Trachea:
- Normally central, slight right displacement .
Apex beat & mediastinum:
- Check for displacement.
Chest expansion:
- Normal expansion ≥ 5cm
- Tactile vocal fremitus (TVF): can be done with the palm of one or both hands.
Thoracic expansion:
- Massive hydrothorax, pneumonia, pleural thickening, atelectasis
Vocal fremitus (tactile fremitus)
- Ask the patient to say “ninety-nine” several times in a normal voice.
- Palpate using the palm of your hand.
- You should feel the vibrations transmitted through the airways to the lung.
- Increased tactile fremitus suggests consolidation of the underlying lung tissues
Assessing chest expansion in expiration (left) and inspiration (right).
(cc) (COMB)
Other Notes
Palpation By - Use the index finger to feel the trachea and to determine whether the trachea feels central or is deviated: - The trachea is deviated away from pneumothorax and effusion and towards collapse and consolidation. - The trachea may also be deviated by a mass - eg, enlarged lymph nodes. Chest expansion: - Usual chest expansion in an adult is 4-5 cm and should be symmetrical. - Symmetrical reduction: overinflated lungs (eg, bronchial asthma, emphysema), stiff lungs (eg, pulmonary fibrosis), ankylosing spondylitis. - Asymmetrical reduction of chest wall expansion: absent expansion (eg, empyema and pleural effusion) or reduced expansion (eg, pulmonary consolidation and collapse). Tactile vocal fremitus: - To assess tactile vocal fremitus, use the ulnar side of the hand, by the hypothenar eminence with the palms facing upwards.
- Place it at various levels over the back, each time asking the patient to say “ninety-nine”.
- Note how the sound is transmitted to the hand. - Tactile vocal fremitus is increased over areas of consolidation and decreased or absent over areas of effusion or collapse. - Feel for the apex beat of the heart; it will be displaced if the mediastinum is displaced or distorted.