Introduction to Respiratory Exam
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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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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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