normal sounds should be vesicular
  • Listen for added sounds eg. Wheezes, crackles, rubs.
  • Assess Vocal Resonance
NOW GO BACK
  • Repeat Inspection/ Palpation/ Percussion / Auscultation on the patients back
 
OTHER…
  • At the end check the patients leg and sacrum for peripheral oedema
CONCLUSION…
  • “To complete my examination I would like to request further investigations including full bloods/CXR/PEFR/Spirometry/Lung function tests” Adapt this appropriately to the patient you are examining.
  • Thank patient
  • Cover up and check comfortable
For more information, see the respiratory examination page

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