Examining the chest involves a systematic approach to assess its structure and function. The pulmonary examination, which focuses on the lungs and respiratory system, comprises four core techniques: inspection, palpation, percussion, and auscultation. Each technique provides different information and contributes to a comprehensive evaluation.
The Four Pillars of Chest Examination
Here's a breakdown of the steps involved:
1. Inspection
- What it is: This is the initial step and continues throughout the encounter. It involves visually observing the chest, paying attention to its shape, symmetry, and respiratory patterns.
- What to look for:
- Shape: Observe for any deformities, such as a barrel chest or pectus excavatum/carinatum.
- Symmetry: Check if both sides of the chest rise and fall equally during breathing.
- Respiratory Rate & Pattern: Note how many breaths the patient takes per minute and whether they are using accessory muscles to breathe.
- Skin changes: Look for any scars, rashes, or discoloration.
- Example: Observing that a patient has a rapid respiratory rate and is using their neck muscles could indicate respiratory distress.
2. Palpation
- What it is: Palpation involves using the hands to feel for abnormalities.
- What to assess:
- Tenderness: Gently press on the chest wall to check for areas of pain or sensitivity.
- Chest Expansion: Place your hands on the patient's chest and observe how much the chest expands during inhalation. Palpation of chest expansion, when confirmed with percussion provides information about the chest's mechanical function.
- Tactile Fremitus: Use the palmar aspect of your hand to feel for vibrations while the patient speaks.
- Example: Feeling tenderness on the chest might suggest an injury, while decreased chest expansion could indicate underlying lung issues.
3. Percussion
- What it is: Percussion involves tapping on the chest wall to produce sounds that indicate the underlying tissue's nature.
- What to listen for:
- Resonance: A normal, hollow sound heard over healthy lung tissue.
- Dullness: A flat sound often heard over dense tissue or fluid (e.g., fluid buildup or consolidated lung tissue).
- Hyperresonance: An abnormally loud sound heard in over-inflated lung tissue (e.g., emphysema) or pneumothorax.
- Example: A dull sound upon percussion could indicate pneumonia or a pleural effusion.
4. Auscultation
- What it is: Auscultation involves using a stethoscope to listen to the sounds of breathing and air movement.
- What to listen for:
- Breath Sounds: Identify and note the intensity, pitch, and duration of normal breath sounds.
- Adventitious Sounds: Listen for abnormal sounds, such as crackles (rales), wheezes, or rhonchi.
- Voice Sounds: Listen to the clarity of spoken words heard through the stethoscope.
- Example: The presence of wheezing upon auscultation may suggest narrowed airways, as seen in asthma.
Summary of Techniques
| Technique | What it Involves | What it Assesses |
|---|---|---|
| Inspection | Visual Observation | Shape, Symmetry, Breathing Patterns |
| Palpation | Feeling with Hands | Tenderness, Expansion, Tactile Fremitus |
| Percussion | Tapping on Chest | Tissue Density |
| Auscultation | Listening with Stethoscope | Breath Sounds, Adventitious Sounds |
By employing these four steps systematically, a thorough chest examination can be performed, leading to a better understanding of the patient’s respiratory health.
