PULMO Flashcards
emphysema, pneumothorax
Hyperresonance (increased air)
pleural effusion, consolidation, mass, heart, liver
dullness
Gastric air bubble
tympanic
Soft or low pitched
I > E in 3:1 ratio, no pause
Most of the lung field
Vesicular
Loud and high pitch
E > I, pause
Manubrium – not a normal breath sound in the lung
Bronchial
Bronchovesicular
Intermediate pitch
I = E, no pause
1st, 2nd intercostal spaces
Increased Intensity Crackles Increased vocal fremitus Increased tactile fremitus percussion dullnes no mediastinal shift ↓expansion,
consolidation (pneumonia)
Decreased or Absent breath sounds Decreased tactile fermitus dull percussion mediastinal shift: away (if large) from affected side ↓expansion
pleural effusion
Decreased breath sounds
Decreased tactile fermitus
hyperresonant
mediastinal shift: none
emphysema
Decreased or Absent breath sounds Decreased tactile fremitus hyperresonant mediastinal shift: away from affected side ↓expansion,
pneumothorax
Decreased or Absent breath sounds
Decreased tactile fremitus
dullness of percussion
mediastinal shift: toward (if large) affected side
atelectasis
Slow and shallow
Hypopnea
Slow’: Decreased respiratory rate
respiratory rate <12
Bradypnea:
Cyclic hyperventilation followed by compensatory apnea
CHF
Cheyne-Stokes
Completely irregular breathing pattern with irregular pauses and unpredictable periods of apnea
Damage to the medulla oblongata 20 to trauma or stroke: preterminal
Ataxic breathing
eliminate more CO2 than the body produces
Hyperventilation
Pulmonary causes for clubbing:
Fibrosis
CF
Bronchiectasis
Malignancy
FEV1:FVC :
< 70 % of predicted
Obstructive
FEV1:FVC : > 70 % of predicted:
Normal or Restrictive
DLCO< 80%:
Emphysema,
ILD,
Anemia,
Pulmonary Vascular Disease
DLCO >120%
Asthma, Polycythemia
TLC < 80%
Restrictive Disease
TLC > 120%
Hyperinflation in Obstructive Lung Disease
FEV1:FVC <70% (>12% reversibility), DLCO >120%
Asthma
FEV1:FVC <70%, DLCO <80%, TLC >120%
COPD
FEV1:FVC >70%, DLCO <80%, TLC <80%
Interstitial lung disease
Volumes normal, DLCO <80%
Pulmonary vascular disease
Risk factors Young 18 – 40 years Male Tall Thin Smoker Usually rupture of subpleural bulla Recurrence: 50%
Spontaneous pneumothorax
Air drawn into the pleural space during inspiration
No route out with expiration
Increased pressure on affected hemi-thorax
Mediastinum pushed over to the other side
Kinking of the great vessels
Cardiac arrest
Etiologies
Blunt penetrating trauma
Tension Pneumothorax
If suspect TENSION pneumothorax what investigations do you do ?
don’t do a CXR: TREAT
