Tactile fremitus

Overview
Tactile fremitus is a method of detecting air, fluid or solid material. It can also detect a bronchial obstruction or solid material in the pleural space.

Differential Diagnosis
In alphabetical order.


 * Increased sound throughout the chest
 * Diffuse alveolitis
 * Diffuse fibrosis
 * Lobar pneumonia
 * Streptococcus pneumoniae


 * Decreased sound throughout the chest
 * Asthma
 * Atelectasis
 * Bronchitis
 * Chylothorax
 * traumatic disruption of the thoracic duct
 * Emphysema
 * Foreign body aspiration
 * Hemothorax
 * chest trauma
 * instrumentation
 * Pleural effusion
 * CHF
 * Cancer
 * Pulmonary embolus
 * Pneumonia
 * Connective tissue disease
 * Pancreatitis
 * Renal disease
 * Liver disease
 * Pleural thickening
 * Ronchal fremitus
 * Airway secretions
 * Friction fremitus
 * pleural friction rubs

History and Symptoms

 * Note: Symmetry of chest movement and sound.

Lungs

 * Place hands firmly on patients chest
 * Have them repeat "99" several times
 * The purpose is to feel the vibration of the conducted sound

Laboratory Findings

 * Labs include:
 * CBC
 * pulse oximetry
 * electrolytes
 * BUN / creatinine
 * calcium
 * glucose
 * Blood culture / sputum culture
 * Arterial blood gas
 * pulmonary function tests

Chest X Ray

 * Aids in exposing pneumonothorax, pneumonia, effusion, atelectasis

MRI and CT

 * consider in the event of an abnormal X-ray

Treatment

 * Attend to airway/breathing patterns
 * Administer supplemental Oxygen
 * Chest tube insertion for pneumothorax, hemothorax, chylothorax