Thorax, Lungs, and Respiratory Assessment Notes

Introduction to Thorax and Lungs

• Homeostasis & Regulation
  • Key determinants:
  • Gas Exchange: Oxygen (O2) and carbon dioxide (CO2) exchange at external (alveoli) and internal (cellular) levels.
  • Ventilation: Mechanical movement of air in and out of lungs.
  • Respiration: Overall process of gas exchange.

Thoracic Anatomy

• Key Structures
  • Frontal sinus, nasal cavity, epiglottis, larynx, bronchi, and lungs: Essential parts of the respiratory system.
  • Right Lung: Composed of Right Upper Lobe (RUL), Right Middle Lobe (RML), and Right Lower Lobe (RLL).
  • Left Lung: Composed of Left Upper Lobe (LUL) and Left Lower Lobe (LLL).
• Thoracic Cage:
  • Consists of clavicles, sternum, 12 pairs of ribs, and thoracic vertebrae.
  • Costal Margin: Inferior rib border important for anatomical reference.

Thoracic Cavity Contents

• Organs include
  • Heart, Lungs, Thymus (immune function), Trachea, Esophagus, Aorta & Great Vessels.

Pleura and Pleural Space

• Visceral Pleura: Covers lungs,
• Parietal Pleura: Lines thoracic wall,
• Pleural Space: Potential space between pleura, can lead to complications like pneumothorax (air) or hemothorax (blood).

Respiratory Muscles

• Inspiration: Triggered by an increase in blood CO2 levels.
  • Muscles Involved: External intercostals and diaphragm.
  • Air Intake Volume: Approximately 500-800 mL.
• Expiration: Longer (typically 2x) and passive process focused on relaxation of muscles.

Assessment Techniques

• General Assessment Components: Vital signs, skin analysis, head and neck examination, thoracic examination, etc.

Respiratory Assessment Components

1. General Survey

   • Overall patient impression and observations.
   • Evaluate skin, anatomy, movement, behavior, and respiratory effort.

2. Symptom History:

   • Use the OLDCARTS method to evaluate respiratory symptoms (Onset, Location, Duration, Characteristics, Aggravating/Alleviating factors, Radiating, Timing, Severity, and Previous treatments).

3. Health History

   • Conditions such as asthma, bronchitis, and COPD should be noted, along with medications, allergies, and vaccinations.

4. Physical Exam

   • Inspection, Palpation, Percussion, Auscultation methods to evaluate respiratory health.

Physical Exam Techniques

• Inspection

  • Observe consciousness, skin, posture, thoracic shape, and respiratory pattern.

• Palpation

  • Assess tactile fremitus and chest expansion to evaluate lung disease.

• Percussion

  • Used to differentiate between air, fluid, or solid masses in lungs by sound during tapping.

• Auscultation

  • Listen to breath sounds, including normal and adventitious sounds (e.g., wheezes, crackles).

Breathing Patterns and Sounds

• Breath Sounds Classification
  • Tracheal, Bronchial, Bronchovesicular, Vesicular.
  • Adventitious sounds indicate potential issues:
    • Wheezing: High-pitched sounds heard during expiration.
    • Crackles: Popping sounds during inspiration indicating fluid in airways.
    • Stridor: Indicates upper airway obstruction.

Respiratory Distress Indicators

• Symptoms of distress include:
  • Short sentences, irritability, altered levels of consciousness, abnormal positioning (tripod position), and use of accessory muscles.

Documentation Example

• Sample Case Outlining:
  • A 60-year-old male with dry cough, no fever, and related symptoms.
  • Discuss relevant history and exam findings.

Conclusion

• Comprehensive assessment of the respiratory system is crucial for identifying pathologies and guiding treatment plans.