THORAX Flashcards
Spinal level for : jugular notch, sternal angle, xiphoid process
T2/3, T4/5, T9/10
Scapula angles
T2 (superior), T3 (medial) and T7 (inferior)
Borders of heart
UL: 2nd ICS, 2.5cm left from sternal edge
UR: 3rd CC, 1cm right from sternal edge
LL: 5th ICS, MC line
LR: 6th CC, 1cm right from sternal edge
Auscultate valves
Aortic: 2nd ICS, right sternal border
Pulmonary: 2nd ICS, left sternal border
Tricuspid: 5th costosternal border, left.
Mitral: apex- 5th ICS, left.
Would you auscultate at the location of the valves?
no. the sound flows with the bloodstream
Where can you detect rate, rhythm, character and volume of blood flow?
rate and rhythm- central and peripheral
character and volume- central only eg. carotid
venepuncture from
median cubital vein or ante brachial vein if this isn’t possible.
or Cephalic vein adjacent to the anatomical snuffbox, Basilic vein on dorsum of arm, Dorsal metacarpal veins
surface mark (SM) aortic arch
beginning: right 2nd cc
top: between jugular notch and sternal angle
end: left 2nd cc
common carotid SM
when does it become the ICA
sternoclavicular joint along anterior border of sternocleidomastoid
becomes ICA after upper border of thyroid cartilage
internal jugular SM
lateral to CCA
Inflation (ant and post)
anterior: hands below breast for woman and just below nipple for men (5/6th rib).
posterior: T10, bit below scapula
thumbs meet at mid sternal line/back midline. thumbs up, off chest and towards you. see chest move 5cm
What would cause reduced or asymmetrical lung expansion?
reduced: asthma, COPD, NM disease
asymmetrical: pneumothorax, pleural effusion, collapsed lung
what helps lungs expand passively ?
expand:
diaphragm (motor, phrenic, C3,4,5)
external intercostals (motor, T1-11)
what helps lungs expand and deflate forcefully?
expand: SCM, scalene
deflate: abd muslces (rectus abdominus and external oblique), internal intercostals (motor, T1-11)
breathing rate
12-20 (16) = normal
regular? deep/shallow?
describe vesicular breathing
over thorax, soft, inspiration > expiration, no pause, lower.
describe bronchial breathing
over trachea, higher and louder pitch, inspiration= expiration, pause.
give some examples of abnormal breath sounds
crackling- pneumonia, pulmonary oedema (2ndary to CHF)
wheeze- asthma, COPD (expiratory)
stridor- upper resp tract obstructions (inspiratory)
what does it mean if the lungs are hyper-resonant or dull?
hyper- pneumothorax
dull- pleural, fluid, solid effusion; pneumonia; or collapsed lung
where is it normal to be hyper resonant/dull?
dull- left upper lung (heart) and right lower lung (liver)
hyper-resonant: left lower (stomach)
chest drain
ant of lat dorsi lateral of pec major apex below axilla sup of line of nipple- rib number? inserted just above rib
AP
heart is magnified (can’t see cardiomegaly)
scapula projects over more of the lungs, clearly seen
is the corresponding rib above or below the vertebral body?
above
superior or inferior costal facet is bigger?
superior
