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Respiratory Exam

Chest Percussion



  • Chest percussion is used to assess the resonance of the lungs as a surrogate for the amount of air in the alveoli.
    • How to Perform

    • Place your left middle finger over the patient's chest, and strike the distal interphalangeal joint with your right middle finger. Tap 2-3 times, rotating the right wrist and allowing it to fall with consistent force.
  • Percuss the intercostal spaces from the bases to the apices, alternating from left to right and comparing the two sides.
  • Note whether the sound is resonant, hyperresonant or dull. Keep in mind that dullness will be present over the liver (right side) and heart (left side).
    • Interpretation

    • Resonance - vibration of the lung parenchymaNormal percussion note
    • Hyperresonance - increased thoracic gas
    • Dullness - fluid or soft tissue within pleura or lung parenchyma

Hyperresonant Percussion Note

  • A hyperresonant chest percussion note suggests pulmonary hyperexpansion.
    • Causes of Hyperresonant Percussion Note

    • Asthma
    • Severe emphysema
    • Pneumothorax

Dull Percussion Note

  • Dullness to percussion of the chest suggests reduced air in the chest due to fluid or soft tissue
    • Causes of Dull Percussion Note

    • Pleural effusion
    • Pneumonia
    • Pulmonary oedema
    • Lung cancer
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