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Due to transmitted air turbulence. Bronchial breathing. Harsher noises; prolonged during expiration. Heard over areas of consolidation, where sound is not filtered by alveoli. Amphoric breath sounds (less common) Hollow noises, heard over a large cavity. The sound is said to be like the noise of air passing over the top of a hollow jar. Intensity.
- Causes of Tracheal Deviation
What are the causes of tracheal deviation? Displacement...
- Types of Percussion Note
What are the types of percussion notes? Percussion Note...
- Types of Sputum
What is the significance of different sputum types? Type...
- Causes of Tracheal Deviation
- Wheezing. This high-pitched whistling noise can happen when you’re breathing in or out. It’s usually a sign that something is making your airways narrow or keeping air from flowing through them.
- Crackling (Rales) This is a series of short, explosive sounds. They can also sound like bubbling, rattling, or clicking. You’re more likely to have them when you breathe in, but they can happen when you breathe out, too.
- Stridor. This harsh, noisy, squeaking sound happens with every breath. It can be high or low, and it’s usually a sign that something is blocking your airways.
- Rhonchi. These low-pitched wheezing sounds sound like snoring and usually happen when you breathe out. They can be a sign that your bronchial tubes (the tubes that connect your trachea to your lungs) are thickening because of mucus.
- Introduction
- General Inspection
- Hands
- Jugular Venous Pressure
- Face
- Inspection of The Chest
- Trachea and Cricosternal Distance
- Palpation of The Chest
- Percussion of The Chest
- Auscultation of The Chest
Wash your hands and don PPEif appropriate. Introduce yourself to the patient including your name and role. Confirm the patient’s name and date of birth. Briefly explain what the examination will involve using patient-friendly language. Gain consentto proceed with the examination. Adjust the head of the bed to a 45° angle. Adequately expose the pati...
Clinical signs
Inspect the patient from the end of the bedwhilst at rest, looking for clinical signs suggestive of underlying pathology: 1. Age:the patient’s approximate age is helpful when considering the most likely underlying pathology, with younger patients more likely to have diagnoses such as asthma or cystic fibrosis (CF) and older patients more likely to have chronic obstructive pulmonary disease (COPD), interstitial lung disease or malignancy. 2. Cyanosis:bluish discolouration of the skin due to po...
Objects and equipment
Look for objects or equipmenton or around the patient that may provide useful insights into their medical history and current clinical status: 1. Oxygen delivery devices: note the type of oxygen device (e.g. Venturi mask, non-rebreathing mask, nasal cannulae) and the current flow rate of oxygen (e.g. 2L, 4L, 10L, 15L). Look for other forms of respiratory support such as CPAP or BiPAP. 2. Sputum pot:note the volume and colour of the contents (e.g. COPD/bronchiectasis). 3. Other medical equipme...
The handscan provide lots of clinically relevant information and therefore a focused, structured assessment is essential.
Jugular venous pressure(JVP) provides an indirect measure of central venous pressure. This is possible because the internal jugular vein (IJV) connects to the right atrium without any intervening valves, resulting in a continuous column of blood. The presence of this continuous column of blood means that changes in right atrial pressure are reflect...
General
Inspect the facefor any signs relevant to the respiratory system: 1. Plethoric complexion: a congested red-faced appearance associated with polycythaemia (e.g. COPD) and CO2 retention (e.g. type 2 respiratory failure).
Eyes
Inspect the eyesfor signs relevant to the respiratory system: 1. Conjunctival pallor: suggestive of underlying anaemia.Ask the patient to gently pull down their lower eyelid to allow you to inspect the conjunctiva. 2. Ptosis, miosis and enophthalmos: all features of Horner’s syndrome (anhydrosis is another important sign associated with the syndrome). Horner’s syndrome occurs when the sympathetic trunk is damaged by pathology such as lung cancer affecting the apex of the lung (e.g. Pancoast t...
Mouth
Inspect the mouthfor signs relevant to the respiratory system: 1. Central cyanosis:bluish discolouration of the lips and/or the tongue associated with hypoxaemia. 2. Oral candidiasis:a fungal infection commonly associated with steroid inhaler use (due to local immunosuppression). It is characterised by pseudomembranous white slough which can be easily wiped away to reveal underlying erythematous mucosa.
