Respiratory Flashcards
Describe and demonstrate the surface marking and palpation of the trachea at the suprasternal notch.
- Go to sternal notch - between clavicles at T2
- Suprasternal/jugular notch is the dip just above
- Can feel the trachea in the dip
Demonstrate how you would investigate symmetrical inflation of the lung and describe
the anatomical basis.
- Patient sits at edge of couch
- Visual observation of rib cage and sternum during quiet and deep breathing
- Place hands around anterior chest wall, just below 5th/6th ribs (beneath breast in females)
- Thumbs touching at anterior midline
- Ask patient to take a big breath in and out
- Thumbs should equally move apart - normal expansion of 5cm
- Repeat on posterior chest wall with thumbs meeting at posterior midline T10 (for lower lobe)
Observe and describe the breathing pattern and the breathing rate.
- Pretend you are measuring the pulse
- Count number of (quiet) breaths in 60 seconds
- Observe whether breathing is regular or not
- Regular - 14 breaths/min
- Normal quiet breathing = vesicular
- Over tracheobronchial tree = bronchial
Demonstrate percussion of upper/lower/middle lobe(s) of right/left lungs.
Anterior view - lie 45’
• Start at right apex - left apex (clavicles)
• Percuss lower on the left then right for upper lobes
• Above left nipple and below left axilla for upper lobe
• Above right nipple and below right axilla for middle lobe
• Below nipples for lower lobes
Posterior view - sit on edge of couch and cross arms in front of chest to move the scapula laterally
• Apex
• Below from T4 to T10 in 2 areas on each side for lower lobes
- Drum-like - air-filled
- Dull - liquid or solid (heart)
Describe where you would auscultate upper/middle/lower lobe(s) of right/left lungs.
Anterior view - lie supine, whilst taking deep breaths through open mouth:
• Bronchial breathing - listen over trachea, manubrium and sternal angle
• Examine apex with bell
• Examine superior, middle and inferior lobe on both sides with diaphragm
• Below right axilla for middle lobe in females
• Below base of breast (6th rib) for lower lobes in females
Posterior view - sit on edge of couch
• Listen to apex, superior lobe and inferior lobe
Describe + demonstrate the surface markings of upper, middle, lower lobe of right/left
lungs
- Superior R lobe: apex (1 inch above medial 3rd of clavicle) to horizontal fissure (after 3rd ICS)
- Middle R lobe: 4th rib to xiphisternum. Lowest point of lobe is 6th rib at MCL
- Inferior R lobe: 6th rib at MCL to 8th rib at MAL (laterally)
- Superior L lobe: apex to 6th rib, lateral deviation at 4-6th ribs (cardiac notch)
- Posteriorly - goes to scapular line at 10th rib
Describe + demonstrate the surface markings of the oblique and horizontal fissures of
right/left lung.
- Horizontal fissure - starts at 4th CC and meets the oblique fissure at the MAL
- Oblique fissure - posterior lung margin below T3, 6th CC anteriorly
(Oblique fissure divides upper and middle lobe from lower lobe on right, and upper lobe from lower lobe on left)
(Transverse fissure divides upper lobe from middle lobe on right)
Describe + demonstrate the surface marking of the margin of parietal pleura of
right/left lung.
- Apex (just over sternoclavicular joint), down next to anterior median line following the costal margin
- Still next to AML at 6th CC (xiphoid process)
- MCL at 8th rib
- MAL at 10th rib
- Scapular line (lateral margin of erector spinae) at 12th rib
- Transverse process of L1 vertebra
- Transverse process of T1 vertebra
• Left parietal pleura is similar, but deflects to the left at 4th-6th CC for cardiac notch
Describe + demonstrate the surface marking of margin of the visceral pleura of
right/left lung.
- Visceral pleura closely covers the lung
* Continuous with parietal pleura at hilium of lung
Describe and demonstrate the triangle of safety for insertion of a chest drain.
• Safe triangle - Posterior: Latissimus dorsi - Anterior: Pectoralis major - Superior: below apex of axilla - Inferior: 5th intercostal space at MAL • Aim to insert drain anterior to the MAL, avoiding the long thoracic nerve
