clinical skills-thorax and lungs

needle decompression (needle thoracostomy)

what is the 2nd ICS a significant landmark for?

chest tube

what is the 4-5th ICS a significant landmark for?

thoracentesis

what is the posterior 7th ICS a significant landmark for?

autonomic

breathing is typically what kind of process?

pleura

what allows the lung tissue to maintain contact with the chest wall to assist in creating a vacuum?

parietal

___ pleura is highly innervated

deep inspiration

irritation causes pleuritic pain with...

fluid and inflammation

what can alter lung auscultation?

hole in the pleura

what can affect the vacuum effect needed for breathing?

feeling of persistent drowsiness during the day

what is daytime somnolence?

musical respiratory sounds

what kind of sounds are wheezes?

lower airway obstruction

what are wheezes typically due to?

<3wks

what is the duration of an acute cough?

3-8 wks

what is the duration of an subacute cough?

>8 weeks

what is the duration of an chronic cough?

volume, color, odor, consistency

if productive cough, what should be noted?

blood from the lung tissue

what is true hemoptysis?

upper respiratory

what is the likely origin of bright red streaks in sputum?

pneumonia

what is rusty blood likely due to?

tripod

what is the abnormal position pts might use to assist in breathing?

seconds to exhale from total lung capacity

what is forced expiratory time?

diaphragmatic excursion

what is the distance that the diaphragm moves with inhalation/exhalation by percussing?

GI tract

what might coffee grounds/dark blood be from?

snoring or stop breathing during sleep, waking with choking sensation or headaches, daytime sleepiness or fatigue

what are signs of obstructive sleep apnea (OSA)?

chest is wider than it is deep, ratio of the anteroposterior diameter is 0.5-0.75

what is the normal shape of the chest?

chest is almost as wide as it is deep, close to 1:1

what is abnormal chest shape (barrel chest)?

COPD

what is barrel chest often seen in?

pleural disease (asbestosis, pleural effusion)

what is asymmetry on chest expansion, lag or delay seen in?

traumas

what does flail chest occur in?

pectus excavatum

name this condition

pectus carinatum

name this condition

sections of ribs broken off

what is flail chest?

moves outward

in flail chest, what happens to the section of chest during expiration?

chest moves inwards

in flail chest, what happens to the section of chest during inspiration?

anteriorly, posteriorly, and laterally

how should you perform chest palpation?

crepitus

what should you palpate the chest for?

crackling or grinding due to subcutaneous air

what is crepitus?

tuberculosis

what can sinus tracks be seen in?

place thumbs at ~ 10 rib, have pt inhale deeply and note hand movement, note symmetry

how do you palpate chest expansion?

lung excursion

what does how far apart your hands move indicate during palpation of chest expansion?

deep, smooth symmetrical chest wall expansion

what is a normal chest expansion finding upon palpation?

costal margins

chest expansion can be palpated anteriorly with thumbs along the...

tactile fremitus

what are palpable vibrations transmitted through the chest wall?

use ball or ulnar surface of hand, perform anteriorly and posteriorly, have pt repeat ninety-nine, use both hands to compare symmetrically

how do you palpate for tactile fremitus?

symmetrical, equal vibrations

what are normal findings for tactile fremitus?

increased, decreased, or absent

what are abnormal findings for tactile fremitus?

lung consolidation, pneumonia

increased tactile fremitus indicates what?

excess air in lungs or thickened chest wall, pneumothorax, COPD, tumor

decreased or absent tactile fremitus indicates what?

chest percussion

what creates sound and vibrations of the chest that determine the density of the underlying tissue?

5-7cm

chest percussion penetrates ____ deep

ladder pattern

percussion should be done anteriorly, posteriorly, and laterally using what pattern?

soft

flat percussion: relative intensity

high

flat percussion: relative pitch

short

flat percussion: relative duration

thigh

flat percussion: example of location

medium

dull percussion: relative intensity

medium (dp)

dull percussion: relative pitch

medium (dd)

dull percussion: relative duration

liver

dull percussion: example of location

loud

resonant percussion: relative intensity

low

resonant percussion: relative pitch

long

resonant percussion: relative duration

healthy lung

resonant percussion: example of location

very loud

hyperresonant percussion: relative intensity

lower

hyperresonant percussion: relative pitch

longer

hyperresonant percussion: relative duration

usually none

hyperresonant percussion: example of location

loud (ti)

tympanitic percussion: relative intensity

high (distinguished mainly by its musical timbre)

tympanitic percussion: relative pitch

longer (td)

tympanitic percussion: relative duration

gastric air bubble or puffed out cheek

tympanitic percussion: example of location

sound goes from resonant to dull

what happens at the level of diaphragm when percussing?

3-5.5 cm

what is the normal distance between resonant and dull sound when estimating level of diaphragm?

diaphragm

what part of the stethoscope should be used to auscultate the chest?

obstructive lung disease, pleural effusion, or pneumothorax

intensity of breath sounds may be decreased in...

bronchial breath sounds

a silent gap between inspiration and expiration is noted with...

right middle lobe

which lobe of the lung cannot be auscultated?

inspiratory sounds last longer than expiratory ones

what is the duration of sound for vesicular breath sounds?

soft (ves)

what is the intensity of expiratory sounds for vesicular breath sounds?

relatively low

what is the pitch of expiratory sounds for vesicular breath sounds?

over most of both lungs

what is the location where vesicular breath sounds can be heard?

inspiratory and expiratory sounds are about equal

what is the duration of sounds for bronchovesicular breath sounds?

intermediate (i)

what is the intensity of expiratory sound for bronchovesicular breath sounds?

intermediate (p)

what is the pitch of expiratory sound for bronchovesicular breath sounds?

1st and 2nd intercostal spaces anteriorly and between scapulae

in what locations can bronchovesicular breath sounds be heard?

expiratory sounds last longer than inspiratory ones

what is the duration of sounds for bronchial breath sounds?

loud (b)

what is the intensity of expiratory sound for bronchial breath sounds?

relatively high

what is the pitch of expiratory sound for bronchial breath sounds?

over the manubrium if heard at all

what is the location of sound heard for bronchial breath sounds?

over the trachea in the neck

what is the location of sound heard for tracheal breath sounds?

inspiratory and expiratory sounds are about equal (t)

what is the duration of sounds for tracheal breath sounds?

very loud

what is the intensity of expiratory sound for tracheal breath sounds?

relatively high (t)

what is the pitch of expiratory sound for tracheal breath sounds?

vesicular

what are normal breath sounds called?

adventitious sounds

what are added sounds that are abnormal?

intermittent, sound like rice crispies or velcro

describe crackles or rales

soft, high pitched

describe fine crackles

lower pitched, often louder

describe coarse crackles

atelectasis, bronchitis, pneumonia, interstitial lung disease, heart failure, pulm fibrosis

what are causes of crackles or rales?

collapse of lung tissue

what is atelectasis