Scars
Closely inspect the chest wall for scars and other abnormalities: 1. Median sternotomy scar:located in the midline of the thorax. This surgical approach is used for cardiac valve replacement and coronary artery bypass grafts (CABG). 2. Axillary thoracotomy scar:located between the posterior border of the pectoralis major and anterior border of latissimus dorsi muscles, through the 4th or 5th intercostal space. This surgical approach is used for the insertion of chest drains. 3. Posterolateral...
Chest wall deformities
Inspect for evidence of chest wall deformities: 1. Asymmetry:typically associated with pneumonectomy (e.g. lung cancer) and thoracoplasty (e.g. tuberculosis). 2. Pectus excavatum:a caved-in or sunken appearance of the chest. 3. Pectus carinatum:protrusion of the sternum and ribs. 4. Hyperexpansion (a.k.a. ‘barrel chest’): chest wall appears wider and taller than normal. Associated with chronic lung diseases such as asthma and COPD.
Assess tracheal position
Gently assess the position of the trachea, which should be centralin healthy individuals (this can be uncomfortable, so warn the patient in advance): 1. Ensure patient’s neck musculature is relaxed by asking them to position their chin slightly downwards. 2. Dip your index finger into the thorax beside the trachea. 3. Gently apply side pressure to locate the border of the trachea. 4. Compare this space to the other side of the trachea using the same process. 5. A difference in the amount of s...
Assess cricosternal distance
Cricosternal distance is the distance between the inferior border of the cricoid cartilage and the suprasternal notch: 1. Measure the distance between the suprasternal notch and cricoid cartilage using your fingers. 2. In healthy individuals, the distance should be 3-4 fingers. Cricosternal distance is actually based on the size of the patient’s fingers so if their fingers are significantly different in size from your own, it may be worth using their fingers for the assessment.
Palpate the apex beat
1.Palpate the apex beat with your fingers placed horizontally across the chest. 2. In healthy individuals, it is typically located in the 5th intercostal space in the midclavicular line.
Assess chest expansion
1. Place your hands on the patient’s chest, inferior to the nipples. 2. Wrap your fingers around either side of the chest. 3. Bring your thumbs together in the midline, so that they touch. 4.Ask the patient to take a deep breath in. 5. Observe the movement of your thumbs (in healthy individuals they should move symmetrically upwards/outwards during inspiration and symmetrically downwards/inwards during expiration ). 6. Reduced movement of one of your thumbs indicates reduced chest expansion o...
Percussion of the chest involves listening to the volume and pitch of percussion notes across the chest to identify underlying pathology. Correct technique is essential to generating effective percussion notes.
When auscultating the chest, it is important that you have a systematic approach that allows you to compare each area on both the left and the right as you progress.
- Dr Lewis Potter
May 7, 2024 · A breath sound, also known as a lung sound, is the sound produced by your lungs whenever you inhale and exhale. These may be heard on their own or with a stethoscope. There are normal breath sounds that your healthcare provider expects to hear. Abnormal breath sounds may indicate a respiratory illness, heart disease, infection, or other ...
Anything that narrows or blocks your airway can cause abnormal lung sounds. This keeps the air from flowing smoothly, creating vibrations and other noises. The most common causes of abnormal lung sounds include: Mucus in the airways in your lungs. Swelling or inflammation of your airways. Foreign object or a tumor blocking your airways.
Oct 18, 2022 · Listening to breath sounds is an important part of diagnosing many different medical conditions. Types of breath sounds. A typical breath sound is similar to the sound of air.
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Auscultation of the lung is an important part of respiratory examination and helps in diagnosing various respiratory disorders. Auscultation assesses airflow through the trachea-bronchial tree. It is important to distinguish normal respiratory sounds from abnormal ones for example: crackles, wheezes, and pleural rub in order to make correct ...
![Charting Lung Sounds [+ Free Cheat Sheet] | Lecturio Nursing](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7 "Charting Lung Sounds [+ Free Cheat Sheet] | Lecturio Nursing")
