Exam 3 - Chest Exam Flashcards
ribs 1-7 articulate with _______.
sternum
ribs 8, 9, 10 articulate with ________________.
costal cartilages
11th rib is
floating, feel tip laterally
12th rib is
floating, feel tip posteriorly
2nd rib articulates with
sternal angle
Inferior angle of scapula is at level of the ___ rib posteriorly.
7th
you can only access middle lobe sounds __________.
anteriorly
apex of lung is ______ above clavicle
2-4 cms
Lower border of lung at 6th rib at ___________________.
mid clavicular line
lower border of lung at 8th rib at ________________.
midaxillary line
Lower border for lung at 10th thoracic spinous process
posteriorly
The sternal angle bifurcates into the main stem bronchi at _____________ anteriorly and at __ posteriorly .
sternal angle, T4
_________ space is between the visceral pleura (on the organ) and parietal pleura
potential
inspection of chest
masses/lesions position of trachea shape/symmetry chest deformities AP/lateral diameter inspiratory retractions local lag Rate (14-20) Rhythm, death, effort use of accessory muscles
Palpation
ID areas of tenderness or suspicious
ID masses
Respiratory expansion - this can confirm local lag
Tactile Fremitus
palpable vibrations with speech
decreased over the heart, scapulae
scouting technique , compare B/l
Indications in which TF will be dampened
soft voice thick chest wall obese COPD plural effusion fibrosis penumothorax
percussion
helps detect air-filled vs. fluid filled or solid
vesicular
soft, low pitched
inspir > expir = normal
Bronchial
louder, high pitched (sternal notch)
expir > inspir = normal
Bronchovesicular
intermediate sound and pitch
inspir = expir
tracheal
very loud, high pitch
inspir = expir
adventitious sounds
crackles wheezes rhonchi stridor pleural friction rub
crackles (rales)
intermittent, non musical, brief - fine or coarse
small airways popping open with inspiration
air bubbles moving through secretions
crackles are normally heard at ______________.
anterior bases, after prolonged bed rest, w/ HF
heard throughout the respiratory cycle
wheezes
longer than crackles, musical, may clear with a cough ( so check again)
high pitch, hiss or shrill quality
suggests a narrowed pathway
NOT heard throughout the respiratory cycle
Rhonchi
low pitch, snoring quality
longer than a crackle
suggests larger airways
may clear with cough
NOT heard throughout the respiratory cycle
Stridor
inspiratory wheeze, especially in neck
indicates partial obstruction of larynx or trachea
immediate TX required
Pleural Friction Rub
inflamed, roughened pleural surfaces grating against each other, creaking leathery sound
Usually confined to a small area
If effusion develops into the potential space, then the rub may disappear
Bronchophony (spoken word)
if fluid in lung then word is louder and clearer
Egophony
eeeeeeeww, fluid will make it sound more like ayyyyyyyyy
Whispered pectoriloquy (whispered word)
fluid will enhance it, normally it is really hard to hear
tachypnea
rapid / shallow breathing - acidosis, restrictive lung disease, pain, pregnant
Hyperpnea
rapid and deep, exercise, anxiety and hypoxic people
Bradypnea
slow breathing, diabetic coma, drug induced increased ICP
Kussmaul
deep breathing but a fast normal or slow rate
METABOLIC ACIDOSIS
Cheyne- Stokes
alternating periods of hyperpnea and apnea
can be normal in children and older adults when sleeping
CHF, drugs or brain damage
Ataxic Breathing (Biot’s)
unpredictable, irregular
shallow, deep, apnea
brain damage
Obstructive Breathing
prolonged expiration, increased resistance in narrowed airway, asthma,, FB,
Pectus excavatum - funnel chest
depressed sternum
compressed heart and great vessels
reconstructive surgery if severe
Pectus carinatum - pigeon chest
sternum is anterior , increased AP diameter
depresses costal cartilages laterally
Thoracic Kyphoscoliosis
hunch back with vertebral rotation
Forced Vital Capacity (FVC)
measure the amount of air you can force out after you inhale as deep as you can.
Forced expiratory Volume (FEV)
measures the amount of air one can exhale with force in one breathe.
1 sec. FEV1
2 sec FEV2
3 sec FEV3
FEV1/FVC
Forced Expiratory flow 25%-75%
this measures the air flow halfway through an exhale
Peak Expiratory Flow (PEF)
measures how much air you can exhale when you try your hardest.
measured at the same time as FVC
Maximum voluntary ventilation (MVV)
measures the greatest amount of air you can breathe in and out during 1 minute
Slow vital capacity (SVC)
measures how much air you can breathe out slowly after you inhale as deep as you can
Total Lung Capacity (TLC)
measures the amount of air in your lungs after you inhale as deep as possible
Functional Residual Capacity (FRC)
measures the amount of air in your lungs at the end of a normal exhaled breath
Residual Volume (RV)
measures the amount of air in your lungs after you have exhaled completely. It can be done by breathing in helium or nitrogen gas and seeing how much is exhaled
Expiratory reserve volume (ERV)
measures the difference between the amount of air in your lungs after a normal exhale (FRC) and the amount after you exhale with force (RV)
medication for loss of consciousness
etomidate, ketamine, propofol, versed
paralyzing agent
succinylchloride
what is better for patient who have not faster
RSI
