Pulmonary PE Lecture Flashcards
Chest cavity
All that falls between clavicles and diaphragm
Anterior chest
Formed by the ribs
Intercostal spaces are named by:
The rib superior to it
2nd ICS space is between 2nd and 3rd rib
Diaphragm at rest is located between which ribs?
5th and 6th
Sternal angle is at the level of the:
2nd rib
Posterior chest borders
C7 SP is superior border
T8 (9th rib or 2nd rib below scapula) is inferior portion
Where is the RLL represented anteriorly?
Costophrenic angle
Inspection for systemic signs of pulmonary disease:
Cyanosis of lips/fingers
Clubbing of fingers
Barrel chest
Tripod position
Signs of respiratory distress:
Rate and effort of breathing
Use of accessory muscles
Unusual respiratory noises
Displacement of the trachea could mean:
PTX
Atelectasis
Pectus carinatum
Pigeon chest (convex)
Pectus excavatum
Funnel chest (concave)
Causes of asymmetric expansion:
Pneumonia
Bronchial obstruction
Pleural effusion
Pleural pain
Tactile fremitus
Palpable vibrations transmitted from bronchial and lung tissue to chest wall
*Avoid bony areas
Most sensitive part of hand to detect tactile fremitus:
Ulnar surface
Decreased tactile fremitus occurs with:
Bronchial obstruction Pleural effusion COPD PTX Tumor COPD
Increased tactile fremitus occurs because:
- An increase in solid tissue will conduct the vibrations better
- Consolidation (caused by PNA) will increase TF
Pleximeter
Finger placed onto the ICS for percussion
Plexor
Finger making the motion of percussion onto the pleximeter
Percussion is performed at which joint?
Distal Interphalangeal Joint (DIPJ)
T/F: Percuss anteriorly AND posteriorly
FALSE, only percuss anteriorly if abnormal findings
Percussion notes:
Flat Dull Resonant Hyperresonant Tympanic
Flat percussion
High pitched, short
Thigh
Dull percussion
Medium pitch & duration
Liver
Resonant percussion
Low pitch, long duration
Normal lungs
Hyperresonant percussion
Lower pitch, longer duration
COPD
Tympanic percussion
Lowest pitch (almost musical), longest duration (PTX, empty stomach)
Pleural effusion percussion
Dull or flat depending on size
Consolidation percussion
Dull over area of decreased aeration (PNA, pulmonary edema)
Atelectasis percussion
Dull - lobar collapse often due to mucus plug (airflow obstructed)
Normal tissue percussion
Resonant
Pneumothorax percussion
Hyperresonant or tympanic if large (air escapes lungs, fills chest cavity, closer to surface)
COPD percussion
Hyperresonant - air trapped in alveoli become hyperinflated
Asthma percussion
Resonant to hyperresonant depending on severity
The diaphragm of the stethoscope picks up ____ pitched sounds, while the bell picks up ____ pitched sounds
High
Low
Use ____ pressure when using diaphragm of stethoscope and ____ pressure when using bell
Higher
Lighter
T/F: Auscultation can be done both lying down and sitting up
FALSE, every effort should be made to auscultate with patient sitting up
How does chest hair interfere with auscultation and how can you improve this?
- Chest hair can sound like crackles
- Press harder or try moistening the hair
What should you do if you hear an abnormal breath sound?
Ask pt to cough to clear any secretions. If the sound is still there, it’s not from secretions
Normal breath sounds:
Vesicular
Bronchovesicular
Bronchial
Vesicular breath sounds
- Soft, low pitched
- All of inspiration, fade out after about 1/3 of expiration
- Heard thru all lung fields
Bronchovesicular breath sounds
- Louder than vesicular
- Heard equally in inspiration and expiration
Where are bronchovesicular sounds heard best?
Anteriorly: 1st/2nd ICS
Posteriorly: between scapulae
Bronchial breath sounds
Very loud, high pitched
Expiratory lasts longer
Where are bronchial sounds heard best?
Over the manubrium
Adventitious sounds:
Rhonchi
Wheezes
Crackles (rales)
Rhonchi
- Low pitched
- Sounds like snoring or geese honking
- Represents secretions in large airways
Wheezes
- High pitched (shrill)
- Can be inspiratory or expiratory
- Represents a narrow airway
- A/w asthma, COPD, bronchitis
Stridor
- Loud inspiratory wheeze
- Heard best over trachea
- Indicates partial tracheal obstruction
Crackles
- Fine: high pitched, brief, arise from alveoli
- Coarse: low pitched, louder, longer, arise from alveoli
Pleural friction rub
- Rarely heard
- Brief and confined to small area
- Disappears w/pleural effusion (fluid is interspersed between inflamed surfaces)
When should vocal fremitus be performed?
If abnormal breath sounds are heard
