Pulmonary examination lecture

Tidal Volume (TV)

Air inspired or expired during normal, relaxed breathing (~500 mL).

Inspiratory Reserve Volume (IRV)

Maximum volume of air forcibly inhaled after a normal tidal inspiration (~3,100 mL).

Expiratory Reserve Volume (ERV)

Maximum volume of air forcibly exhaled after a normal tidal expiration (~1,200 mL).

Residual Volume (RV)

Volume of air remaining in the lungs after maximal forced exhalation (~1,200 mL).

Total Lung Capacity (TLC) Formula

TLC = TV + IRV + ERV + RV (~6,000 mL).

Vital Capacity (VC) Formula

VC = TV + IRV + ERV (~4,800 mL, ~80% of TLC).

Functional Residual Capacity (FRC) Formula

FRC = RV + ERV (~2,400 mL).

Inspiratory Capacity (IC) Formula

IC = TV + IRV (~3,600 mL).

Obstructive vs. Restrictive Lung Disease: RV, FRC, and TLC

Obstructive: RV, FRC, TLC are increased. Restrictive: RV and TLC are decreased. NOTHING INC IN RESTRICTIVE D.

what are examples of obstructive diseases

-C.B.A.B.E.

- Cystic Fibrosis

- Bronchitis

- Asthma

- Bronchiectasis

- Emphysema

what are examples of restrictive dieases

sarcoidosis, lung fibrosis, anklyosing spondylitis, obesity, burns, pneumonia, pneumothorax, hemothorax, pulmonary effusion

GOLD Classification: Mild COPD (Stage 1)

FEV1/FVC < 70% and FEV1 ≥ 80% predicted.

with or without production of cough

GOLD Classification: Moderate COPD (Stage 2)

FEV1/FVC < 70% and 50% ≤ FEV1 < 80% predicted.

shortness of breath w/ exertion, with or without cough

GOLD Classification: Severe COPD (Stage 3)

FEV1/FVC < 70% and 30% ≤ FEV1 < 50% predicted.

greater SOB with exercises, dec exer capacity

GOLD Classification: Very Severe COPD (Stage 4)

FEV1/FVC < 70% and FEV1 < 30% predicted (or < 50% with chronic respiratory failure).

so gold classification COPD for numbers

50-80

30-80

30-50

Vesicular Breath Sounds

Soft, low-pitched sounds heard over most lungs; inspiration is longer than expiration.

broncho-vesticular sounds

Inspiratory & expiratory sounds are equal

Intermediate Intermediate Between 1st & 2nd interspace anteriorly & between the

scapulae

Bronchial Breath Sounds

Loud, high-pitched sounds heard over the manubrium; expiration is longer than inspiration.

tracheal breath sounds

Both Inspiratory & Expiratory are equal

Very loud Relatively high

Over trachea in the neck

Rhonchi abnormal breath sound

Continuous low-pitched, snoring or rattling sounds caused by secretions in large airways.

They can be heard in patients with COPD, bronchiectasis, pneumonia, chronic bronchitis, or cystic fibrosis.

Wheeze abnormal breath sound

High-pitched musical sound heard primarily during expiration due to airway constriction.

(asthma, COPD, or aspiration of any foreign body).

Crackles (Rales)

Discontinuous popping sounds heard during inspiration or expiration, common in CHF and pneumonia.

Pleural rub abnormal breath sounds

Auscultation in the lower lateral chest areas it occurs with each inspiration and expiration. It can be an indication of pleural inflammation.

Bronchophony voice sounds

Increased vocal resonance with greater clarity and loudness of spoken words. Example "99". ideal will hear muffle in sthescope but if hear clear=PROBLEM

secretions=consolidation which is THICK

Egophony voice sounds

Auscultation change where spoken long 'E' sounds like a nasal 'A' (indicates pneumonia/consolidation).

Whispered Pectoriloquy voice sounds

Abnormal elevation in clarity and loudness of whispered words (e.g., '1, 2, 3').

Normal ABG Reference Ranges

pH: 7.35-7.45; PaCO₂: 35-45 mmHg; HCO₃: 22-26 mEq/L.

ROME Mnemonic for ABG Analysis

Respiratory Opposite (pH and PaCO₂ move oppositely); Metabolic Equal (pH and HCO₃ move together).

ROME: Respiratory = Opposite

pH is high, PaCO2 is down

→ Alkalosis

pH is low, PaCO2 is up

→ Acidosis

ROME: Metabolic = Equal

pH is high, HCO3 is high

→ Alkalosis

pH is low, HCO3 is low

→ Acidosis

what are the steps for doing ABG

1.Look at pH

Normal 7.35 - 7.45: Answer is Compensated

2. Look at PaCO2

Normal 35 - 45: Answer is Metabolic

3. Look at HCO3

Normal 22 - 26: Answer is Respiratory

4. None of the three are normal:

Answer is Partially Compensated