Respiratory Assessment- Percussion

Original Editor - Lizzie Cotton

Top Contributors - Lizzie Cotton, Evan Thomas, Scott Buxton and Naomi O'Reilly

Description

A thorough respiratory examination requires multiple elements of objective assessments to aid diagnosis and inform treatment. Percussion plays a key role in such an examination, when performed in conjunction with other techniques such as auscultation, palpation and imaging[1] . Percussion produces audible sounds which can be interpreted by a skilled examiner to discern fluid, air or solid material within the chest cavity [2].

Technique

Place your non-dominant middle and index fingers directly onto the patient’s skin, with your distal interphalangeal joints held firmly against the patient’s chest. Using your dominant middle finger, tap the middle finger of your non-dominant hand (firmly placed on the patient’s chest) at the level of the distal interphalangeal joint. This is best performed by a quick flick of the wrist to achieve a solid strike on the finger [3].

Sequence

With the patient in an upright seated position, with the scapulae protracted; percuss on the posterior chest wall; either side of the mid-clavicular line in the interspaces at 5cm intervals. Ensure you percuss from side to side and top to bottom (omitting areas covered by the scapulae). Repeat for the anterior chest.

Percussion sounds should be categorized as follows: normal, dull, or hyperresonant. Location and quality of percussive sounds should be noted and recorded as part of the objective respiratory examination[3]

Clinical Presentations

Normal

Percussion over normal, healthy lung tissue should produce a resonant note.[3]

Flat or Dull

Dull percussive sounds are indicative of abnormal lung density.
Likely indicating: atelectasis, tumour, plural effusion, lobar pneumonia [4]

Hyperresonant

Hyperresonance on percussion indicates too much air is present within the lung tissue.
Likely indicating: Emphysema or pneumothorax[3]

Video Link

[5]

References

  1. Mangione, S. (2008) Physical Diagnosis Secrets. Mosby Elsevier, Philadelphia)
  2. Hough, A. 1996. Physiotherapy in Respiratory Care. 2nd ed. Chapman and Hall, London
  3. 3.0 3.1 3.2 3.3 Hough, A 1996. Physiotherapy in Respiratory Care. 2nd ed. Chapman and Hall, London
  4. Jarvis C 2007 Physical Examination and Health Assessment 5th Ed. Saunders Elsevier, St.Louis.Douglas
  5. Stanford Medicine. Percussion of the Chest. Available from: https://www.youtube.com/watch?v=48nzLXnEHvg [last accessed 8/2/15]