Thorax And Lungs Flashcards
What is the anterior boundary of the thorax?
Sternum and ribs
What is the posterior boundary of the thorax?
Ribs and thoracic spine
What is the superior boundary of the thorax?
Clavicles and neck tissues
What is the inferior boundary of the thorax?
Diaphragm
How should you describe chest findings?
In two dimensions, along the vertical axis and around the circumference of the chest
What is the vertical axis technique?
- Count ribs and intercostal spaces
- Place finger in the hollow curve of the suprasternal notch move it down 5cm to the sternal angle
- Adjacent to the sternal angle is the 2nd rib
- Use two rings to walk down the interspaces
Why is the 2nd intercostal space a special landmark?
Used for needle insertion for decompression of a tension pneumothorax
Why is the intercostal space between the 4th and 5th ribs a special landmark?
Used for chest tube insertion
Where is the place that a endotracheal tube on a chest X-ray is inserted?
The level of the 4th rib for the lower margin
Where are neurovascular structures on the ribs?
They run along the inferior margin of each rib
Where should needles and tubes be placed into the ribs?
Along the superior rib margin
Which ribs articulate with the sternum?
The first 7 ribs
Which ribs articulate with the costal cartilages just above them?
8th, 9th, and 10th
Which ribs have no anterior attachments?
11th and 12th ribs “Floating ribs”
What can be used as a landmark on the posterior side for counting ribs?
The 12th rib
What is a landmark for thoracentesis?
The intercostal space between the 7th and 8th ribs
*immediately superior to the 8th rib
What are some other helpful landmarks
Inferior tip of the scapula
Spinous processes of the vertebrae
What is the chest circumference technique?
Visualizing a series of vertical lines across the chest?
What is the mid sternal line?
Drops vertically along the sternum
What is the mid clavicular line?
Drops vertically from the midpoint of the clavicle
What is the anterior axillary line?
Drops vertically from the anterior axillary fold
What is the mid axillary line?
Drops vertically from the apex of the axilla
What is the posterior axillary line?
Drops vertically from the posterior axillary fold
What is the scapular line?
Drops from the inferior angle of the scapula
What is the vertebral line?
Overlies the thoracic spinous processes
What is the triangle of safety?
Anatomical region in the mid axillary line formed by
*lateral border of the pectoralis major anteriorly
*Lateral border of the Latissimus Dorsi posteriorly
*The nipple line Inferiorly
*safety position for chest tube insertions
What does the apex of the lung rise to?
Above the clavicle
*Approximately 2cm to 4cm
What does the lower border of the lung cross?
The 6th rib at the mid clavicular line
8th rib at the mid axillary line
Where does the lower border of the lung cross posteriorly?
Lies at the T10 spinous process
What does the oblique fissure run from?
T3 spinous process obliquely down and around the chest to the 6th rib at the mid clavicular line
Where does the horizontal fissure run from?
Runs close to the 4th rib and meets the oblique fissure in the mid axillary line near the 6th rib
Where does the trachea bifurcate to?
*At the sternal angle anteriorly
*T4 spinous process posteriorly
Describe the right main bronchus
Wider
Shorter
More vertical
How does the left main bronchus come into the lung hilum?
Extends inferolaterally
*From below the aortic arch and anterior to the esophagus and thoracic aorta
How does the main bronchus divides?
1.Lobar
2. Segmental bronchi
3. bronchioles
4. Alveoli (terminal)
Where does gas exchange happen
Alveoli
Which bronchus is aspiration pneumonia more common in?
The right middle and lower lobes
*BC the right main bronchus is more vertical
If an endotracheal tube is advanced too far during intubation where will it enter?
The right main stem bronchus
What is the visceral pleura?
Covers the outer surface of the lungs
What is the parietal pleura?
Lines the pleural cavity along the inner rib cage
What is between the visual and parietal pleura?
Pleural space
*Contain serous pleural fluid
Which pleura has nerves?
