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Respiratory system

Static inspection of the chest: the shape normal (normosthenic, hypersthenic, asthenic), pathological (emphysematous, paralytic, funnel, foveated, pigeon, narrow, rachitic, kyphotic, scoliotic), asymmetry (increase or decrease one half of chest, local outpouching or retraction), position of shoulders (usual, sloping, horizontal), supraclavicular and infraclavicular fossae, Ludowici angle (levelling, expressed, moderate), course of ribs (horizontal, more vertical), intercostal spaces (without contour, with contour, wide, narrow), epigastric angle (right angles, obtuse angle, acute angle), position scapulae (closely fit to the chest, separated from the chest).

Dynamic inspection of the chest: two sides of the chest are seen to move with respiration (comparison of movement on the too sides during breathing) (to an equal extent, lagging of one side), retraction intercostal space (symmetric, more expressed in what place), mode of breathing (thoracic, abdominal, mixed), respiratory frequency the number of breath in a full minute, depth of breathing (deep, superficial), rhythm (rhythmical, pathological Cheyne-Stokes breathing, Kussmaul's breathing, Biot's breathing, Grokko), dyspnoea (expiratory, inspiratory, mixed), participation of auxiliary muscles in breathing.

Palpation: rigidity, floppiness of a chest, sites of atrophy, tenderness at palpation of muscles (where exactly, amplification at bending of body in the lesion or the healthy side), bones (ribs, breast bone (sternum), vertebrae), painful points on intercostal space (what under the account, on the right, at the left); vocal fremitus: normal, amplified, weakened, it is not auscultate (to specify localization)

 

Topographical percussion lungs lower borders lungs
Lines Right lung Left lung
Parasternal
Mid clavicular
Axillary anterior
Mid-axillary
Axillary posterior
Scapularis
Paravertebral

 

Range of movement of the lower pulmonary body (diaphragmatic movement) (sm)
Lines Right lung Left lung
Mid clavicular    
Mid-axillary    
Scapularis    

 

Height of position upper lobes:

in front on .. cm on the right and on . cm

at the left is higher clavicle, behind on . And .. cm

is accordingly higher than spinous process of 7-th vertebra cervical.

Width of fields Krenigs, on the right ....... cm, at the left cm.

Space Traube:

length ............. cm

height ............... cm

the form semilunar, changed (displacement, restriction etc.).

Respiratory movements of the lower ribs.

Comparative percussion of lungs

Character percussion sound (note, resonance) on symmetric sites of a chest: clear (resonant), dullish (impaired), dull, clear resonance with tympanic resonance, hyperresonant (tympanic), vesiculotympanitic resonance (bandbox), bell, dull-tympanic (at presence of changes percussion a sound to specify topography lines of an ribs, intercostal space).



Auscultation of lung

Vesicular breathing: normal, pathological diminish vesicular sounds, amplified, absent, rough with prolonged expiration, saccadic (cogged-wheel). Pathological: bronchial breathing, bronchovesicular breath sound, amphoric breath sounds.

Additional respiratory noise: rhonchi (dry rales) (high-pitched, low-pitched, timbre whistling, buzzing etc., in what phase of breathing their most of all); moist rales (fine, medium, coarse bubbling), sonorous, not sonorous), crepitation, pleural rub, Hippocratic succussion).

Vocal resonance (bronchophony), (whispered voice): normal, amplification, it is weakened, absent (not conducting).

In the presence of pathological sound symptoms to specify their topography (where exactly), approximate size of a site where they are listened, a degree of expressiveness.

 


Date: 2015-01-02; view: 1379


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