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Respiratory Examination

A 12-step respiratory examination covering inspection, chest expansion, percussion, auscultation and bronchophony.

Respiratory · Self-paced

Step 1. Introduction

  1. Hand hygiene

    Hand wash/rub

  2. Introduce yourself

    Introduce self

  3. Explain the purpose

    Explain purpose

  4. Obtain consent

    Obtain consent

  5. Position and exposure

    Position patient and expose as necessary

Step 2. General Inspection

  1. General observation

    General observation (coughing, environmental cues, posture, breathing pattern, use of accessory muscles)

  2. Body habitus

    Body habitus

  3. Colour

    Colour

  4. Bedside chart

    Check bedside chart (obs/vitals)

Step 3. Hands and Upper Limb

  1. Peripheral cyanosis

    Peripheral cyanosis

  2. Clubbing

    Clubbing

  3. Tar stains

    Tar stains

  4. Intrinsic muscle wasting and weakness

    Intrinsic muscle wasting and weakness

  5. Flapping tremor

    Flapping tremor

Step 4. Perform Vital Signs

  1. Radial pulse

    Radial pulse

  2. Respiratory rate

    Respiratory rate

  3. Blood pressure and pulsus paradoxus

    Comment on blood pressure measurement and pulsus paradoxus

  4. Assessment limitation

    Students should comment on, but are not required to perform, BP.

Step 5. Face

  1. Eyes

    Eyes: Horner's syndrome (ptosis, miosis, anhidrosis), conjunctival pallor

  2. Sinus tenderness

    Sinus tenderness

  3. Teeth, gums and palate

    Teeth, gums, palate

  4. Tonsils

    Tonsils, exudate, plaques, cyanosis

  5. Cough

    Cough

Step 6. Neck – Lymph Nodes and Trachea

  1. Tracheal position

    Tracheal position

  2. Tracheal tug

    Tracheal tug

  3. Cervical nodes

    Cervical nodes

Step 7. Chest Inspection

  1. Anterior and posterior chest

    Assess anterior and posterior chest for: shape, symmetry, deformities, scars

Step 8. Expansion

  1. Anterior and posterior assessment

    Anterior and posterior assessed

  2. Instructions

    Clear instructions to patient

  3. Technique

    Technique demonstrates a reasonable estimate of full respiratory movement

  4. Assessment limitation

    Students should comment on anterior expansion but do not have to perform.

Step 9. Percussion

  1. Thorax coverage

    Anterior, lateral and posterior thorax assessed

  2. Technique

    Technique creates clearly audible notes

  3. Placement

    Symmetrical and anatomically correct placement

Step 10. Auscultation

  1. Thorax coverage

    Anterior, lateral and posterior thorax assessed

  2. Instructions

    Clear instructions to patient, avoids hyperventilation

  3. Placement

    Symmetrical and anatomically correct diaphragm placement

Step 11. Resonance

  1. Bronchophony coverage

    Bronchophony only: adequate coverage of thorax (anterior/lateral/posterior)

  2. Placement

    Symmetrical and anatomically correct diaphragm placement

Step 12. Conclusion

  1. Thank the patient

    Thank patient

  2. Redressing

    Indicate they may redress

  3. Hand hygiene

    Hand rub/hand wash

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