1.         INTRODUCTION
A.        Wash hands with water or alcohol gel.
B.        Introduce self and seek permission to examine the respiratory system.
C.        Confirm patient’s name and date of birth.
D.        Ask if patient is in any discomfort.
E.         Position patient appropriately with chest adequately exposed.

2.         INSPECTION
A.        Look for signs of breathlessness, discomfort or pain. Use of accessory muscles.
B.        Examine face, eyes and mouth for colour and central cyanosis.
C.        Look at chest shape, movement, scars and deformities.
D.         Examine hands to assess circulation for warmth and venodilation. Look for evidence of tar staining and finger clubbing.
Look for flapping tremor.

3.         PALPATION
A.        Palpate radial pulse and assess rate and rhythm.
B.         Count respiratory rate.

4.         NECK
A.        Check position of trachea.
B.        Assess for subcutaneous emphysema if appropriate.
C.        Examine for cervical lymphadenopathy.
D.        Assess right internal jugular vein for raised JVP.

5.         PALPATION OF CHEST
A.        Locate the apex beat.
B.        Assess chest expansion anteriorly and posteriorly.

6.         PERCUSSION OF CHEST
A.        Percuss front of chest, laterally and posteriorly.

7.         AUSCULTATION OF CHEST
A.         Auscultate front of chest.
B.        If areas of dullness on percussion test for vocal resonance or vocal fremitus.
C.        Sit patient forwards. Percuss (if not already done) and auscultate posterior chest

8.         OTHER AREAS
A.         Feel for ankle oedema.
B.        Look in sputum pot if available.
C.        Examine any observation charts available.  Pulse, BP, Temperature.
D.        Measure peak flow.

9.         CONCLUSION
A.        Thank patient and wash hands with alcohol gel or water.
B.        Summarise and present findings in patient’s notes and orally.