visual inspection of the chest was performed to identify work of breathing, chest dissymmetry or bruising. The chest wall was then palpated to elicit tenderness, chest expansion or subcutaneous emphysema, indicators of chest trauma (Aghajanzadeh et al, 2015). During palpation of the chest both heaves and thrills were sought but not found. Again the environment prevented effective assessment of the apex beat however Ehara et al (2011) question the significance of this measure, a finding that opposes traditional beliefs. Percussion was performed, ensuring the intercostal space was identified. A bilaterally equal resonant percussion note was detected in all fields. Walker, Hall and Hurst(1990) suggest it is important to not only assess the note but also interpret the frequency and intensity.
The lung fields were systematically assessed anteriorly and posteriorly. Normal vesicular sounds were appreciated bilaterally without the presence of crackles, wheeze or a pleural rub. Murphy (2008) concluded that adventitious sounds, or lack thereof, provide clinically useful information and aided decision making. The patient was finally assessed for vocal fremitus, a useful test for determining consolidation (Talley and O’Conner, 2001).
At the centre of any cardiac assessment is the auscultation of heart sounds. Hanno and Silverman (2002) concluded that it is an indispensable method of bedside diagnosis. All four valves were auscultated with a view to identify normal heart sounds as well as any additional sounds or murmurs. Blood flow is typically inaudible unless turbulence is created by high cardiac output or valve disease (Greaves et al, 2006). The examination failed to reveal any abnormality consistent with disease pathology.