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Physical Examination of the Chest. RC 275. Chest Topography: Anterior Chest. Chest Topography: Lateral Chest. Chest Topography: Posterior Chest. Fissures:. Location of Lobes. Physical Exam Techniques. Observation Palpation Percussion Auscultation.

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Presentation Transcript
physical exam techniques
Physical Exam Techniques
  • Observation
  • Palpation
  • Percussion
  • Auscultation
observation
Observation
  • Patient ‘s surroundings, ie: the view from the door
    • Equipment present
    • Posted signs
    • SPUTUM!
observation breathing patterns
Observation:Breathing Patterns
  • Eupnea
  • Tachypnea/Bradypnea
  • Biot’s
  • Cheynes-Stokes
  • Kussmaul
observation thoracic contour cont
Observation: Thoracic Contour(cont.)
  • Pectus Excavatum
  • Pectus Carinatum
  • Kyphosis
  • Scoliosis
  • Kyphoscoliosis
  • Symmetry of chest movement
tracheal alignment abnormalities
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
palpation vocal fremitus
Palpation: Vocal Fremitus
  • BILATERAL comparison of vocal vibrations
  • Increased with alveolar consolidation
  • Decreased with increased distance between lung and chest wall
    • Pneumothorax, Pleural effusion
percussion
Percussion
  • Assess density of underlying tissue
percussion notes
Percussion Notes
  • Resonance – normal
  • Dullness – increased density
    • Atelectasis, alveolar filling/consolidation, pleural effusion, fibrosis
  • Hyperresonance – decreased density
    • Hyperinflation (COPD), Pneumothorax
case study
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.

case study20
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.