1、Physical Examination in Respiratory Systemwang yingyan1.Superficial landmarks,imaginary lines and regions of the chestAnterior landmarkManubriumgladiolusXiphoid processAnterior landmarkSternal angle (louis angle)lCosticartilage of second riblBronchial bifurcationlThe superior edge of cardiac atriuml
2、The junction of upper and lower mediastinumlThe level of fifth thoracic vertebrae posteriorPosterior landmarklThe scapular angle sit or stand,arms at the sideseventh rib or interspace or the level of eighth thoracic vertebralThe seventh cervical vertebral spine prominently protrudingScapulae anglese
3、venth cervical vertebral spineAnterior imaginary linesAnterior midlineMidclavicular linelAnterior midline drawn through the middle of the sternumlMidclavicular line drawn through the middle of the clavicleLateral imaginary linesAnterior axillary linePosterior axillary lineMidaxillary linelAnterior a
4、xillary line drawn along the anterior axillary foldslMidaxillary line drawn from the vertex of the axillaelPosterior axillary line drawn along the posterior axillary foldsPosterior imaginary linesScapular linePosterior midlinelPosterior midline drawn through the pos-terior spinous process of vertebr
5、aelScapular line drawn through the scapular angleAnterior fossaeEpigastric angle Infraclavicular fossaSuprasternal fossaSupraclavicular fossaAxillary fossaAxillary fossaPosterior imaginary regionInfrascapular regionInterscapular regionSuprascapular region2.Thoraxn nShape:symmetrical without deformit
6、y Anteroposterior/transverse diameter is 1:1.5n nRespiratory rhythm：regular and symmetric model n nAbdominal respiratorymen and childrenAbdominal respiratorymen and childrenn nChest respiratorywomenChest respiratorywomenn nvein n ntenderness or subcutaneous crepitus4.LungInspection lRespiratory rate
7、14-18 cycles per minutelIntercostal space:narrow,widePalpation n nChest excursionChest excursionn nHands along costal marginHands along costal marginn nInspire deeply Inspire deeply n nObserve movementObserve movementn nVocal fremitus place both palm or the place both palm or the unlarunlar side of
8、 the hands on the side of the hands on the symmetrical position with a symmetrical position with a light touchlight touch repeat word“repeat word“yiyi”compare vibration compare vibrationn nPleural friction rubsn nBreathe deeply,Breathe deeply,n nPlace palm or the Place palm or the ulnarulnar side of
9、 hands on side of hands on the inferior anterior lateral portion of the the inferior anterior lateral portion of the chestchestn nLike two pieces of leather rubbedLike two pieces of leather rubbedn nHolding breathing disappeared Holding breathing disappeared Percussion1.Position n nSit or lie,balanc
10、ed body,relax muscle,quiet and Sit or lie,balanced body,relax muscle,quiet and even breathingeven breathingn nAnteriorAnterior：throwing out his chest throwing out his chest anteriorlyanteriorlyn nLateral Lateral:arms slightly abducted beyond the:arms slightly abducted beyond the head head n nBackBac
11、k:pulling shoulder forward,:pulling shoulder forward,arm folded in front,arm folded in front,spine spine anteflexedanteflexed,head lower head lower2.Methodn nDirect percussionDirect percussionl lStrike directly with Strike directly with palmarpalmar tips of right tips of right middle three fingersmi
12、ddle three fingersn nIndirect percussionIndirect percussion l lPleximeterPleximeter:distal phalanx of left middle:distal phalanx of left middle finger finger l lPlexorPlexor:right middle finger tip,distal:right middle finger tip,distal interphalangealinterphalangeal joint of joint of pleximeterplexi
13、meter finger finger n nSequenceSequence l lTop to bottom Top to bottom l lanterior to posterior,lateral thoraxanterior to posterior,lateral thorax3.Classificationn nResonancen nNormal n nHyperresonancen nEmphysema n nTympanyn nCavity or pneumothorax,normal abdomenn nDullnessn nPleural effusion,conso
14、lidation of the lung,n nFlatnessn nMassive Pleural effusion,solid organs 4.Normal soundn nLungs sound in percussionn nResonanceResonancen nSlight dullness in some areas(upper,right,Slight dullness in some areas(upper,right,back)due to thickness of muscles and skeletonsback)due to thickness of muscle
15、s and skeletons n nLower bordern n6th,8th,10th intercostal space in midclavicular line,midaxillary line,scapular line,respectively 5.ContentssAlong the scapular linePercussing bottom of lung,markingAsking the pat.to inspire deeply and holdPercussing bottom of lung,markingAsking the pat.to expire dee
16、ply and holdPercussing bottom of lung,markingMeasuring the dist.between upper and lower linesnMovement of the inferior lung baseAuscultation n nPosition:sit or supinen nMethod :n nTop to bottom,anterior to lateral to posteriorTop to bottom,anterior to lateral to posteriorOrder of auscultation Normal
17、 breath soundn nBronchial breath soundBronchial breath soundn nsuprasternalsuprasternal fossafossa,around 6th,around 6th,7th cervical vertebra,1st,2nd 7th cervical vertebra,1st,2nd thoracic vertebrathoracic vertebran nLonger,louderLonger,louder,higher pitch in ,higher pitch in expiratoryexpiratory p
18、hase phasen nBronchovesicularBronchovesicular breath sound breath soundn n1st,2nd 1st,2nd intercostalintercostal space beside of space beside of sternum,the level of 3rd,4th sternum,the level of 3rd,4th thoracic vertebra in thoracic vertebra in interscaplarinterscaplar areaarean nVesicular breath soundVesicular breath soundn nMost area of lungsMost area of lungsn nLonger,louderLonger,louder,higher pitch in ,higher pitch in inspiratoryinspiratory phase phaseBronchovesicularBronchialBronchialBronchovesicular
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