呼吸系统体检

What you must do during auscultation
Determine whether the breath sounds are equal
on both sides Ascertain the character of the breath sounds Detect any added sounds Compared the voice sounds over different part of the lung

Deep and fast


Deep and slow

inspection

Three depression sign: The respiratory muscles contract with inspiration depressions in the suprasternal fossa , the supraclavicular fossae and the intercostal spaces appears in obstruction of the upper airway such as tracheal foreign body and tracheal carcinoma Inspiratory despnea delayed inspiration obstruction of the upper airway Expiratory despnea delayed expiration COPD asthma emphysema
superior lung margin is top of the lung inferior lung margin is in the 6th ribs region at
midclavicular line 8th ribs region at midaxillary line 10th ribs region at scapular line.
5. Abnormal sound
Hyperresonance Emphysema Tympany Pneumothorax Large cavity (TB, lung abscess)
Auscultation
Order of auscultation
Listening procedures and techniques
Anterior view of lobes
Oblique interlobar fissure
plain interlobar fissure
Posterior view of lobes
Right lateral view of lobes
Left lateral view of lobes
4. Normal sound

Shifting range of bottom of lung
Along the scapular line
s
Percussing bottom of lung, marking
Asking the pat. to inspire deeply and hold
Percussing bottom of lung, marking Asking the pat. to expire deeply and hold Percussing bottom of lung, marking Measuring the dist. between upper and lower lines

Normal
Emphysema Cavity or pneumothorax

Hyperresonance


Tympany


Dullness

Hydrothorax, atelectasis
Massive Hydrothorax

Flatness

4. Normal sound
Lung’s sound in percussion Resonance Slight dullness in some areas (upper, right,
Midaxillary line
Posterior imaginary lines and landmarks
Suprascapular region
Interscapular region
Infrascapular region
Scapular line
Posterior midline
Borders of Lung
back) due to thickness of muscles and skeletons
4. Normal sound
Border of lungs in percussion Apex of lungs

Upper lung margin: 5cm in width Narrow: TB, fibrosis wider: emphysema absolute cardiac dullness area


Inspection
3. Respiratory rhythm Cheyne-Stokes’ breathing Biot’s breathing _____Decreased excitability of respiratory center Inhibited breathing
Inspection
Chest wall:veins,skin Thorax:shape,size The ratio of the anteroposterior(AP) diameter AP diameter decreases:long-term disorders AP diameter increases:barrel chest Breast:location,shape
2. Affected factors

Thickness of thoracic wall Hydrothorax Containing gas in alveoli Alveolar tension Alveolar elasticity
3. Classification

Resonance
5. Abnormal sound
Dullness or flatness
Decreased containing gas in alveoli Pneumonia Atelectasis? TB Pulmo. embolism Pulmo. edema Pulmo. fibrosis No gas in alveoli Tumor Non-liquefied lung abscess Others Hydrothorax Pleural thickness

Sudden cessation of breathing due to chest pain

Pleurisy, thoracic trauma
Sighing breathing

Depression, intension
Palpation

Thoracic expansion

Massive hydrothorax, pneumonia,
pleural thickening, atelectasis

Vocal fremitus (语音震颤) location,area Pleural friction fremitus

Cellulose exudation in pleura-increased

Holding breathing
Thoracic deformity
Kyphosis
Thoracic deformity
Barrel chest
Inspection
1.
Respiratory movement

Abdominal breathing: male adult and child Thoracic breathing: female adult Tachypnea: >24 f/min Bradypnea: <12 f/min Shallow and fast

2.
Respiratory rate: 16-20 f/min


respiratory muscular paralysis, elevated intraabdominal pressure, pneumonia, pleurisy Agitation, intension Severe metabolic acidosis (Kussmaul’s breathing)
Physical Examination in Respiratory System
Juan chen, ph.D.
Anterior imaginary lines and landmarks
Suprasternal fossa Supraclavicular fossa
Infraclavicular fossa

Anterior border

Lower border


6th, 8th, 10th intercostal space in midclavicular line, midaxillary line, scapular line, respectively Down: emphysema Up: atelectasis, intraabdominal pressure goes up
Sternal line
Anterior midline
Parasternal line
Midclavicular line costovertebral angle
Lateral imaginary lines
Posterior axillary line
Anterior axillary line
5. Abnormal sound
Dullness, flatness, hyperresonance or tympany
appear in the area of supposed resonance.
Unchanged sound (resonance)


The depth of the lesion > 5 cm The diameter of the lesion 3 cm Mild hydrothorax

Shifting range of bottom of lung
6-8 cm

Decreased: emphysema, atelactasis, fibrosis, pulmo. edema, pneumonia Detected impossibly: pleura adhesion, massive hydrothorax, pneumothorax, diaphragmatic paralysis
disappeared
Percussion
1. Meห้องสมุดไป่ตู้hod


Mediate Direct percussion:Tapping the chest with the palmar of hands Indirect percussion: Pleximeter: distal inter-phalangeal joint of left middle finger Plexor: right middle finger tip Order Up to down, anterior to posterior
Listen carefully to the patients breathing without
stethoscope. Warming the stethoscope and applying it firmly to the chest wall. Order the patient to breathe with his mouth open a little,deeper and faster respiration than normal Asking patient to whisper ninety-nine to note the vocal resonance