Local Examination Local Examination Of The Chest Of The Chest Iman Galal Iman Galal Assistant Professor Pulmonary Medicine Assistant Professor Pulmonary Medicine Ain Shams University Ain Shams University E-mail: [email protected]E-mail: [email protected]
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Local Examination Local Examination Of The ChestOf The Chest
Iman GalalIman GalalAssistant Professor Pulmonary MedicineAssistant Professor Pulmonary Medicine
1.1. Percuss from side to side Percuss from side to side and top to bottom using and top to bottom using the pattern shown in the the pattern shown in the illustration. illustration.
2.2. Compare one side to the Compare one side to the other looking for other looking for asymmetry. asymmetry.
3.3. Note the location and Note the location and quality of the percussion quality of the percussion sounds you hear. sounds you hear.
1.1. Percuss from side to side and Percuss from side to side and top to bottom using this top to bottom using this pattern. Omit the areas pattern. Omit the areas covered by the scapulae. covered by the scapulae.
2.2. Compare one side to the other Compare one side to the other looking for asymmetry. looking for asymmetry.
3.3. Note the location and quality Note the location and quality of the percussion sounds you of the percussion sounds you hear. hear.
4.4. Find the level of the Find the level of the diaphragmatic dullness on diaphragmatic dullness on both sides. both sides.
Page 33
Traube’s area:Traube’s area:
4 points:4 points:
Left 6Left 6thth rib in the MCL to 8 rib in the MCL to 8thth costal cartilage in the costal cartilage in the
parasternal line ,then along the left costal margin parasternal line ,then along the left costal margin
to the 11to the 11thth rib in the MAL, then the 9 rib in the MAL, then the 9thth rib in the rib in the
MAL.MAL.
Page 34
Kronig’s Isthmus :Kronig’s Isthmus :
It is a band of resonance representing lung apex.It is a band of resonance representing lung apex.
LaterallyLaterally it is marked by a line joining 2 points:it is marked by a line joining 2 points:
1.1. The junction of the medial 2/3 of the clavicle with The junction of the medial 2/3 of the clavicle with
the lateral 1/3.the lateral 1/3.
2.2. The junction of the medial 1/3 of the scapular The junction of the medial 1/3 of the scapular
spine with the lateral 2/3.spine with the lateral 2/3.
MediallyMedially marked by a line between the sternal marked by a line between the sternal
end of clavicle and the 7end of clavicle and the 7thth cervical spine. cervical spine.
Page 35
Bare area of the heart :Bare area of the heart :
Medial border: left lateral border of the sternumMedial border: left lateral border of the sternum
Lateral border: left parasternal lineLateral border: left parasternal line
Superior border: lower border of Lt 4Superior border: lower border of Lt 4thth rib. rib.
Inferior border: upper border of Lt 6Inferior border: upper border of Lt 6thth rib rib
Page 36
Surface anatomy of liver:Surface anatomy of liver:
Upper border:Upper border:
It starts from the left 6It starts from the left 6thth rib rib just inside the MCL, just inside the MCL,
passing to the Rt and slightly upwards to the 5passing to the Rt and slightly upwards to the 5thth rib rib
in the MCL, then the 7in the MCL, then the 7thth rib in anterior axillary line, rib in anterior axillary line,
to the 9to the 9thth rib in mid-axillary line. rib in mid-axillary line.
Page 37
1.1. Find the level of the diaphragmatic dullness on both Find the level of the diaphragmatic dullness on both
sides. sides.
2.2. Ask the patient to inspire deeply. Ask the patient to inspire deeply.
3.3. The level of dullness (diaphragmatic excursion) The level of dullness (diaphragmatic excursion)
should go down 3-5cm should go down 3-5cm symmetricallysymmetrically. .
4.4. Decreased or asymmetric diaphragmatic excursion Decreased or asymmetric diaphragmatic excursion
may indicate paralysis or emphysema.may indicate paralysis or emphysema.
Diaphragmatic ExcursionDiaphragmatic ExcursionLocal Examination of the Local Examination of the ChestChest
Page 38
1. It is used to differentiate supra-diaphragmatic from
infra-diaphragmatic dullness.
2. While the patient seated find the upper level of
dullness
3. Ask the patient to take deep inspiration and to hold
it then percuss again.
4. If the note becomes resonant infra-diaphragmatic
cause.
5. If there is no change of the note supra-
diaphragmatic cause as pleural effusion.
Tidal percussion:Tidal percussion: Local Examination of the Local Examination of the ChestChest
Page 39
Auscultation:Auscultation:
Intensity of breath soundsIntensity of breath sounds
Local Examination of the Local Examination of the ChestChest
Page 40
Technique of Auscultation
• While the patient relaxed and breathes normally While the patient relaxed and breathes normally with mouth open, auscultate the lungs, making sure with mouth open, auscultate the lungs, making sure to auscultate the apices and middle and lower lung to auscultate the apices and middle and lower lung fields posteriorly, laterally and anteriorly. fields posteriorly, laterally and anteriorly.
• Alternate and compare both sides at each site. Alternate and compare both sides at each site.
• Listen to at least one complete respiratory cycle at Listen to at least one complete respiratory cycle at each site. each site.
• First listen with quiet respiration. If breath sounds First listen with quiet respiration. If breath sounds are inaudible, then have him take deep breaths. are inaudible, then have him take deep breaths.
• First describe the breath sounds and then the First describe the breath sounds and then the adventitious sounds. adventitious sounds.
Local Examination of the Local Examination of the ChestChest
Page 41
Technique of AuscultationTechnique of Auscultation
•Note the intensity of breath sounds and make a Note the intensity of breath sounds and make a
comparison with the opposite side. comparison with the opposite side.
•Assess length of inspiration and expiration. Listen for Assess length of inspiration and expiration. Listen for
a pause between inspiration, expiration and the a pause between inspiration, expiration and the
quality of pitch of the sound quality of pitch of the sound
•Also compare the intensity of breath sounds between Also compare the intensity of breath sounds between
upper and lower chest in upright position. Compare upper and lower chest in upright position. Compare
the intensity of breath sounds from dependent to top the intensity of breath sounds from dependent to top
lung in the decubitus position. lung in the decubitus position.
•Note the presence or absence of adventitious sounds.Note the presence or absence of adventitious sounds.
Local Examination of the Local Examination of the ChestChest
Page 42
Bronchial breathing may be heard in:Bronchial breathing may be heard in:
ConsolidationConsolidation
Collapse with patent large airwaysCollapse with patent large airways
Compressed lung by a large pl effusion or a Compressed lung by a large pl effusion or a tension pneumothorax tension pneumothorax
Pulmonary fibrosisPulmonary fibrosis
CavitationCavitation
Local Examination of the Local Examination of the ChestChestAuscultation: Auscultation: Bronchial BreathingBronchial Breathing