S-Assessment of The Thorax
S-Assessment of The Thorax
THORACIC LANDMARKS
GENERAL APPROACHES
ANTERIOR
Greet the patient and explain the assessment
techniques that you will be using.
Room should be warm to prevent the patient from
chilling and shivering.
Use a quiet room that will be free from interruptions.
Ensure that the light provides sufficient lightness
Instruct patient to remove clothes and change to a
gown
Place the patient in an upright sitting position
POSTERIOR Exposed the entire area to be assessed. Provide a
drape cover the breast of women when posterior
T thorax is assessed.
When palpating, percussing and auscultating the
anterior thorax of an obese female patient, ask them to
displace breast issue.
For infants, a barrel chest is normal. In a heavy or obese patient, place your fingertips on
ABNORMAL FINDINGS the lower anterior borders of the thoracic skeleton.
PECTUS EXCAVATUM OR A CONCAVE CHEST WALL Gently move your fingertips to the xiphoid process
Depressed sternum or breastbone. NORMAL:
Space in the chest cavity of the lungs to expand is Costal angle is less than 90 deg. During exhalation and
diminished causing difficulty of breathing, shortness of rest
breath and decreased endurance during exercise. E. ANGLE OF THE RIBS
• Stand in front of the patient
Cardiac compression reduces stroke volume and • Visually locate the midsternal area
cardiac output causing fatigue and elevated heart rate. Estimate the angle at which the ribs articulate with
PECTUS CARINATUM OR PROTRUDING STERNUM the sternum
Difficulty in exhaling the air in the lungs which In a heavy or obese patient, place your fingertips on
restricts gas exchange and causes short and fast the midsternal area.
breathing and reduced exercise tolerance. Move your finger along the rib laterally to the
POTT’S DISEASE OR CARIES OF THE SPINE anterior axillary line. Visualize the line that is created by
Chest falls forward and its anteroposterior diameter your hand as it traces the ribs.
in increased. Abdominal contents are crowded up into NORMAL:
the chest and push the sternum and lower ribs forward. The ribs articulate at a 45 degree angle with the
sternum.
Associated with this deformity is oftentimes a lalteral
F. INTERCOSTAL SPACES
deviation of the parts above the site of the disease • Stand in front of the patient
When the scapulae project like wings, it is called • Inspect the ICS throughout the respiration cycle
“alar” or “pterygoid chest” • Note any bulging of the ICS and any retractions.
B. SYMMETRY OF CHEST WALL NORMAL:
Stand in front of the patient Absence of retractions and bulging of the ICS.
Inspect the right and let anterior thoraxes G. MUSCLES OF RESPIRATION
Stand in front of the patient
Note the shoulder height.
Observe the patient's breathing for a few respiratory
Move behind the patient
cycles, paying close attention to the thorax and the
Inspect the right and left posterior thoraxes
neck
Note the position of the scapula.
Note all the muscles that are being used by the
NORMAL:
patient.
The shoulders should be of the same height, so with
NORMAL:
the scapula. No masses.
No accessory muscles used in normal breathing.
ABNORMAL FINDINGS
H. RESPIRATIONS
Scoliosis Inspection of the respiration process includes 7
Kyphosis components:
Lordosis Rate
C. PRESENCE OF SUPERFICIAL VEIN Pattern
• Stand in front of the patient Depth
• Inspect the anterior thorax for the presence of dilated
Symmetry
superficial veins.
NORMAL: Audibility
Dilated superficial veins are not seen. Patient position
D. COSTAL ANGLE Mode
Stand in front of the patient. RATE OF RESPIRATION
Visually locate the costal margins NORMAL : 12. - 20 breaths per minute in a resting
Estimate the angle formed by the costal margins adult.
during exhalation and at rest. EUPNEA - normal breathing
ABNORMAL FINDINGS:
Tachypnea - RR greater than 20
GENERAL PERCUSSION
TACTILE OR VOCAL FREMITUS
A. ANTERIOR
Is the palpable-vibration of the chest wall that is • Patient is in upright position
produced by the spoken word. • Percuss 2-3 strikes in the lung apex
The technique is useful in assessing the underlying • Repeat in the left lung apex
lung tissue and pleura. • Note the percussion sound
PALMAR BASES OF THE FINGERS SEQUENCE FOR PERCUSSING THE ANTERIOR THORAX
ULNAR ASPECT OF THE HANDS
ULNAR ASPECT OF A CLOSED FIST
PROCEDURE
Firmly place the ulnar aspect of an open hand or
palmar base of the fingers or ulnar aspect of a closed
fist) on the patient's right anterior apex.
Instruct the patient to say the word “99” or “blue
balloons”
Feel any vibration on the ulnar aspect of the hand as
the patient phonates.
Move your hand to the same location on the left B. POSTERIOR
anterior thorax •Patient in upright sitting
Repeat steps 2 and 3 •Have the patient bend down his head and fold the
SEQUENCE FOR PALPATING ANTERIOR THORAX arms around his waist
•Percuss the right lung apex located at the top of the
shoulder.
•Repeat on the left lung.
•Note the sound produces
SEQUENCE FOR PERCUSSING TE POSTERIOR THORAX