Chest

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General

  • Patient in gown or loosely dressed
  • ALWAYS examine sequentially from side to side

Pulmonary Inspection

  • Identify the oblique and horizontal fissures
  • Look for asymmetry and deformity of the chest wall and trachea
  • Observe rate, rhythm, depth, and effort of breathing
  • Look for and stated significance of increased A/P diameter

Pulmonary Palpation

  • Palpate the anterior, posterior, and lateral chest
  • Identify areas of tenderness

Special Considerations

  • Chest expansion
  • Tactile fremitus

Pulmonary Percussion

  • Place distal middle finger against chest and tapping smartly with opposite middle finger produced a good percussion "note"
  • Percuss a minimum 6 anterior points
  • Percuss a minimum 4 posterior points
  • Percuss a minimum 1 lateral point bilaterally
  • Identify lobes of each lung bilaterally

Special Considerations

  • Diaphragmatic excursion

Pulmonary Auscultation

  • Auscultate a minimum 6 anterior points
  • Auscultate a minimum 4 posterior points
  • Auscultate a minimum 1 lateral point bilaterally
  • Identify lobes of each lung bilaterally
  • Be able to articulate a description of: rales/crackles; wheezes; rhonchi; abnormal I/E ratio

Special Considerations

  • Egophony

Peak Flow Monitoring

  • Use correct technique with Peak Flow Meter
  • Repeat 3 times and record highest reading

ONLINE PHYSICAL EXAM TEACHING ASSISTANT

The UF College of Medicine Harrell Center