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ADVANCED ASSESSMENT Chest Assessment & Auscultation

ONTARIO. QUIT. BASE HOSPITAL GROUP. ADVANCED ASSESSMENT Chest Assessment & Auscultation. 2007 Ontario Base Hospital Group. ADVANCED ASSESSMENT Chest Assessment & Auscultation. AUTHORS Mike Muir AEMCA, ACP, BHSc Paramedic Program Manager Grey-Bruce-Huron Paramedic Base Hospital

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ADVANCED ASSESSMENT Chest Assessment & Auscultation

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  1. ONTARIO QUIT BASE HOSPITAL GROUP ADVANCED ASSESSMENT Chest Assessment & Auscultation 2007 Ontario Base Hospital Group

  2. ADVANCED ASSESSMENT Chest Assessment & Auscultation AUTHORS Mike Muir AEMCA, ACP, BHSc Paramedic Program Manager Grey-Bruce-Huron Paramedic Base Hospital Grey Bruce Health Services, Owen Sound Kevin McNab AEMCA, ACP Quality Assurance Manager Huron County EMS References – Emergency Medicine REVIEWERS/CONTRIBUTORS Rob Theriault EMCA, RCT(Adv.), CCP(F) Peel Region Base Hospital Donna L. Smith AEMCA, ACP Hamilton Base Hospital Tim Dodd, AEMCA, ACP Hamilton Base Hospital 2007 Ontario Base Hospital Group

  3. MENU QUIT EVALUATE THE PATIENT LOOK FOR SIGNS OF DISTRESSVisual Assessment

  4. Workload Position Ability to speak Check for surgical scars MENU QUIT General Appearance

  5. Normal 12-24 Respiratory pathologies may cause rate to be increased and shallow MENU QUIT Rate of Respirations

  6. Inspiratory Sternocleidomastoids Scalenes Trapezius Expiratory Internal Intercostals Abdominal Muscles MENU QUIT Accessory Muscles=Distress

  7. MENU QUIT

  8. MENU QUIT Oxygen consumption with breathing Normal 5% Distress 25%

  9. MENU QUIT

  10. Resistance = Prolongation I:E Ratio Purse-lip breathing Prolonged expiratory phase MENU QUIT Inspiratory Expiratory Ratio 2:3

  11. Bronchoconstriction/Wet Heavy Lungs = Increased workload of breathing decreased gas exchange leads to LOA NEED POSITIVE PRESSURE VENTILATION MENU QUIT LOA and workload of breathing

  12. MENU QUIT Skin condition in distress Blue = Bad (CYANOSIS) Diaphoresis = Sympathetic Stimulation

  13. Palpation Predominantly used to find traumatic injuries Tenderness, pain, crepitus Subcutaneous emphysema MENU QUIT Physical Exam

  14. Breath Sounds Produced by air passing through respiratory system  Sound on inspiration (louder) Expiration (Quieter) MENU QUIT Auscultation

  15. Breath SoundLocationI/ERatioDescription Bronchial Heard over trachea I E Loud, Harsh 2 to 3 High pitched ---------------------------------------------------------------------------------------------------------------- Broncho- Anteriorly: near I E Soft, Breezy Vesicular 1st and 2nd IC spaces Posteriorly: 1 to 1 Pitch is lower than Bronchial Between scapulas ---------------------------------------------------------------------------------------------------------------- Vesicular Lungs periphery I E Softer, swishy Not over sternum Pitch is lower over scapulas 3 to 1 than Broncho vesicular MENU QUIT Normal Breath Sounds

  16. Breath sounds to the bases Equal breath sounds Inspiration Expiration Abnormal breath sounds Absent or diminished breath sounds Displaced bronchial breath sounds Adventitious breath sounds MENU QUIT Listen with intent for

  17. Most common cause air passing through fluid (other?) Fine = Smaller airways Coarse = Larger airways Predominantly heard on inspiration Can be equal both lungs Can be isolated to one area MENU QUIT Crackles

  18. Produced by air forcing its way through narrowed airways (bronchoconstricted) High pitched musical sounds heard on expiration Can be heard on inspiration Smooth Muscles Irritation = Bronchoconstriction MENU QUIT Wheezes

