498485741-Respiratory-System-Examination.pptx

ppt

1. RESPIRATORY SYSTEM EXAMINATION DR AXELLE SAVERETTIAR

2. Position of subject The respiratory system examination is ideally done with the subject comfortably resting on the bed, sitting at an angle of 45˚ and supported by pillows.

3. RESPIRATORY SYSTEM EXAMINATION

4. 1. INSPECTION I. SHAPE OF THE CHEST Bilaterally symmetrical and elliptical in cross section. Anteroposterior diameter is less than the transverse diameter in a ratio of 5:7 .

5. Abnormal forms of chest A. PIGEON CHEST Chest is elliptical with prominent sternum. Seen in rickets .

6. Abnormal forms of chest B. SCOLIOSIS It is the lateral bending of the vertebral column. P rominence of front of the chest on one side with flattening on the other side.

7. Abnormal forms of chest C. KYPHOSIS It is the forward bending of the vertebral column S hortening of the chest with prominent sternum.

8. Abnormal forms of chest D. BARREL SHAPE CHEST AP diameter of chest increases. It is seen in: Emphysema Bronchial asthma Fibrosis Collapse of lungs

9. 1. INSPECTION II. MOVEMENTS OF THE CHEST a. Rate of respiration Normal rate is 12 – 16 breaths per minute

10. II. MOVEMENTS OF THE CHEST 1. INSPECTION

11. 1. INSPECTION II. MOVEMENTS OF THE CHEST b. Depth of respiration Deep breathing – brain damage Shallow breathing – bronchial asthma

12. 1. INSPECTION II. MOVEMENTS OF THE CHEST c. Rhythm of respiration The normal respiration has regular rhythm with inspiration longer than expiration.

13. 1. INSPECTION II. MOVEMENTS OF THE CHEST d. Expansion of chest Normally both sides of the chest wall move symmetrically (equal on both sides ) Diminished or asymmetrical movements: Consolidation Collapse Fibrosis Pleural effusion Hydro pneumothorax

14. 1. INSPECTION II. MOVEMENTS OF THE CHEST e. Type of respiration Normal – Abdominal

15. 2. PALPATION I. POSITION OF TRACHEA Normal position of trachea is central

16. 2. PALPATION Trachea pulled towards the affected side Collapse Fibrosis of lung Trachea pushed away from affected side Pleural effusion Pneumothorax

17. 2. PALPATION II. POSITION OF APEX BEAT Normal position - 9 cm from midline in the left 5 th intercostal space .

18. 2. PALPATION II. POSITION OF APEX BEAT Cardiac impulse refers to movements occurring due to the impact of the heart against the chest wall during the systole. The apex beat is the lowest and outermost point of definite cardiac impulse, where it is seen / felt most forcibly (point of maximum impulse).

19. 2. PALPATION

20. 2. PALPATION III. EXPANSION OF THE CHEST Two methods: 1. Using a measuring tape Normal chest expansion is 5 – 8 cm. 2. Grasping the chest

21. 2. PALPATION III. EXPANSION OF THE CHEST Using a measuring tape Chest expansion can be measured using a measuring tape around the chest at the level of the nipples. Grasping the chest Place finger tips of both hands on either side of the lower rib cage. Tips of the thumbs meet in the midline in the front but not touch the chest. Ask subject to take deep breath so that the distance between the thumbs will increase and it will indicate degree of expansion. If one thumb remains closer to midline this means that there is decreased expansion of that side.

22. EXAMINATION OF CHEST   RIGHT LEFT ANTERIOR Supra - clavicular Supra - clavicular   Supra - mammary Supra - mammary   Mammary Mammary   Infra - mammary Infra - mammary   Axillary     Infra - axillary         POSTERIOR Supra – scapular Supra – scapular   Inter – scapular     Infra – scapular Infra – scapular

23. EXAMINATION OF CHEST

24. 2. PALPATION IV. VOCAL FREMITUS Vocal : pertaining to voice Fremitus : vibratory sensation perceived by palpation Sound vibrations from the larynx pass down the bronchi and cause the lungs and the chest wall to vibrate.

25. 2. PALPATION IV. VOCAL FREMITUS The vibration may be detected by palpation by ulnar border of hand placed flat on the chest. The subject is then asked to repeat 1 1 1 or 9 9 9 or Ram Ram Ram The vibrations are perceived by the examining hand. Compare right and left side

26. 2. PALPATION IV. VOCAL FREMITUS

27. 2. PALPATION IV. VOCAL FREMITUS

28. 3. PERCUSSION Normal percussion note of the lungs is resonant

29. 3. PERCUSSION Lower limit of left lung: Note changes from resonant to tympanic due to presence of stomach Lower limit of right lung: 6 th rib – Mammary line 8 th rib – Mid axillary line 10 th rib – Scapular line

30. 3. PERCUSSION

31. 4. AUSCULTATION I. BREATH SOUNDS Two main types of breath sounds can normally be heard over the chest: Vesicular Bronchial

32. 4. AUSCULTATION I. BREATH SOUNDS

33. 4. AUSCULTATION I. BREATH SOUNDS a. Vesicular breath sound It is characterized by active inspiration due to passage of air into bronchi and alveoli followed without a pause by passive expiration due to elastic recoil of the alveoli which occurs maximally in the early phases giving an apparent impression of short expiration.

34. 4. AUSCULTATION I. BREATH SOUNDS

35. 4. AUSCULTATION I. BREATH SOUNDS b. Bronchial breath sound It is characterized by active inspiration due to passage of air into the bronchi. The alveolar phase is absent (because of consolidation in alveoli) and hence expiration is also active occupying the same duration time as inspiration.

36.   VESICULAR BREATH SOUNDS BRONCHIAL BREATH SOUNDS Origin In larger airways In larger airways When the lung between the airways and chest wall is airless as in consolidation, fibrosis and collapse of lungs Character Low pitch rustling sound High frequency and harsh Inspiration and Expiration No gap between end of inspiration and beginning of expiration Inspiration is twice as long as expiration Gap between end of inspiration and beginning of expiration Inspiration and expiration are of same duration Sites Heard all over healthy lungs (chest) Heard over trachea Heard in patients with consolidation, fibrosis and collapse of lungs

37. 4. AUSCULTATION II. VOCAL RESONANCE It is the sound of the voice heard on auscultation of the chest . When subject repeats 1 1 1 or 9 9 9, the ear perceives not only the distinct syllables but a resonant sound.

38. 4. AUSCULTATION

39. 4. AUSCULTATION III. ADDED SOUNDS a. Pleural rub It occurs due to inflammation of pleura and it gives rise to a characteristic friction rub. b. Rhonchi or wheeze They are continuous musical sounds associated with airway narrowing and particularly heard during expiration Seen in bronchitis and bronchial asthma

40. 4. AUSCULTATION III. ADDED SOUNDS c. Crepitations or crackles They are crackling sounds produced by sudden change in pressure related to sudden opening of previously closed airways. It is heard both during expiration and inspiration. Seen in pneumonia . d. Stridor It is a loud inspiratory sound heard over the airways due to obstruction to the respiratory tract mainly the larynx and trachea.