CHEST (RESPIRATORY) EXAMINATION) #MDCN #CLINICALS #MEDICAL STUDENTS #RESIDENT DOCTORS #MEDICS

Hello, I want to welcome everyone once again to one of our series. Today we will talk about the

chest

examination

and that it will involve the four key steps: inspection, palpation, percussion and auscultation. So today we are going to talk about the

chest

exam and I will guide you through the steps of how to perform a chest exam, so the first thing you should do is always clean your arms and then read the instructions carefully. Sometimes they might say just examine the patient's chest, don't percuss, so you should do it. Remember that it is not a super course in the

examination

, if that is mentioned apart from that, we will do a step by step examination in the chest examination, so after washing your hands the next thing is to greet the patient.

Good afternoon, sir and doctor. And then Evan has to examine you, that's fine, but bring my attention to your chest while I fill it and also tap it and listen to him if it's okay, okay? Do you have any pain anyway? No, so this is very, very important because this can give you an idea or a clue as to where the problem is, for example, if you tell me that you have a problem here where you have a pin in your chest, most likely the pathology be yes, we will be there, so it is It is very important to always remember to ask this question: are you in pain anyway or specifically do you have any chest pain?

Then the next thing is to go to the foot of the bed while you are at the front of the bed. you have to squat and while you squat you try to see the symmetry of the chest and you ask me to inhale and exhale deeply for me, okay so you try to see the movement of the chest also so that it looks the same on both sides and you may even ask give you a cough for me, you can give me a cup, okay, so sometimes I can give you an idea if he has a wet scarf or a dry cough, but it seems like you know it's okay, don't be patient here and then. that you're trying to count breathing rates and it's very important to remember to count this because a lot of candidates forget to do it, so you might want to distract him a little bit by paying attention to your pulse, but while you're trying to count the breathing rate, so which should normally be between 12 and 18 cycles per minute, so when you ride, you count for 15 seconds and multiply by four, so after you've done this, it's important to pay attention and go to the neck. region because after the inspection during your inspection you have also contained the

respiratory

rate if there is a sputum cup you can ask if you think you are coughing my husband is putting the cup and see what color do you know this what is the call of the splatoon if there is any blood on the spotting and then the next thing is to palpate, so for the purpose of the population, you need to check the centrality of the tracker, so how do you go about putting your ring finger on the clavicular end at this point? on the clavicular end or on the other you put your index finger, so you place this now you run your finger along the midline of the track here to try to see fill the track here it is in the center now reaching this end try to put your finger half on both sides to see if there is more space on one side than the other, so it looks the same in our patients here and in some people, the tracker might be slightly off to the right, so when you feel it, You find that it's okay, you can feel the trachea rings, but when you put your finger on the other side of the tracker, you feel the grip of the finger without filling any rings there, so it's important to remember to check that you know how to fill the tracker rings. again, then place your finger on both sides just the size of the lateral sternocleidomastoid across the tracking ears and see if you can feel the shark ears on one side than the other.

You may also want to quickly check your critical highlight distance, especially for hyperinflated people. lungs like copd, you know there is the cartilage um tara that the cricoid cat leaves somewhere just below, so the ideal is to take the three fingers that we can see here when we are patients with hyperinflated lungs, they may only be needed one or two fingers, so there is a reduced cricostone distance. Also, next is to check the chest expansion and ask him to push it out for you, so it is important to ask him to be in the kimbo position.

You can ask him to do this to make it easier for you to even examine him. it gives you enough room to check the expansion and even when you want to do parkour too so at the top you ask me to take a deep breath or not okay then make sure when you try to check the chest. expansion, make sure to place the palmar surface of your hand on the flanks, you may want to pull the skin a little with it, pull the skin a little with it, make sure your thumbs cross the midline, touch, ya knows. the thumbs are touching, but keep them from touching the chest wall, so do this, inhale and exhale deeply for me, again, okay, very good, so it should take about two inches, so about 5 cm when you take a deep breath and out again, yeah, okay, so same thing, pull a little, pull a little and then make sure the touch doesn't need to touch the chest wall.

Now I'm going to take you in and out directly for me, so take a deep breath. and please very well so that you have a good symmetrical expansion of the chest, the next thing you should do is do a tactile feminist and that is when it asks to say gentleman nine so that the vocal resonance that we will talk about later in this quote can be is more sensitive than the factors parameters so you have to check that you know the long zones so check where you ask them to say 99 please say 99 as soon as you feel my hand touch okay can you say 99 .99?

I make sure it's in the intercostal space not over the bone 99 good 99 99. very good that's for the anterior area of ​​the chest so you may want to divide this place into three zones because it's in a variable upper part , just above the nipple, just below the nipple and the two axials. areas for you to feel the vibration that you feel, then you could know, then the sensitivity that you know alcoholic like this will be reduced, there will be reduced tactile parameters, so that's the concept, um, but this can be better selected during your vocal resonance using a stethoscope below.

