Lecture 4 DSA/CIS: Respiratory Exam Flashcards
Where would a needle thoracentesis take place?
2nd intercostal space superior to 3rd rib
-midclavicular line
Where would chest tubes be inserted?
4th intercostal space superior to 5th rib
-mid or anterior axillary line
Where would the lower margin of the endotracheal tube on a chest x-ray be found?
T4
Where would a thoracentesis take place?
7th intercostal space
What are important vital signs?
Respiratory Rate Heart Rate Blood Pressure Temperature Oxygen Saturation
What is a normal respiratory rate?
14-20 breaths per minute
Normal = quiet, no distress
What are causes of a bad waveform (which affects pulse ox reading)?
Improper placement
Hypoperfusion
Hypothermia
Motion artifact
What does capnography measure?
What are the normal levels?
Ventilation (partial pressure of exhaled CO2 > EtCO2)
PETCO2 (exhaled CO2) = 35 - 40 mmHg
PaCO2 = 35 - 45 mmHg
What are signs of hypoxia?
Cyanosis
-bluish discoloration of skin, lips, nails and mucus membranes
What causes a traumatic flail chest?
What characterizes it?
Multiple rib fractures that may cause paradoxical movements of thorax
Injured area caves inward during inhalation and outward during exhalation
Using accessory muscles for respiration can be a sign of respiratory distress. In what illnesses is this seen in?
Asthma
COPD
Airway obstruction
Viral illnesses
What can cause stridor
Croup
Epiglottitis
Upper airway foreign body
Anaphylaxis
What is atelectasis?
-collapse of alveolar lung tissue
What are signs of atelectasis?
Shallow breathing or shortness of breath especially after surgery (since patients don’t wanna breathe in deep due to pain)
-diaphragmatic excursion elevated one side of the body
What is an incentive spirometer?
Device that measures how deeply a person can inhale
-can treat atelectasis
In what illnesses will there be abnormal bronchophony, whispered pectoriloquy, and egophony?
Lung consolidation
- tumor
- pneumonia
- effusion
What is pulse oximetry?
Photodetector that detects ratio of red to infrared light to give the peripheral O2 sat (SPO2)
What should you check for on inspection?
Sitting position, accessory muscle use, color, shape of nails, pursing, ability to speak
Any anatomical deformities in the chest
What does tracheal deviation indicate?
Pneumothorax (tension and non tension)
Pleural effusion
Atelectasis
Mass
COPD usually presents as ….
Emphysema usually presents as ….
Overweight and cyanotic, daily productive cough, elevated Hgb
Older and thin, quiet chest, hyperinflation of lungs with flat diaphragm
What are the accessory muscles?
trapezius, scalenes, SCM
How do you test for thoracic expansion?
Thumbs at 10th ribs level at lateral rib cage and have patient inhale
-check symmetry during inhalation
OSE for the lungs?
OMT treatments for the lungs?
TART, and check T2-T7 (viscera level of the lungs)
Doming the diaphragm
Rib raising - SNS normalization
Tapotement
Thoracic pump - atelectasis
Generalized hyperresonance suggests?
Unilateral hyperresonance suggests?
COPD, emphysema, asthma
Large pneumothorax, air filled lung (as in COPD or emphysema)
What does asymmetric diaphragmatic excursion suggest?
- pleural effusion
- atelectasis or phrenic nerve paralysis (high diaphragm)
What is the systemic approach to auscultation?
- ) Listen for normal breath sounds
- ) Listen for added/abnormal sounds
- ) Listen for vocal resonance (muffled voice through stethoscope) if abnormalities exist
What do pulmonary function tests like spirometry look for?
Obstructive or restrictive lung disease
How do you systematically read an XRay?
A (PIER) A irway B ones C ardiac size/valves D iaphragm E ffusion/Endotracheal tube F ields and fissures F oreign body G reat vessels G astic bubble H ilar masses I mpression
