It is important to do a general examination of the chest to collect some information about the disease the patient is suffering from.
Enlist the steps included in the general physical examination of the respiratory system.
Inspection of the chest
Palpation of the chest
Percussion of the chest.
Auscultation of the chest
What should be the position of the patient while examining the respiratory system of the patient?
This examination not only includes the front but also the sides and the back of the chest. So the position of the patient varies depending on the part of the chest being examined. while examining the front and sides of the chest, the patient lies supine with the arms lying by the side at some distance i.e. abducted. Meanwhile, the patient sits with the hands placed over the opposite shoulders while examining the back of the chest.
Exposure of the patient
The chest is exposed up to the umbilicus while doing the inspection, palpation and percussion of the chest.
Note: Female patient is not exposed except when it is essential, and a female doctor does it. Adequate privacy is provided.
How to inspect the respiratory system?
Inspection of the chest
The chest is inspected by standing at the foot end of the patient. examination while standing at the side of the patient is avoided as there are chances of missing small irregularities.
Points to be noted while inspecting the respiratory system
1. The shape of the chest
2. Type of the respiratory movement
3. Any deformity
4. What is the respiratory rate
5. Chest movements
6. Any visible scar on the chest
7. Visible pulsation on the chest
8. Prominent veins on the chest
Now we will describe each of these steps.
1. The shape of the chest
Normally the shape of the chest is elliptical i.e. The anteroposterior diameter is smaller than the transverse diameter. The normal ratio between these two diameters is 5:7. The shape of the chest may give us information about the disease the patient is suffering from. An example is:
Barrel shaped -chest
There are cases in which the anteroposterior and transverse diameters become equal. The chest becomes barrel-shaped. It mostly occurs in young patients suffering from emphysema.
Chest movements
Movements on both sides of the chest are compared. There may be abnormalities associated with the movement of the chest.
There may be:
• Abnormal movements due to contraction of extra respiratory muscles
• Inward movements due to the draw of the supraclavicular fossa or intercostal spaces inward
• Reduced movements due to collapse or fibrosis of the lungs. They may also result from pleural effusion and pneumothorax or hydrothorax
• Paradoxical movements:if the chest moves inward during inspiration
Any deformity
There may be present some deformity in the chest, for example, pectus carinatum in which the sternum and costal cartilage become prominent. It is also called a pigeon chest. The reason may be some chronic obstructive pulmonary disease.
There may be local bulging of the chest wall due to pleural effusion, accumulation of fat, or pneumothorax.
Kyphosis (backward curvature of the spine is increased)
Scoliosis (lateral curvature of the spine is increased)
What is the respiratory rate?
Observe the movements of the chest and count the respiratory rate of the patient. Feel the pulse of the patient to distract.
Any visible pulsations, scars and veins
The chest is looked for any kind of visible veins, pulsations or scars.
Type of the respiratory movements
Abdominothoracic type of respiration is found in males and infants as they use a diaphragm atha e s respiratory muscle. On the other hand, the thoracoabdominal type of respiration is found in females as they use thoracic muscles for respiration.
Palpation of the respiratory system
The following is palpated:
Tenderness
Position of trachea
Position of the apex beat
Expansion of chest
Movements of the chest wall
Vocal fremitus
palpable sounds
Tenderness
Check for any tenderness by placing the hand over different parts of the chest. if there is a grimacing appearance on the face of the patient, tenderness is thought to be present.
Position of trachea
There ate three methods to locate the trachea. These are
One finger method
Two finger method
Three finger method
Three finger method is used widely in medicine. So we are going to describe this method.
The patient should be lying supine with the neck extended. Place your middle finger over the trachea in the suprasternal notch in the midline and feel any deviation of the trachea with the index and middle finger on both sides.
Palpation of apex beat
Place your right hand on the leleggyide of the chest with your fingers directed laterally and feel the pulse. count the intercostal spaces and find in which intercostal space you’ve felt it.it is usually present in the 4th intercostal species a little medial to the midclavicular line.
Movements of the chest wall
Grasp the sides of the chest with both hands where thumbs approximate each other .ask the patient to take a deep breath. Compare the movements on both sides by comparing the movements of thumbs from the midline. there are chances of the presence of any pathology if one side of the thumb moves less than the other thumb.
Expansion of chest
Ask the patient to take it deep breath and measure the circumference of the chest just below the nipple at deep inspiration and full expiration. difference between these two measurements is taken as the chest expansion is usually more than 5cm. It is considered to be abnormal if it is less than 2cm. the reasons may be asthma, emphysema and fibrosis of the lungs.
Vocal fremitus
Place your hand over intercostal spaces and ask the patient to say “one, one, one” and feel the vibration. Examine all the parts of the heart i.e. front sides and back and .observe if any abnormality is present. Pleural effusion and pneumothorax decrease vocal fremitus.
Palpable sounds
Two types of palpable sounds may be present :
• Ronchus
• Pleural rub
Conclusion
Percussion of different parts of the chest is done followed by its auscultation to complete the physical examination of the respiratory system.
