physical examination of the chest - · palpation: vocal fremitus • bilateral comparison of vocal...
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Physical Examination of the Chest
Collegio A. Volta
20 Gennaio 2017
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Chest Topography: Anterior Chest
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Chest Topography: Lateral Chest
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Chest Topography: Posterior Chest
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Fissures:
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Location of Lobes
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Physical Exam Techniques
• Observation • Palpation • Percussion • Auscultation
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Observation
• Patient ‘s surroundings, ie: the view from the door – Equipment present – Posted signs – SPUTUM!
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Observation: Breathing Patterns
• Eupnea • Tachypnea/Bradypnea • Biot’s • Cheynes-Stokes • Kussmaul
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Observation: Thoracic Contour
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Observation: Thoracic Contour (cont.)
• Pectus Excavatum • Pectus Carinatum • Kyphosis • Scoliosis • Kyphoscoliosis • Symmetry of chest movement
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Observation: Clubbing
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Palpation: Tracheal Alignment
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Tracheal Alignment Abnormalities
• Pneumothorax – shifts to unaffected side • Pleural Effusion – shifts to unaffected side • Fibrosis or Atelectasis – shifts towards
affected side • Pulmonary consolidation – no shift
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Palpation : Chest Excursion
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Palpation: Vocal Fremitus
• BILATERAL comparison of vocal vibrations
• Increased with alveolar consolidation
• Decreased with increased distance between lung and chest wall – Pneumothorax, Pleural
effusion
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Percussion
• Assess density of underlying tissue
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Percussion Notes
• Resonance – normal • Dullness – increased density
– Atelectasis, alveolar filling/consolidation, pleural effusion, fibrosis
• Hyperresonance – decreased density – Hyperinflation (COPD), Pneumothorax
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Case Study
A patient is recently diagnosed with RLL bronchogenic CA. As you enter the room, you see that the patient is on 4 LPM nasal cannula. He appears short of breath with tachypnea and shallow respirations. Chest
excursion appears normal except in the RLL. Vocal fremitus is also absent in the RLL. Percussion reveals dullness in the RLL.
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Auscultation
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