3 Observe the height of each hand.
4 Determine if the height of the hand on the affected side is
greater during expiration than the height of the hand on the unaffected side.
(f) Look and listen for the casualty gasping for air (dyspnea).Dyspnea
may be present, but is not always an indication of pneumothorax.
(g) Look at and feel the casualty's chest for signs of subcutaneous
(h) Tap the chest for tympany (a sound heard when percussing the
chest). Percuss the chest in this manner:
1 Position the middle finger of one hand on the superior portion of
the unaffected side.
2 Sharply tap the positioned finger with the middle finger of the
3 Repeat the previous two steps and listen for tympany on the
4 Repeat tapping the chest for tympany in successively lower
positions on the chest until the entire chest has been percussed.
Listen for diminished breath sounds.
1 Place the stethoscope on the unaffected side to establish
normal breath sounds.
2 Listen to the affected side to determine if the breath sounds are
fainter. The pneumothorax may be bilateral (affecting both sides of the chest).
Locate the insertion site.
(a) Locate the sternomanubrial joint (Angle of Louis).
(b) Start at the sternomanubrial joint and follow the adjacent intercostal
space to the mid-clavicular line.