PCM: Lung Exam


 * Exam Skills: Lungs
 * Appropriate gown and drape:
 * Patient should be seated upright, naked to the waist with a gown for cover when not being examined.
 * Normal and Abnormal Respiratory Rates:
 * Normal: 12-20 respirations per minute
 * Apnea: Periods of no respiration
 * Tachypnea: Greater than 20 respirations per minute
 * Bradypnea: Less than 12 respirations per minute
 * Hyperpnea: Deep respirations greater than 20 per minute
 * Percussion Tones: Intensity and Quality
 * Resonant
 * Loud and Hollow
 * Flat
 * Soft and Extremely dull
 * Dull
 * Medium and Thudlike
 * Tympanic
 * Loud and Drumlike
 * Hyperresonant


 * Bronchial Versus Vesicular Breath sounds: Description and Location
 * Bronchial
 * Anterior thorax over trachea
 * Loud, long, high pitch expirations that are often longer than inspirations
 * Vesicular
 * Anterior and Posterior thorax over most of lung field
 * Soft, short, low pitch expirations
 * Location of Lung Lobes:
 * Anterior Chest
 * From top to bottom bilaterally: Superior, Middle and Inferior lobes of the right lung and the Superior and inferior lobes of the left lung
 * Posterior Chest
 * From top to bottom bilaterally: superior and inferior lobes of the right lung and the superior and inferior lobes of the left lung
 * Axillary region
 * Inferior lobes bilaterally

Lung Exam Checklist

 * Lungs and Thorax
 * (All percussion and auscultation must be done on skin)
 * 1) Inspect the posterior thorax for scars or asymmetry. Tell patient what you are doing.
 * 2) Percuss the posterior lung fields bilaterally, symmetrically and alternately, over the upper, middle and lower lung fields, comparing the left side and the right side at each of three levels.
 * 3) Fist percuss your palm placed on the costovertebral angle bilaterally (kidney tenderness). Ask the patient if he/she feels pain.
 * 4) Instruct the patient to cross his/her arms and breathe through an open mouth before you begin auscultation.
 * 5) Auscultate the posterior lung fields bilaterally, symmetrically and alternately, comparing right and left.
 * 6) Inspect the anterior chest for scars or asymmetry.
 * 7) Percuss the anterior lung fields in one area on the upper chest, bilaterally, symmetrically, and alternately.
 * 8) Auscultate the anterior lung fields, bilaterally, symmetrically, and alternately.