Resp Flashcards
(22 cards)
Identify on skeleton bony landmarks of the thoracic region including thoracic vertebrae, sternum and ribs.
learn anatomy of vertebra, ribs and sternum
Identify surface markings of bony landmarks – suprasternal notch.
Jugular notch (depression on the upper border of manubrium): T3
Identify surface markings of bony landmarks – sternal angle
Sternal angle: blunt ridge is felt at the manubriosternal joint: T4/T5
At the sternal angle: a) trachea bifurcates, b) aortic arch begins and ends, c) 2nd CC attaches
Identify surface markings of bony landmarks – xiphisternum,
Xiphisternum: T8/T9
Identify surface markings of bony landmarks – costal margins
10th CC: L2
The lateral border of rectus abdominis muscle meets the costal margin at the tip of the 9th costal cartilage (L1)
Identify surface markings of bony landmarks – sternal body
Body of sternum: T5-T8
Demonstrate symmetrical inflation of the lung and describe the anatomical basis.
Visual observation of movements of anterior chest wall:
Observe the movements of the rib cage and sternum during: A) Quiet breathing B) Deep breathing
- Examiner stands facing the subject and places hands firmly on the subject’s anterior chest wall (just below 5th or 6th ribs) with fingers extended around the sides of the chest
- The thumbs should just meet in the anterior midline (mid-sternal line), resting lightly on the chest wall, to allow its movement during respiration
- Female subjects: examiner’s hand should be laid beneath the breast
- Ask patient to take a deep breath
- Observe how far the tips of examiner’s thumbs move apart (at least 5 cm)
- Repeat this on the posterior chest wall with thumbs meeting in the posterior midline of T10
- NOTE: T7 is at the level of inferior angle of scapula
- Movement of the anterior chest wall gives some idea of expansion of upper and middle lobes
- Movement in the posterior chest wall indicates expansion of lower lobe of lung
- The purpose of this is to look for any asymmetry – e.g. in pneumothorax, the lung won’t move
Observe and describe the breathing pattern and the breathing rate.
- RATE: Breathing rate between 12 and 20 breaths per minute is normal (higher in children)
- HYPERPNEA: increased depth and rate of breathing
- HYPOPNEA: decreased depth and rate of breathing
- DEPTH: normal, deep and shallow
- RHYTHM: regular and irregular
Demonstrate percussion of upper lobe of right/left lungs.
Apex:
-Above clavicle anteriorly
- similar level posteriorly
Upper lobe:
-about 2nd ICS (deffo above 4th rib on right due to horizontal fissure) can do it on the 4th ICS on MCL on the left too ANTERIORLY
- T3 at MSL on both sides
-on left side- just below axilla on lateral chest wall
Demonstrate percussion of middle lobe(s) of right lungs.
Middle lobe: 4th ICS in MCL ON RIGHT ONLY (still purcuss the left but it would be the upper lobe still as it doesnt have a middle lobe)
NONE POSTERIORLy but can test just below axilla on lateral chest wall on the RIGHT ONLY
Demonstrate percussion of lower lobe(s) of right/left lungs.
6th ICS on MAL (below 6th rib as oblique fissure) anteriorly
posteriorly- below T3 again because of horizontal fissure
Describe and demonstrate where you would auscultate upper/middle/lower lobe(s) of right/left lungs.
similar to percussion: but make sure they breathe through the mouth
upper lobe:
-Apex and 2nd ICS anteriorly (and 4th ICS on LEFT)
-above T3 and apex posteriorly
Describe and demonstrate where you would auscultate middle lobe of right lung
similar to percussion: but make sure they breathe through the mouth
Middle lobe:
-ON RIGHT: 4th ICS in MCL Anteriorly (no posterior)
Describe and demonstrate where you would auscultate lower lobe of right/left lung.
similar to percussion: but make sure they breathe through the mouth:
Lower lobe:
-6th ICS in AAL ( a bit laterally to MCL) anteriorly
-below T3 posteriorly
Describe & demonstrate the surface markings of upper lobe of right
UPPER: apex (1ich above medical 3rd of clavicle) to sterno Clavicular Jt to sternal angle (2nd CC) then down to 4th cc, the along 4th rib (horzintal fissure ) to 6th rib on MAL (where it meets oblique fissure) then to T3.
Describe & demonstrate the surface markings of upper, and lower lobe of left lungs.
UPPER: apex down to 4th rib (following median sternal line ) then cardiac notch till rib 6 (2-3 cm at 5th CC) then oblique fissure (smooth line from 6th CC to T3 along medial border of the abducted scapula)
Short cut: The oblique fissure closely follows the medial border of the scapula when the arm is raised above the head of the subject.
Describe & demonstrate the surface markings of middle lobe of right lung:
MIDDLE: horizontal fissure ( 4th rib horizontally) to where it meets oblique in MAL then to T4 (close to medial border of scapula)
Describe & demonstrate the surface markings of lower lobe of right lung:
6th rib in MCL, to where it meets horizontal fissure. also 8th rib MAL and 10th rib scapular line and t10
Describe & demonstrate the surface markings of the lower lobe of left lungs.
LOWER: Oblique fissure ( 6th CC to T3) along medial border of scapula when abducted. from 6th rib at MCL to 8th at MAL to 10th at scapular line and then to T10
Describe & demonstrate the surface marking of the inferior margin of parietal pleura of right/left lung.
Same as lungs but 2 down from MCL:
- 8th rib at MCL
- 10th rib at MAL
- 12th rib at scapular line
- transverse process of L1 vertebra at bottom and T1 at top
ON LEFT CARDIAC NOTCH IS LESS DEVIATED THAN THE LUNG (only 1 cm at 5th CC
Describe and demonstrate the triangle of safety for insertion of a chest drain.
Posterior border: Latissimus dorsi - posterior axillary fold
- Anterior border: Pectoralis major - anterior axillary fold
- Inferior border: 5th intercostal space at mid-axillary line
- Superior border: below apex of axilla
- Chest drains used for pneumothorax, haemothorax, pleural effusion and post-operative matters
Describe & demonstrate the surface marking of inferior margin of the visceral pleura of right/left lung.
Same as lung:
6th rib at MCL
8th rib at MAL
10th rib at scapular line
