Physical Examination of the Chest

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Physical Examination of the Chest

RC 275
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Chest Topography
Anterior Chest
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Chest TopographyLateral Chest
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Chest TopographyPosterior Chest
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Fissures
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Location of Lobes
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Physical Exam Techniques

• Observation
• Palpation
• Percussion
• Auscultation

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Observation

• Patient s surroundings, ie the view from the
  door
• Equipment present
• Posted signs
• SPUTUM!

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ObservationBreathing Patterns

• Eupnea
• Tachypnea/Bradypnea
• Biots
• Cheynes-Stokes
• Kussmaul

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ObservationThoracic Contour
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Observation Thoracic Contour(cont.)

• Pectus Excavatum
• Pectus Carinatum
• Kyphosis
• Scoliosis
• Kyphoscoliosis
• Symmetry of chest movement

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Observation Clubbing
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Palpation Tracheal Alignment
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Tracheal Alignment Abnormalities

• Pneumothorax shifts to unaffected side
• Pleural Effusion shifts to unaffected side
• Fibrosis or Atelectasis shifts towards affected
  side
• Pulmonary consolidation no shift

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Palpation Chest Excursion
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Palpation Vocal Fremitus

• BILATERAL comparison of vocal vibrations
• Increased with alveolar consolidation
• Decreased with increased distance between lung
  and chest wall
• Pneumothorax, Pleural effusion

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Percussion

• Assess density of underlying tissue

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Percussion Notes

• Resonance normal
• Dullness increased density
• Atelectasis, alveolar filling/consolidation,
  pleural effusion, fibrosis
• Hyperresonance decreased density
• Hyperinflation (COPD), Pneumothorax

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Case Study
A patient is recently diagnosed with RLL
bronchogenic CA. As you enter the room, you see
that the patient is on 4 LPM nasal cannula. He
appears short of breath with tachypnea and
shallow respirations. Chest excursion appears
normal except in the RLL. Vocal fremitus is also
absent in the RLL. Percussion reveals dullness in
the RLL.
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Case Study
A 90 year old male is s/p CVA and has been
hospitalized for two weeks. He has begun spiking
a temp (101 f). Physical exam reveals an
emaciated patient with audible gurgling, rapid
shallow respirations, and O2 at 6 LPM via simple
mask. There is also a suction machine set up for
N-T suctioning. Vocal fremitus is increased in
both bases and the trachea is midline.