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  • Writer's pictureLavanya Narayanan

Assessing the Trachea: Key Steps in a Respiratory System Examination

The examination of the trachea is an essential component of the respiratory system examination, particularly when assessing for airway compromise or thoracic pathology. Here is a detailed step-by-step guide on how to perform the examination, focusing on 3 key aspects:

🔅Tracheal deviation

🔅Cricosternal distance

🔅Tracheal tug


1. Tracheal Deviation

Examination Steps:

  • Have the patient in a seated or standing position for ease of access to the neck.

  • Inspect the neck visually, looking for any obvious deviation of the trachea from the midline.

  • Palpate the trachea gently with your fingers. Begin with palpating the thyroid cartilage which is the largest cartilage of the larynx beneath the hyoid bone to which it connects by the thyrohyoid membrane. Inferiorly it articulates with the cricoid cartilage.

Palpate the cricoid cartilage (just below the Adam's apple in males) and move downwards along the trachea.

  • Compare the position of the trachea with the midline of the neck, which can be estimated from the position of the sternal notch.

  • Note any deviation to either side.

Clinical Significance:

  • Tracheal deviation can indicate underlying thoracic pathology, such as a tension pneumothorax, pleural effusion, or lung mass, which may shift the trachea away from the affected side.

Table showing causes of tracheal deviation

2. Cricosternal Distance

Examination Steps:

  • With the patient still seated or standing, identify the cricoid cartilage and the sternal notch.

  • Use your fingers or a ruler to measure the distance between the upper border of the cricoid cartilage and the suprasternal notch.

  • Normally, this distance is about 3-4 fingers wide or approximately 5-6 cm.

Clinical Significance:

  • A reduced cricosternal distance may indicate conditions such as hyperinflated lung fields.

3. Tracheal Tug

Examination Steps:

  • Observe the patient from the side.

  • Look for any downward movement of the trachea during inspiration.

  • This can sometimes be better appreciated by placing a finger lightly on the trachea and feeling for any tugging movement with each breath (an inspiratory descent of the trachea during inspiration).

Clinical Significance:

  • A tracheal tug is often a sign of severe hyperinflation or other situations of acute respiratory distress. It is due to an excessive inspiratory pull on the trachea during strong diaphragmatic contraction.

  • This is an accurate predictor of severity of airflow obstruction, correlating well with duration of symptoms and reduction in forced expiratory volume in 1 second (FEV1).

These examinations provide critical information about the status of the trachea and potential underlying conditions. It's important to integrate these findings with the patient's overall clinical picture and other examination findings for accurate diagnosis and management.

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