Clinical Examination of Respiratory System

Respiratory system is a ventilator system that keeps us alive to breath everyday.It is very important to keep all our systems of our body in good condition.Clinical examination of Respiratory System gives us an idea about how our respiratory system is actually working based on various aspects.

Before we go through clinical examination we need to know anatomy of respiratory system.

Mid sternal line

Mid clavicular line

Anterior and Posterior axillary lines

Mid axillary line

Mid spinal line and Mid scapular line

What do i need to do before examination?

Wash hands

Introduce yourself

Confirm patient's details(Name and Date of birth)

Explain about examination in detail

Ask and gain for consent

Expose the patient's chest

Position patient at 45 degree

Before starting ask if the patient feels any pain

What is the method of examination?

General Examination

Cyanosis,Shortness of breath,cough,wheeze,stridor and cachexia.

1.Hands

Peripherial cyanosis

2.Temperature

Coldness which indicates that there is poor perfusion or vasoconstriction

3. Bruising or thinning skin

Due to long term steroid use

4.Tar staining

Due to smoking

5.Tremors

Flapping tremors

Due to Asterixis-CO2 retention

Fine tremors

Due to beta-agonist use(salbutanol)

6.Clubbing test

Schamroth's window test-lost when finger clubbing

7.Tongue

Central cyanosis

Bluish discoloration of lips and mucous membrane

8. Conjuctival Pallor

Indicates anemia

9.Jugular Venous Pressure

It is located between two heads of sternocleidomastoid. It is raised in cor pulmonale

10.Examination of chest

There are four methods,

1.Inspection:You only look at patient without touching or palpating the patient and look for bad condition or deformities

1.Shape of chest

Check for any chest deformations and scars.

Scars:

Central chest: Sternotomy and Thoracotomy

Mid Axillary: Chest drain

Clavicular: Pacemaker

2.Symmetry of chest

Bilaterally symmetrical and elliptical in cross section

3.Movement of chest

Symmetrical movement of chest when patient inspires and expires

4.Respiratory movement

Respiratory rate:12-20 breaths/min is normal

Tacypnea: Abnormal rapid breathing

Bradypnea: Abnormal slow breathing

Cheyne-Stokes respiration

Kussmaul breathing

2. Palpation:Method of feeling with the fingers or hands.

1. Tracheal Position

Tracheal diversion is most common in Pneumothrox.

Normal cricosternal distance is 3-4 fingers

  

2.Palpate Apex Beat

Mid clavicular line at 5th intercostal space

3.Palpate Lymph Nodes

Lymphadenopathy causes

Sarcoidosis

Infection

Malignancy

4.Expansion of chest

Reduced chest expansion when lung collapse and pneumonia.

Should be done on both anterior and posterior; upper and lower parts of chest and compare.

3.Percussion: Method of tapping body parts with fingers or hands .It indicates the presence of fluid or not in chest.

1. Percuss the lung fields

It should be done on both sides of chest anterior and posterior and even axial region.

Resonant percussion-Normal

Hyper Resonant-Pneumothorax

Dull percussion- Abnormal

Consolidation

Collapse

Effusion

Stony Dullness-Pleural Effusion

Note:Cardiac Dullness

Anterior

Posterior

4.Auscultation: Listening to internal sounds of body using a stethoscope.

1.Positions of auscultation

Anterior

Posterior 

Types of breath sounds

1.Vesicular breathing

Normal breath sound

2.Inspiratory stridor

Upper airway obstruction

3. Wheez

Asthma and COPD

4.Fine Crackles

Pulmonary fibrosis

5.Coarse Crackles

Pneumonia and Pulmonary Edema

2.Vocal Fremitus

Ask the patient to tell a number or letter when stethoscope placed on chest.

Increased Vocal Fremitus

Consolidation

Lobar collapse

Tumor

Decreased Vocal Fremitus

Pleural Effusion

Additional 

Sacral Edema

Pedal Edema(Right Ventricular Edema)

After Examination

Thank the patient

Wash Hands

Note:Examination should be done on both sides of chest anterior, posterior and lateral axilla region.

This completes the Clinical Examination of Respiratory System

I hope I was able to give an view on Clinical Examination of Respiratory System.