PO Box 4066 Alice Springs NT 0871
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Ask about
Figure 9.1
Expose chest and look
If small child or baby
Feel chest (palpate)
Figure 9.2
Figure 9.3
Figure 9.4
Measure chest expansion (symmetry)
Compare movement of both sides of chest wall (symmetry). If problem expanding (inflating) one or both lungs — may be fluid in pleural space, pneumonia, pneumothorax, etc.
Figure 9.5
Percuss chest
Table 9.1 Chest percussion sounds
Left front chest sounds dull over heart — from sternum to mid-clavicular line, at third or fourth rib space. Normal resonance again at sixth rib space
Practise on yourself
Figure 9.6
Percuss patient
Figure 9.7
Figure 9.8
Listen to breath sounds (auscultation)
Stethoscope can only hear (penetrate) the lung approximately 5cm below the skin. Abnormalities that lie deeper might not result in an abnormal sound (eg large pneumonia but normal breath sounds).
If small child — always rely on what you can see
Put warm stethoscope diaphragm firmly onto skin. Do not listen through clothing — covers sounds and confuses findings
Table 9.2 Normal breath sounds
Table 9.3 Abnormal breath sounds
If breath sounds
FVC (forced vital capacity)
FEV1 (forced expired volume in one second)
FEV1/FVC ratio
Improvement in FEV1 following bronchodilator (eg salbutamol)
To be classified as a 'good' test, spirometry needs to meet criteria for acceptability and reproducibility
Acceptability
Reproducibility
Table 9.4 Examples of spirograms
PO Box 4066 Alice Springs NT 0871
P: +61 8 8951 4700
General Enquiries: remotephcmanuals@flinders.edu.au