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Respiratory Disorders

Respiratory System Examination

Not yet clinically reviewed

This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.

  • A respiratory examination, or lung examination, is performed as part of a physical examination, in response to respiratory symptoms such as shortness of breath, cough, or chest pain, and is often carried out with a cardiac examination.

Stages

  • After positioning in which the patient sits upright with their arms at the side, with the chest clear of clothing, the four stages of the examination can be carried out. In order to listen to the lungs from the back the patient is asked to move their arms forward to prevent the scapulae (shoulder blades) from obstructing the upper lung fields. These fields are intended to correlate with the lung lobes and are thus tested on the anterior (front) and posterior (back) chest walls.

Inspection

  • Inspect the front from the foot end and the back of the chest from behind. To estimates the patient's respiratory rate by observing how many times the patient breathes in and out within the span of one minute. Adults normally breathe about 14 to 20 times per minute, while infants may breathe up to 44 times per minute. Note
  • Respiratory rate per minute
  • Type of respiration
  • Shape of chest
  • Deformity, prominent veins, Pulsations or scars
  • Chest movements

Palpation

  • Palpation is the use of physical touch during examination. Palpate the chest to look for
  • Tenderness
  • Crepitus
  • Position of trachea and apex beat
  • Movements of the chest wall
  • Chest expansion
  • Vocal fremitus
  • Palpable added sounds

Percussion

  • It is the act of tapping on the surface of the body in order to assess the structures that lie beneath the skin. Percussion and resonance (the quality and feeling of sound) are used to examine lung movement and possible lung conditions. Percuss anteriorly, laterally and posteriorly.

Specifically, percussion is performed by first placing the middle finger of one hand over the area of interest. The middle finger of the other hand is used to strike the last joint of the placed finger. Percussion is performed in a systematic matter, from the upper chest to the lower ribs, and resonance is compared between the left and right sides of the chest. This is done from the front and back of the thorax.

Percussion over different body tissues results in five common 'notes'.

  1. Resonance: Loud and low pitched. Normal lung sound.
  2. Dullness: Medium intensity and pitch. Experienced with fluid.

o A dull, muffled sound may replace resonance in conditions like pneumonia or hemothorax.

​3. Hyper-resonance: Very loud, very low pitch, and longer in duration. Abnormal.

o Hyper-resonance can result from asthma or emphysema

​4. Tympany: Loud and high pitched. Common for percussion over gas-filled spaces.

o Tympany may result in pneumothorax.

​5. Flatness: Soft and high pitched.

Auscultation

  • Using the diaphragm of the stethoscope listen from front and back. Ask the patient to take big breaths in and out through the mouth and note the following points
  • Air entry
  • Breathing sounds
  • Added sounds (Wheezes/Crackles)
  • Vocal resonance