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anterior chest respiratory examination (percussion of anterior chest…
anterior chest respiratory examination
inspection of anterior chest
scars - chest drains, thoracotomy scars, traumatic scars, radiotherapy
movement of the chest wall - look for asymmetry, unilateral reduction due to consolidation, pneumothorax, pleural effusion; bilateral reduction - abnormality like pulmonary fibrosis
chest wall abnormalities - pectus excavatum, pectus carinatum, barrel-shaped, kyphoscoliosis
subcutaneous emphysema - swelling of chest wall and neck
palpation of anterior chest
tactile fremitus - include apices and axillae; palpate the front of the chest with the hand in two comparable positions as the patient repeats 99; differences in vibration can be detected; over consolidated lung the sound can be transmitted better
chest expansion - is it equal on both sides; place hands over upper anterior chest wall, chest movement should be equal on both sides - checking anterior expansion; hands can also be wrapped around the lower chest to measure outward expansion
apex beat - may be displaced in pneumothorax or pleural effusion
percussion of anterior chest
include apices and axillae
if underlying structure contains air - resonant sound; if solid - dull sound; we expect to hear resonant sounds throughout all lung fields
begin with percussion in the supraclavicular fossa over the apex of the lung
percuss clavicles directly
percuss around 4 positions after percussing the clavicle and supraclavicular fossa
dull - over solid structure - consolidation of lung; stony dull - fluid filled area - pleural effusion; resonant - normal lung; hyper-resonant - hollow structures; pneumothorax
auscultation of anterior chest
compare both sides
ask patient to breathe in and out through their mouth
start using the bell of the stethoscope, applied above the clavicles to listen to the lung apices
apices and axillae and anterior chest
listen over the same areas you percussed to compare right and left side
listen for quality and intensity of breath sounds and the presence of additional sounds
may mention at the end of the exam
ideally would perform a full cardiovascular examination