The examiner can determine the position of the trachea by placing his or her right index finger in the patient's suprasternal notch and moving slightly lateral to feel the location of the trachea. The examiner repeats this technique, moving the finger from the suprasternal notch to the other side. The space between the trachea and the clavicle should be equal on each side. A shift of the mediastinum can displace the trachea to one side. This technique is demonstrated in Figure 13-20.
Look at the patient pictured in Figure 13-21. Notice that the trachea is markedly displaced to the right in this very cachectic woman. The diagnosis of a mass either pushing or pulling the trachea to the right is suggested.
Now ask the patient to lie on his or her back for the rest of the examination of the anterior chest. The patient's arms are at the sides. If the patient is a woman, either have her elevate her breasts herself or displace them yourself as necessary during palpation, percussion, and auscultation. These examinations should not be performed over breast tissue.
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