Inspection
General Inspection
• Is patient ill or not?
• complexion (colour of the skin)
• Facial expression
• eyes
• Colour of the lips & tongue (blue = central cyanosis ->
heart and/or lung problem)
• Fingers & nails:
• Drumstick fingers & clubbed nails --> Due to Chronic
Hypoxemia (e.g. in COPD)
• Posture
• use of accessory muscles to breathe
• Assess breathing: Palpation
• Chest or Abdominal?
• Respiratory frequency (normal adult = 14-20 per min) Palpation:
• Depth or respiration • Thoracic Excursion
• Inspiration: expiration (5:6) • Thorax pressure pain points
• cough or audible breathing • Lymph node stations
• Vocal Fremitus
Inspection of the Thorax :
• The skin of the thorax Thoracic Excursion:
• Thoracic subcutis --> only determined if inspection raises suspicion of
• insufficient or asymmetric thoracic excursions
The breasts
• • Feel respiratory movement + Assess the symmetry of
The Musculature
the excursions:
• The Skeleton
5 hand positions
• Circumference -> men nipple height, women above
breasts -> normal = insp. & exp. about the same 1. Stand in front of patient -> place both hand on Chest
below left & right clavicles -> fingers point cranially
• may increase 5-10 cm upon max. inspiration
2. Place thumbs on the costal triangle formed by costal
• Respiratory Excursions
margins-> anterior side of thorax
• Asymmetry or other deformities:
General Inspection
• Is patient ill or not?
• complexion (colour of the skin)
• Facial expression
• eyes
• Colour of the lips & tongue (blue = central cyanosis ->
heart and/or lung problem)
• Fingers & nails:
• Drumstick fingers & clubbed nails --> Due to Chronic
Hypoxemia (e.g. in COPD)
• Posture
• use of accessory muscles to breathe
• Assess breathing: Palpation
• Chest or Abdominal?
• Respiratory frequency (normal adult = 14-20 per min) Palpation:
• Depth or respiration • Thoracic Excursion
• Inspiration: expiration (5:6) • Thorax pressure pain points
• cough or audible breathing • Lymph node stations
• Vocal Fremitus
Inspection of the Thorax :
• The skin of the thorax Thoracic Excursion:
• Thoracic subcutis --> only determined if inspection raises suspicion of
• insufficient or asymmetric thoracic excursions
The breasts
• • Feel respiratory movement + Assess the symmetry of
The Musculature
the excursions:
• The Skeleton
5 hand positions
• Circumference -> men nipple height, women above
breasts -> normal = insp. & exp. about the same 1. Stand in front of patient -> place both hand on Chest
below left & right clavicles -> fingers point cranially
• may increase 5-10 cm upon max. inspiration
2. Place thumbs on the costal triangle formed by costal
• Respiratory Excursions
margins-> anterior side of thorax
• Asymmetry or other deformities:
