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.
Describe & demonstrate the surface markings of upper, and lower lobe of left lungs.
UPPER: apex down to 4th rib (following median sternal line ) then cardiac notch till rib 6 (2-3 cm at 5th CC) then oblique fissure (smooth line from 6th CC to T3 along medial border of the abducted scapula)
Short cut: The oblique fissure closely follows the medial border of the scapula when the arm is raised above the head of the subject.
Describe & demonstrate the surface markings of middle lobe of right lung:
MIDDLE: horizontal fissure ( 4th rib horizontally) to where it meets oblique in MAL then to T4 (close to medial border of scapula)
Describe & demonstrate the surface markings of lower lobe of right lung:
6th rib in MCL, to where it meets horizontal fissure. also 8th rib MAL and 10th rib scapular line and t10
Describe & demonstrate the surface markings of the lower lobe of left lungs.
LOWER: Oblique fissure ( 6th CC to T3) along medial border of scapula when abducted. from 6th rib at MCL to 8th at MAL to 10th at scapular line and then to T10
Describe & demonstrate the surface marking of the inferior margin of parietal pleura of right/left lung.
Same as lungs but 2 down from MCL:
- 8th rib at MCL
- 10th rib at MAL
- 12th rib at scapular line
- transverse process of L1 vertebra at bottom and T1 at top
ON LEFT CARDIAC NOTCH IS LESS DEVIATED THAN THE LUNG (only 1 cm at 5th CC
Describe and demonstrate the triangle of safety for insertion of a chest drain.
Posterior border: Latissimus dorsi - posterior axillary fold
- Anterior border: Pectoralis major - anterior axillary fold
- Inferior border: 5th intercostal space at mid-axillary line
- Superior border: below apex of axilla
- Chest drains used for pneumothorax, haemothorax, pleural effusion and post-operative matters
Describe & demonstrate the surface marking of inferior margin of the visceral pleura of right/left lung.
Same as lung:
6th rib at MCL
8th rib at MAL
10th rib at scapular line