The parietal pleura
*Innervated by intercostal and phrenic nerves
What is the primary muscle of inspiration?
The diaphragm
What happens to the diaphragm during inspiration?
Diaphragm contracts
*descends in the chest
*expands thoracic cavity
During exercise what muscles are recruited for the extra work required to breathe?
The sternocleidomastoid muscles and scalenes
What is dyspnea?
Painless but uncomfortable awareness of breathing that is inappropriate for the levels of exertion
What are wheezes?
Occurs in a partial or airway obstruction from secretions and tissue inflammation in asthma or from a foreign body
What is a cough?
A reflex response to stimuli that irritates receptors in the larynx, trachea, or large bronchi
What can a cough signal?
Left-sided heart failure
What is the most common cause of an acute cough?
Viral upper respiratory infection
What is a cause of a chronic cough?
Post nasal drip
Asthma
Chronic bronchitis
What is the mucus from a cough look like during a viral or bacterial infection?
Viral: white, gray
Bacterial: green
What is hemoptysis?
blood coughed up from the lower respiratory tract
What is a Levine sign?
Clenched fist over the sternum
*Angina pectoris
Does lung tissue have pain fibers?
NO
What are the six P’s of Dyspnea?
- Possible foreign body
- Pulmonary embolus
- Pneumonia
- Pump failure
- Pneumo-thorax
- Pulmonary brachial constriction
What is the patient positioning for the posterior thorax?
Patient sitting
*Arms folded
*hands on opposite shoulders
What is the patient position for the anterior thorax?
Patient is supine
What is Cheyenne-stokes breathes?
Irregular
Deep breaths
*Drugs, heart failure, brain damage
What is possible reason for prolonged expiration?
COPD
Obstruction breathing
What is a barrel chest?
Increased AP diameter
What is a funnel chest (Pectus Excavatum)
Depression in the lower portion of the sternum
What is pigeon chest (Pectus carinatum)
Sternum is displaced anteriorly, increasing AP diameter
What is lung excursion?
As the lungs move during inspiration
*placed hands on 10th ribs
What is Fremitus/
Palpable vibrations that are transmitted through the bronchopulomary tree to the chest wall
When can tactile fremitus be decreased?
COPD
Fibrosis
Thick chest wall
What does percussion help with?
Establish whether the underlying tissues are air-filled, fluid filled or consolidated
What is the pleximeter?
Finger that is getting hit
What is the plexor finger?
Finger that is doing the hitting
When does dullness replace resonance?
When fluid or solid tissue replaces air-containing lung
Describe the steps of diaphragmatic excursion
- Determine the level of diaphragmatic dullness during quiet respiration
- Percussion downward until dullness replaces resonance
- Have the patient hold their breathe and percussion when until dullness replaces resonance
- Have the patient take a deep breath out and hold it. Percuss until resonance replaces dullness
What is the duration, intensity, pitch and location of a vascular sound?
Duration: Inspiratory sound last longer than expiratory
Intensity: Soft
Pitch: Relatively low
Location: Over lungs
What are you listening for during auscultation?
Adventitious breath sounds
Where are tracheal breath sounds located?
Over the trachea
Where are bronchial breath sounds located?
Over manubrium, between clavicles
Where are bronchovesicular breath sounds located?
Over large airways near sternum
Where are vesicular lungs sounds located?
Over peripheral lung tissue
What are the adventitious breath sounds?
Crackles
Wheezes
Rhonchi
What can severe asthma indicate?
A silent chest
*No airflow
*No gas exchange
When are transmitted voice sound technique used?
If there are abnormally located bronchiovesicular or bronchial breath sounds auscultated during exam
*Testing for consolidation
What does a bronchophony sounds like?
Speaking 99
*Heard clearly
What does a egophony sound like?
Speak a long E
*Sounds like a long A
What does a whispered pectoriloquy sound like?
Whisper 99
*heard very clearly
What is the position of the anterior chest exam?
Supine position
