1. Respiratory system examination

2. Primary assessment
Dr. Miada Mahmoud Rady

3. Chest examination Use the standard approach : Inspection ( looking ).
Palpation and percussion ( touching ).
Auscultation ( hearing ).

4. Chest examination Inspect the chest for any obvious DCAP-BTLS.
Note the shape of the chest and symmetry of movement.
Auscultate the lung fields, noting any abnormal lung sounds.
Percuss the chest to detect any abnormalities.

5. Signs of respiratory distress
Nasal flaring
Retraction (intercostal , subcostal and supraclavicular).
( Sharp pulling of spaces in between ribs , below costal margins and above clavicle )
Cyanosis . ( bluish discoloration of lips , nail beds )
Rapid , shallow breathing .

6. Warning signs of breathing affection
Altered mental status
Shortness of breath
Retractions
Asymmetric chest wall movement
Accessory muscle use
Cyanosis
Audible sounds
Abnormal rate or pattern
Nasal flaring

7. Steps of chest examination
Inspection :
Retractions .
Trauma , wounds .
Swelling .
Discoloration , ecchymosis and bruising
Bleeding .
cyanosis

8. Inspection
DCAP-BTLS = Deformities, Contusions Abrasions, Punctures/Penetrations, Burns Tenderness , Lacerations and Swelling.

11. Palpation Palpation of the chest : Tenderness Hotness
Symmetrical expansion of the chest
Crepitus
Masses
Broken ribs

12. PRINCIPLES OF PALPATION
Have short fingernails.
Warm your hands prior to placing them on the patient.
Encourage the patient to continue to breathe normally throughout the palpation.
If pain is experienced during the palpation. discontinue the palpation immediately.
Inform the patient where, when, and how the touch will occur, especially when the patient cannot see what you are doing.

14. Palpate the anterior chest for excursion.

15. Percussion Rules of percussion :
1. Place your hand lightly against the surface to be examined.
2. Hyperextend the middle finger and apply firm pressure.
3. Strike the middle finger with one or two fingertips of the other hand.

16. Percuss the anterior chest.
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17. Percussion of chest
Compare the percussion note (resonant) with that of the corresponding area on the opposite side of the chest

18. Percussion

19. Auscultate the anterior chest.

20. Normal Breath Sounds

21. Pneumothorax diagnosis
Pneumothorax is air in pleural cavity , signs of which are :
Complaint : dyspnea and cheat pain.
Inspection : may be fracture rib
Palpation : limited chest expansion on affected side.
Percussion : hyperresonance on affected side.
Auscultation : diminished air entry on affected side.

23. How to identify location of heart apex
Identify manubrium sternai
Then second intercostal space
Count down to the fifth intercostal space
Apex is in the fifth intercostal space midclavicular line

24. Palpate for the apical impulse (PMI).

25. Auscultation of the heart
Place the patient in a position that will bring the heart closer to the left anterior
chest wall, such as sitting up and leaning slightly forward.
Place your stethoscope at the fifth intercostal space over the apex of the heart.
Ask the patient to breathe normally and hold the breath on inhalation.

26. Auscultate for heart sounds.

27. Examining the abdomen Inspect the abdomen for any DCAP-BTLS.
Auscultate the abdomen for bowel sounds (if time and quiet environment permit).
Palpate the four quadrants of the abdomen in a systematic pattern, beginning with the quadrant farthest from the patient’s complaint.
Note any tenderness or rigidity.

28. Inspection
DCAP-BTLS = Deformities, Contusions Abrasions, Punctures/Penetrations, Burns Tenderness , Lacerations and Swelling.

29. Light Abdominal Palpation

30. Abdominal Trouble Indicators
Cullen’s sign
Discoloration around the umbilicus suggestive of intra-abdominal hemorrhage.
Grey-Turner’s sign
Discoloration over the flanks suggesting intra-abdominal bleeding.
Ascites
Swelling in the flanks and abdomen.
Borborygmi
Loud, prolonged, gurgling bowel sounds.

31. Signs of acute abdomen from examination
Abdominal guarding and rigidity.
Abdominal tenderness
Absent or decreased bowel sounds

32. Examination of different body parts

33. Palpate the cranium from front to back.

34. Inspect the mastoid process.

35. Palpate the facial bones.

36. Palpate the TMJ.

37. Inspect the external eye.

38. Test the pupil’s reaction to light.

39. You can test the extraocular muscles by moving your finger in an H pattern.

40. Check the corneal reflex.

41. Examine the external ear.

42. Palpate the external nose.

43. Inspect the internal nose with an otoscope.

44. Inspect the nose for nasal obstruction.

45. Palpate the frontal sinus.

46. Palpate the frontal sinus.

47. Palpate the maxillary sinus.

48. Palpate the lips.