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posterior chest respiratory examination (inspection of posterior chest…
posterior chest respiratory examination
inspection of posterior chest
scars
symmetry
patient repositioned - closer inspection
deformities - scoliosis, kyphosis etc.
ask patient to lift up their arms
compare both sides during every task
palpation of posterior chest
chest wall expansion - place hands on lower posterior chest wall with fingers extending around the sides of the chest; thumbs are lifted slightly and should meet in midline; on inspiration the thumbs should move at least 5cm - lower lobe expansion
ask patient to move elbows forward to move scapulae
ask patient to take a deep breath in and let it all the way out; this is when you place your hands; then ask patient to take a deep breath
vocal (tactile) fremitus - with edge of palm; don't forget the axillae, ask patient to say 99; ask patient to cross their arms to remove scapulae
percussion of posterior chest
don't forget to percuss lateral aspects of the chest; axillae
put left hand on the chest wall with fingers slightly separated and aligned with the ribs; middle finger is pressed firmly against the chest; with the pad of the right middle finger strike firmly the middle phalanx of the middle left finger; percussing finger must be slightly flexed + loose swinging movement of the wrist
sound should be resonant
auscultation of posterior chest
quality of breath sounds: normal vesicular breath sounds; gap between inspiratory and expiratory sounds - bronchial breath sounds - heard over areas of consolidation like pneumonia, pleural effusion, collapsed lung
using diaphragm begin from apex of lung, posterior chest including axillae with good technique and percussion note
intensity of breath sounds - normal or reduced
added sounds - wheeze (inspiration, expiration or both, louder on expiration); crackles/crepitations - location, timing and quality - fine crackles - hair rubbed between the fingers; medium crackles, coarse crackles - change with coughing, unpleasant gurgling quality
pleural rub - grating sound
vocal fremitus - auscultating while a patient speaks - 99; over normal lung the sound is muffled; over consolidated lung the numbers are clearly audible
may mention at the end of the exam
ideally would perform a complete cardiovascular examination