RESPIRATORY Flashcards
What are the identifying features of the thoracic vertebrae?
2 pairs of demi facets
- Superior costal facet articulates with head of rib of the same number
- Inferior costal facet articulates with head of rib below
Transverse processes have an additional facet = transverse costal facet which articulates with tubercle of rib of same number
Body of tharacic vertebrae typically heart shaped
Vertebral foramen typically circular
Name the 3 parts of the sternum and their corresponding vertebral levels.
Manubrium - T2/3- T4/5
Body - T5-8
Xiphoid process - T8/9
Describe the true and false ribs and where they articulate
R1-7 = true ribs
- articulate anteriorly with sternum via costal cartilages
R8-12 = false ribs
- R8 - 10 articulate anteriorly with the costal cartilage of the rib above
- R11 + 12 = floating - no anterior articulation, posteriorly articulate with bodies of their own vertbrae
vertebral level of subcostal plane
Level of L3
plane passing through lowest margin of the ribs
Surface mark the upper lobe of the right lung
apex - 2-3cm above medial 3rd of clav
sternoclavicular joint –> right 2nd CC –> 4th right CC –> T3 just lateral to PML –> T1 just lateral to PML
surface mark the middle lobe of the right lung
4th right CC –> 6th right CC –> 6th rib at MCL –> 4th rib at MAL (where oblique fissure meets horizontal fissure)
surface mark the lower lobe of the right lung
6th right CC –> 6th rib at MCL –> 8th rib MAL –> 10th rib just lateral to PML
surface mark the upper lobe of the left lung
apex 2-3cm above clav –> left 2nd CC –> 4th CC –> 6th CC –> T3 –> T1
surface mark the lower lobe of the left lung
6th left rib at MCL –> 8th rib at MAL –> 10th rib lateral to PML
demonstrate the oblique fissure in both lungs
palpate T3 (scapular spine) and 6th CC anteriorly - then connect the two points
demonstrate the transverse fissure of the right lung
palpate 4th CC anteriorly –> trace along 4th rib until it meets oblique fissure at MAL near axilla (no posterior surface markings)
surface mark the right parietal pleura
apex = 2-3cm above clav –> 6th CC at sternal border –> 8th rib at MCL –> 10th rib at MAL –> T12 at scapular line
surface mark the left parietal pleura
apex = 2-3cm above clav –> defelect left between 4th and 6th CC –> 6th CC at sternal border –> 8th rib at MCL –> 10th rib at MAL –> T12 at scapular line
surface mark the right visceral pleura
apex = 2-3cm above clav –> 6th CC at sternal border –> 6th rib at MCL –> 8th rib at MAL –> T10 at scapular line
surface mark the left visceral pleura
apex = 2-3cm above clav –> defelect left between 4th and 6th CC –> 6th CC at sternal border –> 6th rib at MCL –> 8th rib at MAL –> T10 at scapular line
palpate the trachea
using index fingers palpate above the jugular notch and comment whether it is central or deviated
Which way would the trachea deviate in a tension pneumothorax?
away from the affected side
which way would the trachea deviate in an upper lobe collapse or fibrosis?
towards affected side
investigate the breathing pattern and breathing rate
breathing pattern - regular/irregular
breathing rate 12-20 breaths per min = normal
demonstrate percussion of the upper, middle and lower lobes of the right lung on the anterior chest wall
apex = use the clavicle
upper lobe = 3rd ICS at MCL
middle lobe = 5th ICS/just below axilla at AML
lower lobe = 7th ICS near MAL
demonstrate percussion of the upper, and lower lobes of the right lung on the posterior chest wall
upper lobe = T1 and T3
lower lobe = anywhere below scapula above T10
what sound is expected during percussion of a pneumothorax?
hyperresonant (air-filled)
what sound is expected during percussion of a haemothorax?
hyporesonant (blood filled)
demonstrate auscultation of the upper, middle and lower lobes of the right lung on the anterior chest wall
apex = above the clavicle (use the bell)
upper lobe = 3rd ICS at MCL
middle lobe = 5th ICS/just below axilla at AML
lower lobe = 7th ICS near MAL
demonstrate auscultation of the upper, and lower lobes of the right lung on the posterior chest wall
upper lobe = T3
lower lobe = anywhere below scapula above T10
borders of the triangle of safety
post - ant border of lat dorsi
ant - lat border of pec major
inf - 5th ICS at MAL
sup - apex of axilla
position of patient for chest exam
supine at 45 degrees
