96824 Respiratory palpation systematic examination

Symmetrical Palpation to identify:

Palpate neck muscles and structures including the trachea to ensure it is midline.

Right = Left Equal expansion Areas of tenderness and crepitus Depressions, bulges, pulsations Abnormalities such as paradoxical movement

Palpate intercostal spaces (for bulging or retractions) collar bone, ribs, and for subcutaneous emphysema.

Deviation from the midline may suggest a pneumothorax / haemothorax.

Palpate for tactile fremitus

Palpate for Thoracic Expansion

Place both of your hands on either side of the upper sternum (anterior thorax) or on either side of the spinal process (posterior thorax), with the thumbs in the middle. Ensure your thumbs are lifted up from the chest so they are able to move with chest expansion. Ask patient to take a deep breath through the mouth and observe lateral movement of both lumbs.

Place your hands on the patient's back, ask the patient to say "99" systematically while palpating the chest, so you can feel vibration. Increased tactile fremitus may indicate a inflamed lung tissue (ie. pneumonia); decreased tactile fremitus may indicate pleural effusion or pneumothorax (Hendrickson, 2013).