1. Physical Examination of the Chest
RC 275

2. Chest Topography: Anterior Chest

3. Chest Topography: Lateral Chest

4. Chest Topography: Posterior Chest

5. Fissures:

6. Location of Lobes

7. Physical Exam Techniques
Observation
Palpation
Percussion
Auscultation

8. Observation Patient ‘s surroundings, ie: the view from the door
Equipment present
Posted signs
SPUTUM!

9. Observation: Breathing Patterns
Eupnea
Tachypnea/Bradypnea
Biot’s
Cheynes-Stokes
Kussmaul

10. Observation: Thoracic Contour

11. Observation: Thoracic Contour (cont.)
Pectus Excavatum
Pectus Carinatum
Kyphosis
Scoliosis
Kyphoscoliosis
Symmetry of chest movement

12. Observation: Clubbing

13. Palpation: Tracheal Alignment

14. 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

15. Palpation : Chest Excursion

16. Palpation: Vocal Fremitus
BILATERAL comparison of vocal vibrations
Increased with alveolar consolidation
Decreased with increased distance between lung and chest wall
Pneumothorax, Pleural effusion

17. Percussion
Assess density of underlying tissue

18. Percussion Notes Resonance – normal Dullness – increased density
Atelectasis, alveolar filling/consolidation, pleural effusion, fibrosis
Hyperresonance – decreased density
Hyperinflation (COPD), Pneumothorax

19. 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.

20. 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.