Rural Emergency Medicine

Respiratory exams are used in conjunction with the appropriate history taking to ascertain the likelihood of a respiratory disease (e.g. upper respiratory tract infection, asthma, pneumothorax, pulmonary embolism and so on).

Some of the most important symptoms to look for when diagnosing a respiratory illness are;
  • Cough
  • Sputum
  • Haemoptysis (coughing up blood) - which is a major red flag
  • Dysponea (sudden onset = red flag)
  • Wheeze
  • Chest sounds (e.g. wheeze, stridor, etc)
  • Chest pain
  • Voice change
Major Threats to Life
  • Pulmonary Embolism
  • Pneumothorax
  • Upper airway failure
  • Acute respiratory failure
  • Massive haemoptysis
  • Hypoxia with inadequate tissue oxygenation 
Basic Anatomy
Before proceeding with learning how to perform the clinical examination, it is important to understand some basic surface anatomy. The diagrams below provide a basic illustration of the trunk surface and lung anatomy.

Adapted from ADAM & Wikipedia.

Respiraotry Clinical Examination
As with any clinical examination you begin with an introduction and general inspection of the patient. It is important to remember to always wash your hands, preferably with an antimicrobial wash before beginning the examination. Then proceed through the following;
  1. Hands/Upper Limbs
  2. Face/Neck
  3. Chest Inspection
  4. Palpation
  5. Percussion of lung fields and,
  6. Auscultation (Breath sounds, added breath sounds & vocal resonance.)
The video below done by the Clinical Skills Online project from the University of London below provides a good demonstration of how to perform a simple respiratory exam.

Just to note this is only an example of a respiratory exam and it's best to follow either the method you've been taught at medical school or the procedure used by your hospital/clinic.

Finally some further assessment includes;
  • Pulse Oximetry - a device that is clipped onto a finger and typically measures heart rate and oxygen saturation
  • Spirometry - depending on the technology that is utilised, it can return a range of Pulmonary measurements (e.g. forced vital capacity, peak expiratory flow, tidal volume and so on) 
Further Resources
Next up in clinical examinations is performing a cardiovascular exam.

Other Clinical Exams
Cardiovascular | Respiratory | Gastrointestinal | Neurological | Musculoskeletal


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