Have patient sit up. Inspection: normally the thorax is symmetrical and the anterior posterior diameter is less than the transverse diameter, respirations should be even, unlabored, at a rate of 12 to 20 bpm, inspiration is normally half as long as expiration and chest expansion should be symmetrical. If patient appears anxious, has nasal flaring, cyanosis of the lips/mouth, intercostal retractions, or use of accessory muscles he/she may be in respiratory distress. Start on back check for symmetric lung expansion by noting that thumbs move apart symmetrically, feel for fremitis (say 99 to generate vibrations, examine for crepitus (a course crackling sensation when palpating skin), measure diaphragmatic excursion (distance between marks to determine-normally 5-6 cm in adults). Auscultate his lung sounds starting at C7 down to T10, percuss anterior and lateral chest (dullness over diaphragm, liver, or other organs is normal, but over lungs may indicate a mass or consolidation.