EXAMINATION OF RESPIRATORY SYSTEM RESPIRATORY RATE & BREATH SOUNDS Requirements: Stethoscope, Measuring tape, Toreh Procedure: Notedown the name, age, sex, occupation and address of the sul Lxpose the chest of the subject, and seat him in a comfortable position, GENERAL EXAMINATION: ofthe subject is done with special emphasis to dy’ pulse rate, and respiratory rate Examination of Upper Respiratory Passages Nasal Cavities: are examined under proper light for any discharye, congestion, deviated septum, or Throatand Pharynx: are also observed for any congestion oF growth Examination of chest: This is dane in 4 step: INSPECTION 1. Trachea: Norm Form and shape of the chest: Is noted from the front, sides, back and above. Look for any asymm ‘or depression in the chest. y central, can be shifted to either side in lung diseases netrival, anteroposterior diameter less than transverse diameter malities seen are Common abn symmetry due to lateral bending of vertebral column Seoliosi Kyphosis: Forward bending of vertebral column, Pigeon Chest: Sternum ‘projects forwards seen in rickets Barrel Shaped Chest: Antero posterior diameter equal to or more than transverse diameter in vay obstruction, eg: Bronchial asthma, the above conditions chest movements are restricted. Movements of Chest and respiratory rate Shest movements are sy nal sides whether metrical or diminished inany pat. Observe the rate and rhythm of respiratory movements, Normal: 12-18 per minute, regular in rhythm, ate is called tachypnoea, Decrease in rate isST... a 74 ° RIODIC BREATHING: is irregular breathing eyeles with periods of apnoea in between, See whether the movements are thoracic, abdominal, horace abdominal or abdomino thoracic type. 4. Look forthe position ofapex beat: 5. Dilated chest wallint PALPATION ns, Visible pulsations other than apex bea ostal oedema ‘ani localised prominence / depression on the L._ Using the palm palpate over the chest and see ifany tenderness. 2. Position of trachea: Whether central or shifted to any side, This is assessed by/placing the tips of index anal ring fingers on the sternoclavicular joints and the tip of the middle finger on the erieoid cartilage Slowly move the middle finger downwards over the trachea fo the suprasternal notch and see whether ‘aay deviation is present. Marked deviation to one side is present in fibrosis ofapex of lung on same sie, 3. Chest Expansion: is found out by noting the chest circumference atthe end of expiration and deep inspiration, using a measuring lape al the level of4th intercostal space. Normal values $-8em, Apex Beat: locate by palpating with the palm of han first then with the ulnar border of palm an Sally wth he dex finger Nonny locaton be Sth ef intercostal space I cm medial to the nclavicua linc. Apex beatis the lowermost and outermost point over the precordium, where a definite cardiac smpuike ean be scen or fel Shift in position of apex beat ean occur in conditions like pleural effusion, pneumothorax In dextrocandia itis eon height ie Movements of chest he two palms on either side ofthe anterior chest wall and the tips ofthe thumbs are allowed to n the midline, Ask the subject to tale deep inspiration and observe the distance to which the tips ‘ofthe thumbs move from the midline, Ses whether the movements re equal on both sides. Repeat the procedure on the posterior chest wall also. Underlying lung diseases can diminish the expansion ata particular area orareas 6 Vo ‘The sound vibrations produced during phonation, transmitted through the lungs can be felt inthe palma placed over te chestwall, Thsis tested while the subject repeats the words “one one one” ina whisper- ing voice, Compare vocal fiemitus on corresponding areas on both sides of chest. Its deere: pleural thickening, flbrosis ofthe lung, pleural effusion ete tis increased overs cavitiesin the lang. PERCUSSION: is the method by which the coneistency of the underlying tissue isussessedby listening to the percussion note emitted ftom the area. 1 Fremitus To do this the middle finger ofthe left hand (pleximeter finger] is placed firmly on the cist wall axl the middle phalans ofthe pleximeter finger is tapped withthe midale finger ofthe right hand [plexorifinger), tapping the movement should take place atthe right wrist joint only and during Rulesof percussion: “The pleximeter finger should be placed parallel to the border ofthe organ tobe percussed andthe line ‘of'percussion should be perpendicular to the botder fo be percussed, The pleximeter finger should beplaced firmly over the body surface and there should not be ai in benween the finger and the body surice, Peres sion should always be done from resonantto adil area and not inthe reverse retin, During persion the movement should take place atthe wrist joint ony. Over clavieular area, percussion is done diresy ove the clavicle.