Checklist
WIPER
• Patient sitting on edge of examination couch with all clothing above the waist removed
Physiological parameters
General
• End of bed: shortness of breath, wheeze
• Bedside: sputum pot, bedside oxygen, cigarettes, inhalers
• Hands: nicotine staining and finger clubbing
• Face: Horner's syndrome (ptosis and meiosis) and venous engorgement of head and neck veins
Inspection
• Neck: lymphadenopathy, low transverse cervical scar for mediastinoscopy, tracheostomy scar, tuberculous abscesses
• Chest wall deformities: pectus excavatum (pushed in) or pectus carinatum (pushed out)
• Chest movement: asymmetry of expansion, contraction of one side of the chest wall, paradoxical movement (flail chest)
• Scars: midline sternotomy, lateral/posterior/posterolateral thoracotomy, small scars (video-assisted thorascopic surgery or chest drains)
• Radiotherapy tattoos
• Chest drains
Palpation
• Neck: lymphadenopathy, goitre, position of trachea
• Chest: sternal tenderness or instability, rib tenderness, asymmetry of expansion
Percussion
• Chest wall: resonant, dull or hyper-resonant
Auscultation
• Chest wall: breath sounds (vesicular, crackles, wheeze, reduced air entry)
To complete the examination…
• Bedside spirometry
• Chest x-ray
The main symptoms of thoracic disease are shortness of breath, fatigue, wheeze, stridor, cough, sputum production, haemoptysis, chest pain and voice hoarseness.
The patient needs to be sitting on the edge of the examination couch, exposed from the waist up.