《胸部查体英文》PPT课件.ppt

Physical Examination in Respiratory System wang yingyan,1. Superficial landmarks, imaginary lines and regions of the chest,Anterior landmark,Anterior landmark,Sternal angle (louis angle) Costicartilage of second rib Bronchial bifurcation The superior edge of cardiac atrium The junction of upper and lower mediastinum The level of fifth thoracic vertebrae posterior,Posterior landmark,The scapular angle sit or stand, arms at the sideseventh rib or interspace or the level of eighth thoracic vertebra The seventh cervical vertebral spine prominently protruding,Anterior imaginary lines,Anterior midline drawn through the middle of the sternum Midclavicular line drawn through the middle of the clavicle,Lateral imaginary lines,Anterior axillary line,Posterior axillary line,Midaxillary line,Anterior axillary line drawn along the anterior axillary folds Midaxillary line drawn from the vertex of the axillae Posterior axillary line drawn along the posterior axillary folds,Posterior imaginary lines,Posterior midline drawn through the pos-terior spinous process of vertebrae Scapular line drawn through the scapular angle,Anterior fossae,Axillary fossa,Posterior imaginary region,2. Thorax,Shape : symmetrical without deformity Anteroposterior /transverse diameter is 1:1.5,Respiratory rhythm： regular and symmetric model Abdominal respiratorymen and children Chest respiratorywomen vein tenderness or subcutaneous crepitus,4. Lung,Inspection,Respiratory rate: 14-18 cycles per minute Intercostal space: narrow, wide,Palpation,Chest excursion Hands along costal margin Inspire deeply Observe movement,Vocal fremitus place both palm or the unlar side of the hands on the symmetrical position with a light touch repeat word “yi” compare vibration,Pleural friction rubs Breathe deeply, Place palm or the ulnar side of hands on the inferior anterior lateral portion of the chest Like two pieces of leather rubbed Holding breathing disappeared,Percussion,1. Position,Sit or lie, balanced body, relax muscle, quiet and even breathing Anterior：throwing out his chest anteriorly Lateral : arms slightly abducted beyond the head Back : pulling shoulder forward, arm folded in front, spine anteflexed, head lower,2. Method,Direct percussion Strike directly with palmar tips of right middle three fingers Indirect percussion Pleximeter: distal phalanx of left middle finger Plexor: right middle finger tip, distal interphalangeal joint of pleximeter finger Sequence Top to bottom anterior to posterior ,lateral thorax,3. Classification,Resonance Normal Hyperresonance Emphysema Tympany Cavity or pneumothorax , normal abdomen,Dullness Pleural effusion, consolidation of the lung, Flatness Massive Pleural effusion, solid organs,4. Normal sound,Lungs sound in percussion Resonance Slight dullness in some areas (upper, right, back) due to thickness of muscles and skeletons,Lower border 6th, 8th, 10th intercostal space in midclavicular line, midaxillary line, scapular line, respectively,5. Contents,s,Along the scapular line Percussing bottom of lung, marking Asking the pat. to inspire deeply and hold Percussing bottom of lung, marking Asking the pat. to expire deeply and hold Percussing bottom of lung, marking Measuring the dist. between upper and lower lines,Movement of the inferior lung base,Auscultation,Position : sit or supine Method : Top to bottom, anterior to lateral to posterior,Order of auscultation,Normal breath sound,Bronchial breath sound suprasternal fossa, around 6th, 7th cervical vertebra, 1st, 2nd thoracic vertebra Longer,louder ,higher pitch in expiratory phase Bronchovesicular breath sound 1st, 2nd