What are the break down segments of the right upper middle and lower lobe?
upper- apical, anterior posterior
middle- medial, lateral
lower- superior, anterior basal, medial basal, lateral basal, posterior basal
What are the break down segments of the left upper lingula and lower lobe?
upper- apical, anterior, posterior, superior, inferior
middle- superior, inferior
lower- superior, anterior basal, lateral basal, posterior basal
How should you prepare for auscultation?
inform patient what going to do and gain consent
ask patient to remove excess clothing but maintain dignity
position patient to access anterior and posterior aspects
(ideal upright scapula protracted, if not side lying)
before use stethoscope listen to what can hear
ear pieces face forward, diaphragm side on chest
ask patient not to speak and breathe through their mouth slightly deeper than normal (if pick up abnormal sounds=ask to breathe deeper)
listen to whole cycle on alternate sides
What is a monophonic wheeze in the upper airway indicative of?
stridor is a serious sign denoting laryngeal or tracheal narrowing as small as 5mm (a medical emergency)
Where would you auscultate the apical segment of the superior lobe?
Above the clavicle L+R
Where would you anteriorly auscultate the anterior segment of the superior lobe?
Below the clavicle L+R
Where would you auscultate the anterior basal segment of the inferior lobe?
Lower zone- approx 6th rib
Where would you auscultate the lateral basal segment of the inferior lobe?
Lower zone- mid axillary 6th rib
Where would you posteriorly auscultate superior lobe?
L+R upper zones above T3
Where would you posteriorly auscultate inferior lobe?
L+R lower zone below T3
What are the areas to auscultate?
Anterior: 2 above clavicle 2 below clavicle 4 middle lobe come into mid-axillary around 8th rib on lateral? (or 6th) posterior: 2 sites superior lobe everything below T3 is lower lobe
What are the surface lung markings?
2-3 cm above the medial end of the clavicle, at the level of the the angle of Louis, R, goes straight down to 6th costal cartilage, L goes down to 4th costal cartilage then out around heart to join at 6th costal cartilage, to 8th. rib in mid axillary line, round posteriorly to T10, then back up to join at the apex, approx 2-3cm away from spine
Approximately where is the horizontal and oblique fissure?
horizontal from 5th rib mid axillary to 4th costal cartilage
oblique fissure from T3 along medial border of scapula when arm abducted, joins round at 6th costal cartilage anteriorly
What level of the spine is the inferior angle at? What rib is next to T11 and T1O etc?
inferior angle= T7
T10=rib 9
T11= rib 10
What are the 3 examples of normal breath sounds?
Vesicular, insp longer than exp, soft and low pitch
trachea insp=exp heard over trachea
bronchial exp longer than insp, gap between insp and exp, heard of manubirum
If you were to hear bronchial breath sounds in the periphery of the lung what is this indicative of?
sign of consolidation
Why are normal breath sounds quieter in the bases of the lung than the apex?
Because the bases have a greater volume which filters sound further
Why are normal breath sounds muffled?
Because air in the alveoli filters the sound
What would cause a diminished breath sound on auscultation?
there is no air entry to generate sound e.g. atelectasis
there is air entry but transmission of sounds is deflected by an acoustic barrier e.g. it is blocked by a solid/liquid interface i.e consolidation
there is not enough air flow to generate a sound or excess air in the lung e.g. hyperinflation
How may the patient present if they have diminished breathe sounds?
obese
poor positioning
not breathing deeply
What are the 4 examples of abnormal/added sounds?
crackles, wheezes, pleural rub, voice sounds
What is a crackle?
A sudden opening of small airways/alveoli previously stuck together by fluid
(airway still patent air into alveoli causes cracked as going into liquid interface)
Where crackles occur help identify pathology. if crackles are heard:
early inspiration in the large airways
early and mid inspiration and expiration
late inspiration in alveoli and peripheral airways
what is this indicative of?
early inspiration in the large airways -COPD
early and mid inspiration and expiration- bronchiectasis
late inspiration in alveoli and peripheral airways- Pneumonia, fibrosis, pulmonary oedema
What is a wheeze?
High pitched and continuous caused by vibration of the walls of a narrowed airway as air rushed through