It's for parkours, so for percussion, tell them you're going to play the chest if that's okay, sir. As you hit the chair, start directly over your collarbone and then again over the areas you've done before as well, so I'm going to stop your chest, okay again, do you have any pain anywhere? It's not right, so tap gently and then just below the collarbone in the space, make sure your arms are burning, you may want to lift these fingers up a little bit from the chest and then do the movement. be on your wrist, so it looks like you know it's the same as it looks resonant, except for the hepatic dulling area which is a big gate and the cardiac dulling area, so if there's an absent heart latency area or an absent area from liver donors which could suggest that there are hyperinflated lumps that the lungs would have pushed down, you know, the liver and also in the region of the heart, the heart may have also been displaced, in case of um, you know, displacing the beats in hypothesis and take the sum. from the heart area, so it is important to recognize us in COPD patients, we may actually have a barrel-shaped chest, they may also be short of breath, they may be passing their lips, they may also have a standard distance of reduced ripple and, over time, they may have reduced horizontal thoracic expansion and at the time of filtration they discover that they have long hyperresonant fields with loss of the cardiac dulling area and loss of what is cardiac hepatic dulling and hepatic dulling , the next thing is to auscultate, so for auscultation remember again. to direct a statistical advance, but you want to listen to all the long areas, so the apic parts of the long ones, you want to place your stethoscope just above the end of your collarbone, ask it to breathe in and out deeply for you.

You may want to ask him to do this with his mouth slightly open and possibly turn his face to the other side if possible. Alright, can you turn your face the other way and ask? Okay, can you turn your faces together? Leave it there. very good, now it's very good, thank you, well, it comes back again, so those are the red sounds, that's what the bread sounds like, so the best ones, I think they should be vesicular from Britain, where they are probably your inspiration you know longer than the expiration and there is no space in between the runner's bread sounds what they expected that the Bransons are a little harsh and it almost sounded like you know what you are putting if you put your status quo next to your tracker and you are listening to the kind of Brighton you'll hear from a normal person. is the station, so it seems like a gap in the middle, as it is a bit harsh, compared to vascular crises, so the next thing is to check your vocal resonance, which is like the oscillatory equivalent of the tactile premises, so each time I put on my stethoscope my central stethoscope it's your turn you'll say 99 okay 99 99 1999 99 99 99 which one what you see 99 99 99 1999 okay so red sounds before the vocal resonance just so you know so I checked the birth sounds I listened to the breath sounds to see if there are any additional breath sounds or there are bronchial breath sounds or there are crackles there will be stones uh pure rubbing can be a little squeaky, so it's important to take breads and then check your vocal resonance, so again the resonance Vocal resonance and tactile affirmations will reduce the corresponding areas. of the lung, so after that, the next thing is to make sure you inspect the back again just as you would have done.

You also know the anterior chest wall before you know it. while you use the foot of the bed and even though you know you were on the bad side of the patient, it is also important to do the same on the back, you ask me to sit down, pay attention to the chest, we will see a chest wall and see if there is any abnormality, okay, you can ask him to cross his hands like this and put his hands like this and then the other one on top as well to give him room for the scapula to move away, I mean, and he will be able to do that.

To do a good test here, you don't want to be Australian versus scapula, you don't want to touch the scapula also crossing the scapula, so you've checked that you are and then you want to check if there's any chest expansion, so I want to take a deep breath in and out when I say wait please okay now please inhale and exhale that's very good now again okay so check the chest expansion in the back as well and then after. that's what you want to know, those are the expansions after that, you want to check the touch parameters, so asking me to say 99, at the top you might want to do this.

Can you say 99 99 now 99? Make sure it is not on the scapula. It must be established. We don't put your hand on the scapula. We'll do this at 99 99 99 99 99 99 19. We want to split it into four areas, one, two, three, four and then you want to split it. you want to filter, okay, then I'm going to hit your knife, okay, then you change your finger, okay, it seems resonant in all areas, then again we're going to do it, so I'm going to take a deep breath. and out for me and the time is your turn, okay, okay, very good, now, now, so you don't need to check the axle again because you've already checked it while you're doing it while you're in front, so you can.

Ask me to say 99 again, so who cares 99 99 99 19 99 99 99 99. So pay attention to whether the sound is louder on one side or reduced on one side and obviously keep an eye out for any scarring. Torah may have. Because of the monectomy, it could lead to prolonged debulking surgery or it could be due to a wedge section, so always make sure to keep an eye out for those flakes on the posterior chest wall and then it's important that you know how to thank the patient. meet and wash your hands also thank the patient for his time and my dad will arrive at the end of the exam thank you very much, thank you