Principles of Chest Examination
Natalie HarperRespiratory Advanced Nurse Practitioner – Dorset County HospitalFoundation Trust
UK/KOL/17/0009 Date of Preparation: February 2017
The views expressed in this presentation are those of the speaker and are not necessarily those of the meeting sponsors.
This presentation may contain off-licence information. Please refer to the product SmPCs for the approved indication for use.
Disclosures:
• Teva UK Limited
Chest examination
• Always start with a general examination
• Then focus on respiratory aspects of a chest examination
PLEASE NOTE: Being competent at chest examination takes a lot of time and practice.
This is an introductory session only, so please seek the support and guidance of someone in your practice or workplace to help you develop your chest examination skills further.
Landmarks
Anterior chest
Lateral chest
Posterior chest
Physical exam techniques
Inspection
Palpation
Percussion
Auscultation
Inspection
Pectus excavatum
Pectus carinatum
Kyphosis
Scoliosis
Kyphoscoliosis
Symmetry of chest movement
Ease/difficulty of breathing including use of accessory muscles
Audible sounds – wheeze, stridor etc
Colour – do they look cyanotic?
Pectus excavatum and carinatum
Assessing for spinal deformities
Assessing for spinal deformities
Inspection/palpation
From the hand upwards:
HANDS
Clubbing
Tar staining
Peripheries and capillary refill time
Clubbing Tar staining
Capillary refill
Inspection/palpation
WRISTC02 retention flapPulseRespiratory rate (done immediately after pulse before letting go, so patient is unaware you’re counting their breaths)
Fine and course tremor
Fine tremor of Beta Agonist overuse Course tremor of CO2 retention
Inspection/palpation
From the hand upwards:
NECK
JVP (jugular venous pressure)
Lymph nodes
JVP
Lymph nodes
Inspection/palpation
FACE
Conjunctiva for anaemia
Central cyanosis
TRACHEA
Changes in the face, eyes and mouthYellowing of the skin and sclera
Corneal arcus XanthelasmaPaleness in the
conjunctiva
Angular stomatitisGlossitis
Blue lips –central cyanosis
Dry tongue
Tracheal alignment abnormalities
• Tension pneumothorax - shifts away from affected side
• Pleural effusion - shifts away from affected side
• Fibrosis or atelectasis - shifts towards affected side
• Pulmonary consolidation - no shift
Palpation: chest expansion
Palpation: tactile vocal fremitus
• Bilateral comparison of vocal vibrations
• Increased with alveolar consolidation
• Decreased with increased distance between lung and chest wall
– pneumothorax, pleural effusion
Tactile fremitus
Percussion
• Assess density of underlying tissue by resonance of sound
• Presence of fluid will produce a dull sound
• Air between the lungs and the chest wall (pneumothorax) produces a hollow note
Percussion
Percussion notes
Resonance – normal
Dullness – increased density
• Atelectasis, alveolar filling/consolidation, pleural effusion, fibrosis
Hyperresonance – decreased density
• Hyperinflation (COPD), pneumothorax
Auscultation – areas
Video
Feel calves fortenderness/warmth/swelling
Deep vein thrombosis
Sacral and pitting oedema
Any questions?
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