Thorax : respiratory Flashcards
Describe the surface marking of the trachea ?
superior to the jugular notch is the first tracheal ring
demonstrate palpation of the trachea at the suprasternal notch?
Place your right index finger in the sternal notch. Palpate the lateral borders of the trachea to determine if it is in normal (midline) position
deviation from the normal might suggest a tumor or node enlargement
Demonstrate how you would investigate symmetrical inflation of the lung and describe the anatomical basis?
- ask the patient to sit down and remove the shirt
- get the patient to breathe in and place hands around the patient’s thorax with thumbs lined up in the center
- get the patient to breathe out normally and look at how your thumbs deviate from the midline
- in symmetrical breathing the deviation of the thumbs from the midline is the same on both sides
- perform on two places in the anterior and posterior thorax
what is the anatomical basis for testing symmetrical inflation?
- Air entry into the lungs through bronchi induce expansion
- Obstructive or restrictive lung diseases may reduce expansion unilaterally or bilaterally
Observe and describe the breathing pattern and the breathing rate?
- ask to take the patients pulse (to distract)
- observe the chest
- count the number of chest rises in 15 seconds at multiply by 4
- also, observe the nature of the breathing (should be regular)
- observe the nature of the rise (should be symmetrical)
how to describe the
breathing pattern?
breathing rate?
breathing pattern: Normal/Deep breaths/Use of accessory breathing muscles/Tripod/Purse Lip breathing
breathing rate: Normal, Tachypnoea, Bradypnoea
what is the normal breathing rate?
what is higher or below?
normal breathing rate = 12-20 breaths/min
- above = tachypnoea
- below = bradypoea
Demonstrate percussion of upper/lower/middle lobe(s) of right/left lungs?
- patient lies down (anterior)
- patient sits (posterior)
- percussion = hand rigid and flat on the chest wall use the middle finger, on the other hand, to firmly tap on the middle finger of the first hand
- perform the percussion systematically and symmetrically
- carry out in a like for like manner
when percussing the apex just push down directly onto the clavicle - no need to put the other hand down
what will be heard over
lungs
bone
organs
lungs - resonant sounds
bone - flat and dull sounds
organs - thudlike
where should the percussion be done?
For upper lobe:
2nd ICS
For the middle lobe - percuss at 2 locations
The 4th/5th ICS MCL
AND
Just below the base of the axilla at the MAL
For the inferior lobe:
Posterior 7 ICS
show the axillary lines
- anterior axillary
- midaxillary line
- posterior axillary line
show the midclavicular lines :
what is the procedure for auscultating the lungs?
- tell the patient to sit at a 90 degree angle
- tell the patient to breathe in and out when they feel the stethoscope touch the skin
- wear the stethoscope and turn it on
- perform in a like for like manner between the lungs
- eg. UR then UL
what different types of breathing will be heard with auscultation?
bronchial breathing = over the trachea, manubrium, and sternal angle
(turbulent)
vesicular breathing = lungs (not turbulent)
Describe & demonstrate the surface markings of the upper, middle, lower lobe of right/left lungs?
show where one should auscultate on the lungs?
right lung anterior
Apex - 1 inch above the medial 3rd of clavical (use the bell)
Upper lobe - 2nd ICS
Middle lobe - 4th ICS medial to nipple and base of the axilla MAL
Lower lobe - 6 ICS anterior axillary line
left lung - posterior
- 1st 3rd and 8th ICS
show the surface markings for the right lung? anteriorly
(A) The apex of the lung (in the root of the neck above the medial 1/3 of the clavicle)
(B) Just over the sterno clavicular joint
(C) Straight line to just right of AML at level of 6th CC (xiphoid process)
From here, the lower border of the lung follows two ribs above the pleural reflection around the chest wall.
(B) MCL at 6th rib (anteriorly)
(C) MAL at 8th rib (laterally)
(D) Scapular line (verticle line through the inferior angle of the scapular) at 10th rib (posteriorly) - inferior border of scapular = T7
show the surface markings posteriorly :
describe and demonstrate the triangle of safety for insertion of a chest drain :
Superior: Axilla
Inferior: 5th intercostal space, mid-axillary line
Anterior: Pectoralis major (Lateral Aspect) -> landmark for the anterior axillary line
Posterior: Latissimus Dorsi (Lateral Aspect)