  19. High pitched continuous crowing sound that is heard over the trachea and larynx Stethoscope not normally needed Best heard over neck Partial airway obstruction from: MENU QUIT Stridor • foreign objects, swelling

  20. Constant grating sound that is heard on inspiration and expiration Caused from parietal and visceral pleura rubbing together Pleura inflamed (loss of serous fluid) Usually localized MENU QUIT Pleural Rub

  21. Attempt to place patient in sitting position Attempt to minimize as much outside noise as possible Encourage patient not to make any moaning and groaning noises *Auscultation should take place within the first 2 minutes MENU QUIT Proper Auscultation Procedure

  22. WHERE SHOULD I LISTEN? MENU QUIT

  23. MENU QUIT

  24. MENU QUIT Anterior Chest

  25. MENU QUIT Posterior Chest

  26. MENU QUIT Question # 1 Why do sick asthmatics often have very little wheezing? Severe bronchoconstriction resulting in decreased ventilation and movement of air resulting in decreased wheezing A B The patient is faking it The patient has used their Ventolin and no longer has wheezes C D Asthmatics have crackles

  27. MENU QUIT Question # 1 Why do sick asthmatics often have very little wheezing? Severe bronchoconstriction resulting in decreased ventilation and movement of air resulting in decreased wheezing A B The patient is faking it The patient has used their Ventolin and no longer has wheezes C D Asthmatics have crackles

  28. MENU QUIT Question # 2 You are called for a child choking. You note small toys around the child. Which of the following breath sounds are you most likely to hear with a foreign body aspiration? A Crackles B Wheezing C Stridor D Friction rub

  29. MENU QUIT Question # 2 You are called for a child choking. You note small toys around the child. Which of the following breath sounds are you most likely to hear with a foreign body aspiration? A Crackles B Wheezing C Stridor D Friction rub

  30. MENU QUIT Question # 4 A high pitched airway noise that results from lower airway narrowing is known as: A Rales B Stridor C Crackles D Wheezing

  31. MENU QUIT Question # 4 A high pitched airway noise that results from lower airway narrowing is known as: A Rales B Stridor C Crackles D Wheezing

  32. MENU QUIT Question # 5 End inspiratory sounds associated with fluid in the small airways are known as: A Crackles B Vesicular C Wheezes D Stridor

  33. MENU QUIT Question # 5 End inspiratory sounds associated with fluid in the small airways are known as: A Crackles B Vesicular C Wheezes D Stridor

  34. MENU QUIT Question # 6 Chest wall diameter may be increased in patients with what condition? A Pregnancy B Heart Disease C Rib fractures D Obstructive Pulmonary Disease

  35. MENU QUIT Question # 6 Chest wall diameter may be increased in patients with what condition? A Pregnancy B Heart Disease C Rib fractures D Obstructive Pulmonary Disease

  36. MENU QUIT Question # 8 During inspiration, the major muscle utilized in the healthy normal patient is the: A Diaphragm B Intercostals C Scalenes D Sternocleidomastoid muscles

  37. MENU QUIT Question # 8 During inspiration, the major muscle utilized in the healthy normal patient is the: A Diaphragm B Intercostals C Scalenes D Sternocleidomastoid muscles

  38. MENU QUIT Question # 9 When wanting to auscultate the chest at the bases, the best location would be: A The eighth rib mid-axillary B The sixth rib anterior chest wall C T3 posterior chest wall The eighth rib anterior chest wall D

  39. MENU QUIT Question # 9 When wanting to auscultate the chest at the bases, the best location would be: A The eighth rib mid-axillary B The sixth rib anterior chest wall C T3 posterior chest wall The eighth rib anterior chest wall D

  40. MENU QUIT Question # 10 Abnormal breath sounds can be: A Absent or diminished breath sounds B Displaced bronchial breath sounds C Adventitious breath sounds D All of the above

  41. MENU QUIT Question # 10 Abnormal breath sounds can be: A Absent or diminished breath sounds B Displaced bronchial breath sounds C Adventitious breath sounds D All of the above

  42. ONTARIO START QUIT BASE HOSPITAL GROUP Well Done! Ontario Base Hospital GroupSelf-directed Education Program

  43. MENU QUIT SORRY, THAT’S NOT THE CORRECT ANSWER 

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