Pulmonary Flashcards
Which pleura hurts when inflamed?
parietal
Where do you insert a chest tube with a tension pneumothorax?
2nd intercostal space
Where is anterior chest tube placement?
4th intercostal space
Where is ET tube tip placement?
T4
In what order do you perform a lung exam?
inspect, palpate, percuss, auscultate
What are you inspecting?
rhythm, depth, effort of breathing. Color, shape of chest, use of accessory muscles, asymmetry, trachea midline, stridor (high pitched inspiratory whistling, urgent), wheezes (expiratory), the skin
What are the two ways you palpate the lungs?
chest expansion and tactile fremitus
What should you look for while palpating?
areas of tenderness, any crepitus, brusing
What could asymmetry in the chest expansion indicate?
pleural effusion, splinting, chronic fibrosis, unilateral airway obstruction, paralysis of hemidiaphragm
What is fremitus?
palpable vibrations transmitted from bronchus to chest, repeating “ninety-nine” and identify decreased, increased, absent fremitus
What does decreased fremitus mean?
excessive amounts of air, pleural effusion, pneumothorax, asthma, COPD
What does increased fremitus mean?
increased transmission through consolidated tissue
What does percussion help with?
to determine if there is fluid in the lungs or not: flat (pleural effusion), dullness (fluid or solid), resonant (healthy), hyperresonant (hyperinflated), tympanic (large pneumothorax)
What does the diaphramatic excursion identify?
the amount of distance of diaphragm into thorax during inspiration
3-5.5 cm is normal
Do you listen to the lungs with the diaphragm or a bell?
diaphragm
What should you be paying attention to in auscultation?
pitch, intensity, duration
What is a vesicular breath sound?
normal, soft low pitched heard in inspiration
What is a bronchovesicular breath sound?
normal with equal inspiratory and expiratory sounds with a gap in between
What is a bronchial breath sound?
normal with louder and harsher in pitch with short silence in between I & E sounds, e lasting longer than i
What is a tracheal breath sound?
loud harsh sounds over trachea (normal)
What are irregular sounds?
crackles/rales (discontinuous, intermittent, brief), rhonchi (continuous, musical, prolonged with snoring quality), wheezes (high pitched hissing or shrill quality)
What is a bronchophony?
asking the patient to say ninety-nine as you listen to the same ladder positions
anything clearly heard is BAD
What is an egophony?
ask the patient to say “Eeeee” as you listen in ladder format
normal = long E sound
abnormal = a sound “bleating”
What is a whispered pectoriloguy?
ask patient to whisper ninety-nine as you listen in the ladder format
abnormal = loud and clear sound
What are you inspecting of the anterior chest wall?
shape of chest and movements of chest wall; deformities, asymmetries, bruising, skin changes
What palpation is done on the anterior chest?
chest expansion (verbalize in PE)
tactile fremitus (have ms girl hold her boobs up)
how many spots do you percuss on the anterior chest?
12
What are clinical tests of pulmonary function?
6 minute walk test, forced expiratory time (longer the time, more likely for COPD)
What can you hear better with inspiration manuever?
right side murmurs
What can you not hear as well with inspiration?
left side murmurs
What can you hear better with making the patient lean forward?
aortic murmurs (aortic stenosis, aortic regurgitation)
What can you hear better in lateral decubitus position?
mitral murmurs
What can you hear better when you are increasing venous return (squatting/raising legs)?
all murmurs EXCEPT mitral valve prolapse, hypertrophic cardiomyopathy
What can you hear better when you are decreasing venous return (standing)?
Mitral valve prolapse and hypertrophic cardiomyopathy and the rest are quieter
What can you hear better when you increase afterload and utilize handgrips?
aortic regurg/mitral regurg
What can you hear better when you lower afterload with amyl nitrate?
aortic stenosis, mitral valve prolapse, hypertrophic cardiomyopathy
What’s the most prominent bony landmark on the back?
C7/T1
What’s the landmark for thoracentesis?
between 7th and 8th ribs (superior 8th)
What is the triangle of safety?
lateral border of pectoralis major, lateral border of latissmus dorsi, and nipple line for safe chest tube positioning
Where does the lower lung lie?
T10
If an endotracheal tube is advanced too far during intubation, where will it broach?
right mainstem bronchus
What does it mean when the SCM and scalenes become visible during respiration?
extra work is required to breathe
What is hemoptysis?
blood coughed up
What are you listening for in auscultation?
sounds generated by breathing, added sounds, abnormalities
