Lung Exam

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Pneumonia and respiratory distress is a top complication of Covid-19. Here is a review of lung exam findings. There a several good prediction rules out there but you need a good lung exam so we can find the patients who need our help most.

Respiratory rate (10-20 normal) and SpO2 (100%-95% normal) should be first things checked along with how the patient looks when breathing. Also check temp and heart rate.
Listen (6 quadrants)- Compare each side to the other. Normal= good airflow without below findings (listen to healthy patient or yourself to compare). Decreased air flow sounds are concerning (compare to other side)
Crackles- Popping/Rice crispy sound (COPD, Pneumonia, Heart Failure).

Wheeze- High pitched continuous sound (asthma, COPD, obstruction, mucous plugging)
Rhonchi- Low pitched continuous sound (typical come from bronchi, can clear after coughing)
Stridor- Loud high pitched musical sound (upper airway obstruction)
Pleural rub- Similar to crackles, sounds like stethoscope rubbing against cotton (inflamed pleura rubbing against each other).
Pectoriloquy- Patient whispers “99”, when consolidation is present it will make the whisper sound louder and clearer.
Egophony- Patient says “E”, when consolidation is present it will make the “E” sound like “A”.

Additional Reading - Predicting Pneumonia in Adults with Respiratory Illness