How To: Perform a general chest exam on a patient

There's no better way to learn then by visual media, and that's what makes this video lesson on performing a chest exam so great. It's perfect for any future doctor, and great for nursing students to understand the proper procedure for examining a patient's chest. Medical students can easily learn how to perform a general chest exam, because ever step and technique is outlined and shown. A chest examination is very important to determining what's wrong with your patient, and you will be able to identify the significance of a positive finding in any of the tests performed.

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