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LUNG INSPECTION

Inspection

Examine skin over the chest for lesions that restrict respiratory excursion and structural deformities.(e.g. barrel chest,pigeon breast)

Note cough and noisy breathing Observe respiratory movements: rate, amplitude and rhythm.

Observe retraction of interspaces and other signs of labored breathing (i.e. use of sternocleidomastoids

From a midline position behind the patient, note the shape of the chest and the way it moves, including:

Deformities or Asymmetry Abnormal retraction of interspaces during inspiration; note supraclavicular retraction also.

Impaired respriatory movement on one or both sides or unilateral lag or delay in movement

Palpitation

Identify any areas of tenderness or deformity. Assess expansion and symmetry of the chest. Abnormalities - mass, sinus tract Tactile fremitus Palpate to test respiratory excursion, esp. posteriorly. Palpate for tracheal position. Palpate for any soft tissue masses/tenderness.

Palpate for rib/costochondral tenderness

Palpate for tactile fremitus, using base of fingers or edge of your hand, comparing the two sides of the chest.As you palpate the chest,

FOCUS ON AREAS OF TENDERNESS, ABNORMALITIES IN OVERLYING SKIN, RESPIRATORY EXPANSION AND FREMITUS.

Identify tender areas. Assess any observed abnormalities such as masses or sinus tracts. Test chest expansion Feel for tactile fremitus. Palpate and compare symmetric areas. Acoustic repertoire of the respiratory system

The chest cavity resonates like a barrel being struck but this resonance is moderated by the surrounding soft tissueand the lung tissue contained within

Reflections, resonances and damping affect the sound May appear to come from a variety of directions

Percussion

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Percussion Notes and their Characteristics:

1.Flatness: soft intensity, high pitch, short duration thigh mm.

2. Dullness: medium intensity, medium pitch, medium duration liver.

3. Resonance: loud intensity, low pitch, long duration normal lung.

4. Hyperresonance: very loud, lower pitch, longer duration none, normally.

5. Tympany: loud, high pitch, longer duration gastric air bubble.

Defines density of underlying structures by differences in sound wave conduction. Dull over liver. Flat over forehead. Resonant over right pectoralis. Relative Relative Relative Example Intensity Pitch Duration of Location Flatness Soft High Short Thigh Dullness Medium Medium Medium Liver Resonance Loud Low Long Normal lung Hyperresonance Very loud Lower Longer None normally Tympany Loud High * Gastric air bubble or puffed- out cheek Sounds heard over specific locations of a healthy chest during breathing

Vesicular Bronchovesicular Bronchial Tracheal

Clear lung fields is ambiguous