Cardiorespiratory assessment Lung Anatomy surface markings of the lungs and chest assessment PDF

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Cardiorespiratory assessment Lung Anatomy surface markings of the lungs and chest assessment...

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Cardiorespiratory assessment Lung Anatomy surface markings of the lungs and chest assessment Apex of each lung extends 3 cm above medial 1/3 of clavicle. Anterior marking Descends from apex behind sterno-clavicular joint Come together at manubriosternal joint (angle of Louis) At level of 4 costal cartilage on the left the border goes laterally and inferiorly (cardiac notch) to reach the inferior border at the level of the 6 costal cartilage in the mid clavicular line. The right border continues straight down to the 6 costal cartilage and the border continues round to mix axilla, and follows the 8th rib Posterior marking Passes down from apex 2 cm lateral to the spinous processes to the level of 10th rib Inferior marking Passes almost horizontally around chest wall Anterior 6 costal cartilage Mid axillary line 8 rib Posterior 10 rib Fissures Each lung has an oblique fissure; the right lung in addition also has a horizontal fissure. The right lung therefore has an upper, middle and lower lobe while the left has only an upper and lower. Oblique fissure Marked by a line drawn obliquely downward and forward starting: From a point 2 cm lateral to spine of T3 crossing mid axillary line at the 5 rib reaching inferior border of the lung at 6 costal cartilage The medial border of the scapula gives (a good guide for the direction of this line when the arm is raised above the head) Transverse fissure Indicated by a line drawn from: The oblique fissure at the level of the 5 rib in the mid axillary line running along lower border of the 4 rib to the medial border of right lung Pleura The lung marking coincides with those of the pleura except inferior where the lungs do not extend into the lateral recesses. The parietal pleura extend approx. 5 cm (2 rib spaces) below the inferior border of the lung. Anterior 6 costal cartilage Mid axillary line 10 rib Posterior 12 rib

Apex beat Left 5 intercostal space in mid clavicular line (in line with nipple) Carina Lies behind the manubriosternal joint This also represents the level where the: Second ribs join the sternum Both lungs reach the mid-line

Percussion Note Object of percussion is to compare the degree of resonance over equivalent areas of the two sides of the chest Technique • L hand placed on the chest wall, palm downwards, fingers separated so the second phalanx of the middle finger is precisely over the area to be percussed • The middle finger of the L hand is then pressed firmly against the chest wall and the centre of its second phalanx is struck sharply with the tip of the R middle finger. In order to produce a satisfactory percussion note the R middle finger must be held at R angles and the entire movement must come from the wrist.

Positions • Anterior Chest Wall Clavicle Infraclavicular area 2-6 intercostal space • Lateral Chest Wall 4-7 intercostal space • Posterior Chest Wall Trapezius Above spine of scapula At intervals of 4-5 cm from below spine of scapula down to 11 rib

Trachea • Place tip of index finger into the suprasternal notch, exactly in the midline • Obese or thick set patients may be difficult or impossible to feel • Thyroid enlargement may displace trachea

Auscultation

Technique • Bell-low frequencies of heart sounds and children • Diaphragm-high frequencies of breath sounds • Ear pieces face forward • Patient relaxed, sitting upright for anterior auscultation • Arms forward to protract scapula for posterior auscultation • Patient is asked to breath in and out through their mouth • Patient takes slightly deeper breaths than normal but must not deep breath repeatedly as they will hyperventilate, better to ask them to take a deep breath if you think the sound is abnormal • Compare the findings in equivalent areas on the two sides of the chest both Anterior and Posterior Breath Sounds • Normal- heard over most lung fields; low pitch; soft short expirations • Abnormal Bronchial Heard over trachea they are louder and higher pitch Inspiratory and expiratory phases are long, if they are heard over periphery suggest consolidation of lung tissue

• Diminished normal breath sounds are not heard or may be reduced with shallow breathing or localised diminished breath sounds occur with airway obstruction atelectasis Added Sounds • Crackles- are discontinuous sounds – thought to because to terminal airways popping open late in inspiration because fluid or secretions have accumulated • Wheeze – musical or whistling in nature caused by air passing through narrowed airways often heard on expiration but may be heard through respiratory cycle may be high or low pitched...