Introduction
Wash hands
3Ps – position at 45%
General observations
End of bed
Surroundings – sputum pot, oxygen, inhalers
Patient – respiratory rate (Normal=12-16), use of accessory muscles, pursed-lips (Þsevere COPD), cough
Hands & Arms
Nails – clubbing (non-small cell lung carcinoma/ chronic suppurative lung disease/ pulmonary fibrosis, esp. fibrosing alveolitis)
Fingers – peripheral cyanosis, nicotine stains
Wasting (small muscles of the hand)
Radial pulse (rate, rhythm)
CO2 retention flap
Face
Eyes – anaemia, Horner’s syndrome (apical lung cancer)
Tongue – central cyanosis
Facial plethora – smoker, SVC obstruction
Neck
Tracheal displacement
JVP – raised in cor pulmonale
Lymphadenopathy (carcinoma, TB, lymphoma, sarcoidosis)
Chest
Inspection
Chest shape – pectus carinatum, pectus excavatum, barrel chest, Harrison’s sulcus
Scars – thoracotomy, pneumonectomy, previous chest drains
Radiotherapy stigmata – tattoos, skin changes
Palpation
Apex beat
Expansion
Percussion
Compare both sides
Ausculation
Breath sounds
Added sounds
Vocal resonance OR tactile fremitus
Additional ‘SPOT X’ (sputum, peak flow, O2 sats, temperature chart, CXR)