Heart and Lungs Exam

We're now going to proceed with examination of the chest and lungs. We haven't examined the lungs yet, so we'll begin with that right now. We first want to do the anterior chest, again just as we did with the posterior chest, first by palpation, followed by percussion, and then ascultation. Say 99. 99. 99. 99. 99. 99. 99. 99. 99. 99. 99. 99. One uses the same technique, applying the heel of your hand in an interspace. Obviously, we have the heart in this area, and we do not evaluate over the heart because

this would be an area in which tachylofeminist would be different than the area on the other side. Percussion is done by the same technique that we did in the back. Mr. Johnson, would you just turn your head off to the side and we evaluate the percussion note as well. There are some people who believe that percussion of the cardiac border is a technique worth doing. It generally is a technique of low sensitivity and specificity, and I feel that it's not a technique that is very useful to determine cardiomegaly.

Finally, the last part is the ascultation of the lungs. We will ascultate in the same areas that we were doing our percussion and palpation. Mr. Johnson, just turn your head to the side and open your mouth. Take a nice big breath in, out, again, again, again, again, and again. That completes the examination of the lungs. We're going to continue with examination of the heart. We do the same procedure as we did when the patient was sitting using the pads of our fingers in the aortic area, in the pulmonic area, down along the left sternal

border to the tricuspid area, over to the mitral area, palpating very lightly with our pads of our fingers for cardiac thrills. We'll then take the heel of our hand and place it on the sternal border to see if there's any impulse that we can palpate. Patients who have right ventricular enlargement may have something called a right ventricular lift or heave, and the hand may be actually lifted off the chest wall. We can do the same technique over here at the fifth intercostal space, midclavicular line, and if we found that same impulse, this would be suggestive of left ventricular

enlargement or hypertrophy. Finally, we're going to do auscultation of the heart in a lying position as well in the left lateral cubitus position, which are the two other standard positions for cardiac auscultation. We will listen again in the aortic, pulmonic, herbs point, left lower sternal border, tricuspid, and the mitral area. Auscultation of the pulmonic area with the patient lying is the best position to evaluate splitting of the second heart sound. The final standard cardiac position is evaluation of the mitral area using the bell with the patient in the left lateral decubitus position.

Mr. Johnson, can you just move your body closer to me? Just move over straight this way and turn over on your left side. That's fine. And with the bell listening in the mitral area, through the low-pitched diastolic murmur of mitral stenosis, and you can turn back. Comfortable? Application of the bell to the chest wall should be very, very gently, because if you press too hard with the bell on the chest wall, the skin becomes a diaphragm, and you lose the ability to hear the low-pitched sounds. Remember that the diaphragm is best used for high-pitched and medium-pitched

sounds. The bell is used for low-pitched sounds. This completes examination of the anterior chest, and we're now going to move on to examination of the abdomen.