The article provides a brief overview of the respiratory examination. For a detailed walk-through please see the 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