Synopsis
Perform a reproducible respiratory examination that first detects physiological danger, then integrates inspection, palpation, percussion and auscultation into a testable anatomical and clinical synthesis rather than a list of signs.
- Observe before touching: respiratory rate, speech, posture, pattern, accessory-muscle use, symmetry, audible sounds, cough, sputum and oxygen device often reveal severity immediately.
- Record oxygen saturation, device and target alongside pulse, blood pressure, temperature and mental state; an examination without physiology cannot grade acute illness.
- Hands can show clubbing, nicotine staining, peripheral cyanosis, fine beta-agonist tremor or coarse carbon-dioxide-retention flap, but each sign needs clinical context.
- Compare both sides systematically: tracheal position, expansion, percussion note, breath-sound intensity and added sounds localise pleural, parenchymal and airway abnormalities.
- Dull percussion with reduced breath sounds and expansion supports pleural fluid; hyperresonance with reduced sounds supports pneumothorax, but body habitus and technique limit accuracy.
- Bronchial breathing and focal crackles support consolidation; fine late inspiratory crackles suggest interstitial or oedematous processes; wheeze indicates narrowed airflow but not its cause.
- Complete the respiratory examination with cervical and supraclavicular nodes, jugular venous pressure, heart, legs and relevant abdomen because cancer, heart failure and thromboembolism cross organ boundaries.
- End with a synthesis stating severity, localisation, likely mechanism, important alternatives and the next investigation that will test the conclusion.
Key red flags
Stridor, drooling, inability to speak, silent chest, paradoxical breathing, exhaustion, falling respiratory rate or reduced consciousness indicates threatened airway or ventilation. Routine examination should stop while help and respiratory support are mobilised.
Unilateral reduced expansion and air entry with hyperresonance supports pneumothorax. Severe distress, hypotension, distended neck veins or rapidly deteriorating physiology raises tension, which is treated clinically before radiography.
Investigation priorities
Quantify physiological severity and trigger the appropriate acute response.
Management branches
Every respiratory examination, especially an acutely unwell patient.
- Observe from the end of the bed, assess speech, breathing effort, pattern, colour, posture and equipment, then measure observations and identify the prescribed oxygen target.
- If airway, ventilation or circulation is threatened, switch immediately to ABCDE, call help and treat; do not complete an examination sequence for presentation's sake.
- When stable, introduce yourself, confirm consent, position the patient, expose the chest respectfully and adapt for pain, mobility, hearing or infection-control needs.
A stable patient requiring a full respiratory examination.
- Inspect hands, face, neck and chest for clubbing, cyanosis, anaemia, nodes, tracheal deviation, scars, deformity and respiratory effort; check pulse and relevant venous pressure.
- Palpate trachea and bilateral expansion, then percuss matched anterior, lateral and posterior areas, noting whether dullness or hyperresonance follows an anatomical boundary.
- Auscultate matched areas for breath-sound intensity and character, timing and quality of crackles, wheeze or rub; ask the patient to cough and reassess sounds that may represent secretions.