Inspect Posterior Chest
- size, shape, and symmetry of back of chest
- observe for use of accessory muscles (SCM, trapezius)
- observe for retractions (usually lower intercostal spaces)
Percuss Posterior Chest
Percuss three region going side to side. Can be flat, dull, resonant, hyperresonant, or tympanic.
Auscultate Posterior Chest
Listen to full breath, go side to side, listen to minimum of three regions. Want vesicular symmetric breath sounds with no adventitious sounds (wheezes, rales, rhonchii)
Inspect Anterior Chest
- inspect for shape, size, and symmetry
- observe for accessory muscle usage (SCM, trapezius, alae nasi)
- observe for retractions (lower intercostals)
- Inspect for cyanosis of mouth
- inspect nails for clubbing (look for diamond shape)
Auscultate Anterior Chest
Listen to two regions side to side for vesicular symmetric breath sounds and no adventitious breath sounds (wheezes, rales, ronchii)
Palpate posterior and lateral chest
- palpate thoracic muscles and skeleton looking for tenderness/masses
- place hands at level of tenth ribs, squeeze flap of skin together, have patient inhale, flap should tighten as rib cage expands
- check for fremitus by using ulnar surface of hand and having patient say 99 at 4 areas of back. Check both sides at the same time
Palpate Anterior Chest
- suprasternal notch, sternal angle, costal-sternal articulation of 2nd rib
- palpate thoracic muscles and skeleton for tenderness/masses
Percussion of lateral chest
patient holds arms out or over head, compare side to side
diaphragmatic excursion
percuss until you find diaphragm. Have patient inhale fully and percuss down until you find where diaphragm moved to. Have patient exhale fully and percuss upwards until you find where diaphragm moved to. Measure space in between.
Percuss anterior chest
compare side by side
Auscultate lateral chest
have patient lift arms and compare side by side, only need 1 region
Special Tests
Test at 3 sites and compare side-to-side
Egophony: Have patient say E
Bronchophony: have patient say 99
