Approach to Lower Respiratory Flashcards
Where does the neurovascular bundle of the rib run?
Runs along inferior margins of each rib
Where would you insert a chest tube in general to avoid neurovascular bundle?
Over superior margin of rib
Inspection?
- Breathing rate
- rhythm
- Effort
- Skin color
- Nail clubbing
- Pursed lip breathing
- Accessory muscles
What is cheyne stokes breathing?
- Tachypnea Gradual hyperpnea then hypopnea
- Followed by periodic apnea
- Seen with heart failure and hypoperfusion of the brain
What is Kussmaul breathing?
- Abnormal respiratory pattern of deep rapid breathing
- Seen in patients with DKA
Reasons for Kusmal breathing?
- K: ketones
- U: uremia
- S: sepsis
- M: methanol
- A: aldehydes
- (U)
- L: lactic acidosis
What causes nail clubbing?
- Congenital failure
- Chronic hypoxia
- ILD
- Pulm fibrosis
- CF
- Lung absesses
- Lung cancers
What is pectus carinatum?
Beaked chest
What are the accessory muscles of breathing?
- Supraclavicular
- scalene
- SCM
- Intercostal
- Subcostal
What is purpose of pursed lipped breathing?
- As they exhale they are trying to keep high pressure in their lungs to foce alveoli to stay open by resisting air low out
What is tripod postion?
Leaned slighlty forward hands on knees to allow for best position for gas exchange to occur
productive cough fever for 4 days, episodes of chills and sweating. Elderly acutely ill appearning man in mild respiratory distress. He has 4 word converstational dyspnea. Tactile fremitus is increased over right ant chest near midclavicualr line at y4 and over posterior chest at same level and side. Crackeles and rhonci are ausclultated over RML and RLL. Percussion reveals dullness. Dx?
RLL pneumonia
If you percuss a patient with a collapsed lung what would you hear?
Tympany
Percussion of pleural effusion sounds like?
low sounding solid percussion
What are transudates?
- Fluid leaking from blood vessels
- Low protein and cell content
What are exudates?
- Fluid leaks from inflammation of pleura and lung
- High protien content and can contain WBC and RBC
What is empyema?
- abscess in lung parenchyma
- Reuires drainage
- Can collect in the pleural space and cause pleural effusion
What are considered normal breath sounds?
- Bronchovesicular
- Vesicular
- Bronchial
- Tracheal
What are abnormal/adventitious sounds?
- Stridor
- Wheezes
- rhonchi- low pitched wheezes
- Crackles (rales)
What is CTAB?
Clear to auscultaion bilaterally
What can cause absent or decreased breath sounds?
Unilateral:
- pneumothorax
- Lung full of fluid
Bilateral:
- extreme COPD
- Asthma
Common causes of stridor?
- Croup
- Epiglottitis
- Upper airway foreign body
- Anaphylaxis
What can cause wheezing?
- caused by rapid airflow through a narrowed bronchial airway
- RAD
- Asthma
- COPD
What are crackles and what causes it?
- inspiratory sound
- thought to be caused by small airay closed during expiration popping open during inspiration
- Causeed by pneumonia CHF, Atelectasis pulm fibrosis, Asthma bronchiectasis, COPD
What does pulse ox do?
- measures peripheral arterial oxygen saturation
What is end tidal CO2?
- concentration of CO2 exhaled in air at end of respiration
- measures ventilation
- Normal PETCO2=40 mmHg
- Normal PaCO2=40 mm Hg
What does atelectasis mean? What is seen in patients with it?
- Complete collapse of alveolar lung tissue affecting oxygen absorption
- low o2
- tachypnea
- posturing tripod
- accessory mm activation
