Resp Flashcards
Identify on skeleton bony landmarks of the thoracic region including thoracic vertebrae, sternum and ribs.
learn anatomy of vertebra, ribs and sternum
Identify surface markings of bony landmarks – suprasternal notch.
Jugular notch (depression on the upper border of manubrium): T3
Identify surface markings of bony landmarks – sternal angle
Sternal angle: blunt ridge is felt at the manubriosternal joint: T4/T5
At the sternal angle: a) trachea bifurcates, b) aortic arch begins and ends, c) 2nd CC attaches
Identify surface markings of bony landmarks – xiphisternum,
Xiphisternum: T8/T9
Identify surface markings of bony landmarks – costal margins
10th CC: L2
The lateral border of rectus abdominis muscle meets the costal margin at the tip of the 9th costal cartilage (L1)
Identify surface markings of bony landmarks – sternal body
Body of sternum: T5-T8
Demonstrate symmetrical inflation of the lung and describe the anatomical basis.
Visual observation of movements of anterior chest wall:
Observe the movements of the rib cage and sternum during: A) Quiet breathing B) Deep breathing
- Examiner stands facing the subject and places hands firmly on the subject’s anterior chest wall (just below 5th or 6th ribs) with fingers extended around the sides of the chest
- The thumbs should just meet in the anterior midline (mid-sternal line), resting lightly on the chest wall, to allow its movement during respiration
- Female subjects: examiner’s hand should be laid beneath the breast
- Ask patient to take a deep breath
- Observe how far the tips of examiner’s thumbs move apart (at least 5 cm)
- Repeat this on the posterior chest wall with thumbs meeting in the posterior midline of T10
- NOTE: T7 is at the level of inferior angle of scapula
- Movement of the anterior chest wall gives some idea of expansion of upper and middle lobes
- Movement in the posterior chest wall indicates expansion of lower lobe of lung
- The purpose of this is to look for any asymmetry – e.g. in pneumothorax, the lung won’t move
Observe and describe the breathing pattern and the breathing rate.
- RATE: Breathing rate between 12 and 20 breaths per minute is normal (higher in children)
- HYPERPNEA: increased depth and rate of breathing
- HYPOPNEA: decreased depth and rate of breathing
- DEPTH: normal, deep and shallow
- RHYTHM: regular and irregular
Demonstrate percussion of upper lobe of right/left lungs.
Apex:
-Above clavicle anteriorly
- similar level posteriorly
Upper lobe:
-about 2nd ICS (deffo above 4th rib on right due to horizontal fissure) can do it on the 4th ICS on MCL on the left too ANTERIORLY
- T3 at MSL on both sides
-on left side- just below axilla on lateral chest wall
Demonstrate percussion of middle lobe(s) of right lungs.
Middle lobe: 4th ICS in MCL ON RIGHT ONLY (still purcuss the left but it would be the upper lobe still as it doesnt have a middle lobe)
NONE POSTERIORLy but can test just below axilla on lateral chest wall on the RIGHT ONLY
Demonstrate percussion of lower lobe(s) of right/left lungs.
6th ICS on MAL (below 6th rib as oblique fissure) anteriorly
posteriorly- below T3 again because of horizontal fissure
Describe and demonstrate where you would auscultate upper/middle/lower lobe(s) of right/left lungs.
similar to percussion: but make sure they breathe through the mouth
upper lobe:
-Apex and 2nd ICS anteriorly (and 4th ICS on LEFT)
-above T3 and apex posteriorly
Describe and demonstrate where you would auscultate middle lobe of right lung
similar to percussion: but make sure they breathe through the mouth
Middle lobe:
-ON RIGHT: 4th ICS in MCL Anteriorly (no posterior)
Describe and demonstrate where you would auscultate lower lobe of right/left lung.
similar to percussion: but make sure they breathe through the mouth:
Lower lobe:
-6th ICS in AAL ( a bit laterally to MCL) anteriorly
-below T3 posteriorly
Describe & demonstrate the surface markings of upper lobe of right
UPPER: apex (1ich above medical 3rd of clavicle) to sterno Clavicular Jt to sternal angle (2nd CC) then down to 4th cc, the along 4th rib (horzintal fissure ) to 6th rib on MAL (where it meets oblique fissure) then to T3.
