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Thorax and Lungs

Thorax and Lungs. Landmarks. Anterior Ribs Intercostal space – below corresponding rib Manubriosternal angle Costal margin Posterior Prominens and Processes Scapula 12 th rib. Lines of Reference. Anterior Anterior axillary Midclavicular Midsternal Posterior Scapular Vertebral

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Thorax and Lungs

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  1. Thorax and Lungs

  2. Landmarks • Anterior • Ribs • Intercostal space – below corresponding rib • Manubriosternal angle • Costal margin • Posterior • Prominens and Processes • Scapula • 12th rib

  3. Lines of Reference • Anterior • Anterior axillary • Midclavicular • Midsternal • Posterior • Scapular • Vertebral • Lateral • Anterior, Mid, and Posterior Axillary lines

  4. Lungs • Asymmetrical lobes • Pleurae • Trachea • Bronchial tree

  5. Breathing • Purpose • Supply oxygen • Remove carbon dioxide • Maintain acid-base balance • Heat exchange • Control • Hypercapnia • Hypoxemia • pH

  6. Breathing • Respiration – chest cavity changes shape • Inspiration • Superior-Inferior • Diaphragm • Sternocleidomastoid • Scalenus • Posterior-Anterior • External intercostals • Expiration – passive plus • Abdominals • Internal intercostals

  7. History • Cough • Shortness of Breath • Chest Pain with breathing • Past history of Resp Illnesses • Smoking history (packs per day, pack years) • Environmental exposure • Self-care

  8. Developmental Considerations • Infant and children • Allergy • Colds • Wheezing, asthma • Childproofing home • Smokers • Aging adult • Dyspnea on exertion • Activity level, particularly changes • Chronic Diseases

  9. Physical Examination • Inspection • Resp rate • Thoracic cage • Shape and AP diameter • Neck muscles • Posture/position – tripoding • Movement – ease, accessory muscles, retractions, • Skin and nails • Level of Consciousness

  10. Physical Examination • Palpation of Posterior Chest • Symmetric expansion • Tactile fremitus • Palpate chest wall • Percuss posterior chest • Lung fields • Diaphragmatic excursion • CVA tenderness • Auscultate posterior chest

  11. Physical examination • Inspect Anterior Chest • Palpate Anterior Chest • Expansion • Tactile • Tenderness • Percuss anterior chest • Auscultate anterior chest

  12. Normal Tracheal Bronchial Bronchovesicular Vesicular Adventitious Crackles/Rales Wheeze Rhonchus Rub Voice sounds Egophony Whispered petriloquy Bronchophony Breath Sounds

  13. Respiratory Conditions • Pneumonia • COPD • Chronic Bronchitis • Emphysema • Asthma • Heart Failure • Respiratory Failure

  14. Book References • Chest configurations: pg 374 – 376 • Respiration patterns, pg 374 – 376 • Normal breath sounds: pg 382 – 383 • Adventitious Sounds, pg 385 – 388 • Common Resp Conditions, pg 388 table 13-8

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