Examination of the Respiratory System• Wash your hands.• Introduce yourself to the patient, and ask permission to examine them.• Expose the patient, and position them at 45°.
Look around the bedOxygen mask/nasal prongs, sputum pot, drips, PEFR,inhalers, nebuliser
, cigarettesLook at the patientComfortable at rest, cyanosis, breathless, use of accessory muscles, scars (eg following a rib for pneumonectomy), asymmetry, deformity, hyperexpansion(Barrel chest), pectus carinatum, pectus excavatum,cachexia, radiotherapy marks, chest drainLook at the handsClubbing (purulent lung disease – CF, bronchiectasis,bronchogenic carcinoma – but not small cell), peripheralcyanosis, nicotine staining, muscle wasting, CO
retentionflap, tremor (β2-agonists)Feel the radial pulseAssess rate and count respirationsAsk for blood pressureEnquire about pulsus paradoxusLook at the facePtosis, Miosis and Anhydrosis (Horner’s), SVCobstructionLook in the eyesAnaemiaLook in the mouthCentral cyanosis, pursed lips, tonsils, hoarse voice,stridor.Look at the neckExamine the JVP (raised in cor pulmonale and tensionpneumothorax)
Check trachea is centralIncluding the cricosternal distanceCheck for lymphadenopathyFeel for the apex beatMay be displaced, eg in pneumothorax or effusionAssess chest expansionanteriorly
Percuss anteriorlyCompare L with R, and don’t forget the axillae andsupraclavicular regions. Can be normal, hyperresonant,dull and stony dull.