 Hi, welcome to Nursing School Explained and this video on some specialized respiratory assessment techniques. These techniques are something that most likely in the clinical setting you will not encounter, but it's nice to know what they are and how they are performed. Now why do we need to know about those? These are some more specialized techniques and they might also help you in case you are more in a rural setting or you decide to go on some medical missions where maybe there is not an x-ray equipment or any of the advanced diagnostic tests available. So when you really are able to fine-tune your assessment techniques with these special tests, then you can assess the patient in a little bit more detail. And these include tactile fremitis, egophany, bronchophony, as well as whispered pectoriloquy. So let's take a look at how those are done. Okay, first we'll look at tactile fremitis which is checking the vibrations underneath the patient's skin and when there is consolidation or anything unusual under the patient's skin it will feel differently. So for the purpose of this video I'm not going to wear gloves but you know to always put on gloves when you assess your patient. So I'm going just like when I check for chest excursion I'm going to place my hands in this kind of a wing fashion on the patient's back and ask him to say 99 and I feel the vibration underneath and then I move my hands down and I ask him to say 99 again and again and again and again and again and I can see I can feel that the vibrations underneath his skin are the same throughout which means that there is no abnormalities. If there was increased fremitis so increased vibration that would mean that there is a density so that could be fluid or underlying pathology and if there was decreased fremitis that could mean that there is fluid around the lungs such as in an pleural effusion or maybe the patient has some emphysema. Now bronchophony is the other test that we'll do and we'll need to auscultate the patient and it's very similar with him saying 99 but in this case I'm going to listen and hear him say 99 through my status scope so go ahead say 99 every every time I touch my stethoscope. Okay. So, a normal finding here is that when I move from the top to the bottom that the sounds that are here become a little bit less distinct or even muffled and that is because on the top here we have the trachea going down breaking off into the bronchi and then into the smaller airways. So the sound is going to be transmitted through the bigger airways a lot louder than through the smaller ones. So as I move from the top to the bottom I'm going to hear the sound of 99 less distinct and a little bit more muffled. If it was the same throughout then that means that there's something abnormal, something going on with the airways, maybe some congestion or some hyperexpansion even such as again an emphysema. The third test that we do is egophany which again I'm going to listen to him while I auscultate and I'm going to ask him to say ee every time. So the letter ee but drawn out. So here we go with the egophany it is normal that again the ee sound is more distinct on the top and then less distinct towards the bottom because again we have the bigger branching off into the smaller airways here. So the sound gets more muffled and more indistinct towards the bottom. If the sound was to sound more like an a on the bottom like the letter a like when you say a and stick out your tongue then that would mean that now it could be some consolidation or some density or some kind of like an underlying pathology like a mass for example. But in this case everything again sounded normal. Now the last test is whispered pectoriloquy which is similar to bronchophony but in this case the patient just whispers 99 rather than actually saying it out loud while I listen to the back. So go ahead and whisper 99 every time I touch my stethoscope to you please. And similarly to bronchophony what the normal finding is that the sounds are more indistinct and faint as I move down but abnormal would be if they would be very clear and distinct throughout the lung fields which again could indicate this consolidation or any kind of underlying pathology. And again these tests are not very commonly used but it's kind of nice to know what they are and what they are used for and again this might be in a setting where you don't necessarily have access to diagnostic equipment such as a chest x-ray or if you find yourself working in a more rural area or you will work in a pulmonary specialty. Thanks for watching this video on nursing school explained and we'll see you soon.