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James Wight

Examination of the Respiratory System

Wash your hands. Introduce yourself to the patient, and ask permission to examine them. Expose the patient, and position them at 45.

Inspection

Look around the bed Oxygen mask/nasal prongs, sputum pot, drips, PEFR,inhalers, nebuliser, cigarettes

Look at the patient Comfortable at rest, cyanosis, breathless, use ofaccessory muscles, scars (eg following a rib forpneumonectomy), asymmetry, deformity, hyperexpansion(Barrel chest), pectus carinatum, pectus excavatum,cachexia, radiotherapy marks, chest drain

Look at the hands Clubbing (purulent lung disease CF, bronchiectasis,

bronchogenic carcinoma but not small cell), peripheralcyanosis, nicotine staining, muscle wasting, CO2retention flap, tremor (2-agonists)

Feel the radial pulse Assess rate and count respirations

Ask for blood pressure Enquire about pulsus paradoxusLook at the face Ptosis, Miosis and Anhydrosis (Horners), SVC

obstruction

Look in the eyes Anaemia

Look in the mouth Central cyanosis, pursed lips, tonsils, hoarse voice,stridor.

Look at the neck Examine the JVP (raised in cor pulmonale and tensionpneumothorax)

Palpation

Check trachea is central Including the cricosternal distance

Check for lymphadenopathy

Feel for the apex beat May be displaced, eg in pneumothorax or effusionAssess chest expansionanteriorly

Percussion

Percuss anteriorly Compare L with R, and dont forget the axillae andsupraclavicular regions. Can be normal, hyperresonant,dull and stony dull.

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Auscultation

Auscultate anteriorly,asking pt to breath thoughtheir mouth

Compare L with R, listening forair entry, crackles,wheeze and bronchial breathing. Dont forget the

supraclavicular regions and axillae.

Assess vocal resonance,asking pt to say 99 Compare L with R, listening for increased vocalresonance

Repeat chest expansion, percussion and auscultation posteriorly, with the patientsarms crossed in front of them.

Final manoeuvresExamine for ankle andsacral oedema

Thank the patient andcover them up

I would complete my examination by.

I would like to take a blood pressure, examine the sputum pot, look at the observationschart (temperature, sats) and perform a peak flow measurement.

Glossary

Pectus carinatum a chest deformity in which the sternum bulges forwards (pigeon chest

deformity)

Pectus excavatum a chest deformity in which the sternum caves inwardsCachexia severe wasting usually associated with cancer