Overview
This lecture covers the assessment of the thorax and lungs, focusing on inspection, palpation, percussion, and auscultation techniques for both anterior and posterior chest.
Anterior Thorax Assessment
- Begin with inspection, ensuring patient privacy and dignity.
- Observe for signs of breathing distress, chest expansion symmetry, and note breathing rate and rhythm.
- Assess shape and symmetry; AP (anteroposterior) diameter should be half the transverse diameter; equal diameters suggest barrel chest (common in COPD).
- Inspect skin color and condition for redness, lesions, or cyanosis; check chest tubes or lines if present.
- Palpate for crepitus (crackling), which may indicate subcutaneous air from lung trauma.
- Percuss intercostal spaces from apex downward, side-to-side, listening for resonance; dullness may indicate fluid or underlying organs.
- Listen first with the naked ear for wheezes or stridor, then use stethoscope over 10-12 sites, asking patient to take deep breaths at each site.
- Don't forget to auscultate mid-axillary regions to assess right middle lobe.
Posterior Thorax Assessment
- Have the patient sit up; proceed with auscultation using the same side-to-side method as anterior, avoiding shoulder blades.
- Identify bronchial, bronchovesicular, and vesicular breath sounds.
- Note any adventitious sounds (crackles or wheezes).
- Inspect for symmetry, skin color, and chest expansion.
- Palpate for crepitus and assess for chest expansion by placing hands on lower rib cage, thumbs together—thumbs should move equally during deep breath.
- Assess tactile fremitus by placing palms in four to five spots while patient says "99"; decreased vibration may indicate fluid consolidation.
- Percuss posterior thorax for resonance, avoiding scapula.
Key Terms & Definitions
- Barrel Chest — Increased AP diameter, often seen in COPD.
- Crepitus — Crackling sensation under the skin due to air in subcutaneous tissue.
- Resonance — Normal sound heard over healthy lung tissue during percussion.
- Adventitious Sounds — Abnormal lung sounds like crackles and wheezes.
- Tactile Fremitus — Vibration felt on the chest wall when a patient speaks; reduced with lung consolidation.
Action Items / Next Steps
- Review the lung sounds lesson in the respiratory course for more details on breath sounds.
- Check resources attached to the lesson for further study.