DOCSLIB.ORG

Bronchophony. Thisis More Intense Than Normal Vocal

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bronchophony. Thisis More Intense Than Normal Vocal AN INVESTIGATION INTO SOME OF THE PRIN- CIPLES OF AUSCULTATION. By ALBERT A. GRAY, M.D. Glasgow. (Continued from page 232.) PART II.-B. Changes in Quality of Sound conducted through the Lung. HITHERTo differences in intensity of the auscultatory signs have been considered. It remains to investigate the differences in quality which occur when sound is transmitted through the lungs to the ear. It is evident that in this part of the investigations the tuning-fork can help us but little: being a pure note, either entirely without audible partial tones, or very nearly so, there can be no change in the quality of the sound. For the most part we must depend upon the voice and the respiratory murmur to represent compound tones and sounds. Of these two the voice is, for the present purpose of investigation, the more valuable, because we know exactly where it is pro- duced and its acoustic characters; but there is some doubt as to the point of generation of the respiratory murmur. The physician recognizes four types of the thoracic voice,- the Normal Vocal Resonance; Bronchophony; £Egophony; and Pectoriloquy. The characteristics usually associated with each are: (1) Normal Vocal Resonance. An indefinite humming or buzzing noise; the spoken words are not distinguish- able. (2) Bronchophony. This is more intense than normal vocal resonance; the words are distinguishable; it is usually associated with increased vocal fremitus. (3) }Egophony. The voice is not quite so intense as in bronchophony, and is not associated with increase of INVESTIGATION INTO SOME PRINCIPLES OF AUSCULTATION. 355 the vocal fremitus. The sound is high-pitched, with a very pronounced nasal twang. Laennec compared it to the voice of Punch (I'Auscultation mediate, tome i. sec. 154) (4) Pectoriloquy. In this type the characteristic feature is not so much a difference in the quality of the musical part of speech, but a remarkable distinctness of the consonants. Usually the patient is told to whisper, in order that the vowels may not overpower the con- sonants. It is usually heard over phthisical cavities, when bronchophony may also be heard if the patient speak in the ordinary voice. What are the causes of these changes in quality? In the first place, it is evident that if the investigation is to have any scientific value, the acoustic character of speech must be borne in mind. The works of reference which the writer has used for this purpose are Helmholtz' Tonempftndung, chapters v. and vi., 1870; and Gavarret's Audition et Phonation, pp. 310-400, 1877. Normal Vocal Resonance. On page 215 of this paper it will be seen that, in the writer's opinion, Skoda was justified in assuming that a certain amount of resonance or reinforcement of sound would occur in the trachea and bronchi. In considering alterations in quality, it appears that this statement will be fully justified, but in a way exactly the opposite of that which Skoda meant. When phonation occurs, there is no doubt that the sound will pass downwards into the chest, both by the walls of the respi- ratory tract and by the air enclosed in those structures. The question at issue is, to find out to what extent the sound occur- ring in these two media reaches the stethoscope. Skoda main- tained that the vibrations which occurred in the air were finally transmitted to the tissues, and thence to the stethoscope; while Laennec and most physicians nowadays hold that chiefly the sounds occurring in the walls reach the instrument. It appears to the writer that there can be no doubt that vibrations pass to the parietes by both media, though to a vary- ing extent, both in health and disease. 356 DR ALBERT A. GRAY. In health it is very plain that any sound occurring in the air in the bronchi, bronchioles, and alveoli will, without much diffi- culty, pass into the tissue, because the healthy lung is such an exceedingly light, delicate structure, easily set in vibration by a sound occurring in the air which is in contact with it. From the parenchyma the sound will easily pass into the stethoscope. Similarly, vibrations conducted downwards by the walls of the respiratory tract will pass by the walls of the bronchioles and alveoli to the instrument, provided of course that these struc- tures are tense. To what extent do these two sets of vibrations contribute to the normal vocal resonance? It would be impossible to say accurately; but it appears to the writer that the reason why the normal thoracic voice is so indefinite, and of a buzzing or humming character, is, that all that part of the sound which has passed down by the air has become confused in its course by constant reflection. It is a well-known fact that the voice becomes rapidly confused and indistinct if it be passed through a tube with elastic or rigid walls; the reason being that the consonants or articulate parts of speech become overpowered by the more musical or continuous parts, because of reflection of sound or reverberation. Normal Respiratory Murmur. Before considering changes in the quality of the respiratory murmur, it is necessary that the point of origin of that sound be discussed. In regard to this point, the theory most in vogue at present is, that the normal respiratory murmur occurs at those points where the bronchioles open into the infundibula (Fagge and Pye-Smith, op. cit., vol. i. pp. 935 and 936; Bristowe, op. cit., p. 387). A few physicians, however, hold that the normal respiratory murmur is produced at the larynx, and conducted to the stethoscope through the lungs. There are some serious objections to the hypothesis that this murmur is produced in the iufundibula. (1) It has never been shown that the passage of an exceed- ingly minute quantity of air from a minute tube ( 5 mm. diameter,-M'Kendrick, op. cit., p. 299) into a minute cavity really does produce a sound at all. The amount of air actually INVESTIGATION INTO SOME PRINCIPLES OF AUSCULTATION. 357 passing in and out of each infundibulum during the inspiration and expiration must be exceedingly little, because the whole con- tents of an infundibulum is very small, and the differences in the cubic space during expiration and inspiration must be far smaller still, because there is no approach to collapse of the structure during expiration. Could, then, these exceedingly minute quantities of air really produce a sound in the infundi- bula of such intensity that, even summed up together, the result would be audible at the thoracic wall? To the writer it appears highly improbable that they could, and most certainly it has never been shown that they do. Therefore the present theory has to assume that a sound occurs at all,-an assumption which has no basis in fact. This objection is a very serious one. (2) The theory in question totally fails to explain the occur- rence of the expiratory portion of the respiratory murmur. That is to say, even if the inspiratory portion were accounted for by assuming that a fluid vein in the infundibulum produced the sound, there is no fluid vein at all during expiration. Fagge (op. cit., vol. i.; op. cit., p. 936, footnote) suggests that the bron- chiole may project into the infundibulum and form a rim. Now, there is no evidence at all, either anatomical or other, for supposing that such a condition exists; and even if it were the case, there is no proof that such a structure could produce a sound during expiration. (3) It is a well-known clinical fact, and was pointed out by Stokes long ago (Pye-Smith and Fagge, op. cit., vol. i. p. 936), that when the larynx is diseased it is often difficult or impos- sible to tell by auscultation if the lung is healthy or affected. Now, if the normal respiratory murmur depended upon the formation of a fluid vein in the infundibula, it is difficult to see why it should be altered by changes at the larynx (dyspncea is understood to be absent). (4) The experiments upon which in great part this theory rests are open to quite other interpretations than those put forward by the supporters of the theory. These experiments were per- formed by Bondeau, Bergeon, and Chauveau, and are to be found in the Gazette Hebdom., December 1863, Paris. The trachea of a horse was cut through and dragged out through the wound in the skin. On listening over the lungs the inspiratory murmur VOL. XXXI. (N.S. VOL. XI.) 2 A 358' DR ALBERT A. GRAY. was not diminished in intensity. From this experiment it was held as proven that the inspiratory murmur could not be pro- duced at the larynx. It appears to the writer that there is this fallacy: the trachea could hardly be brought through a wound of such a nature without either being pinched by the edges of the wound, or being bent and narrowed at the point where it is turned out of its natural course before being brought through the wound. This sudden narrowing would produce all the requisite conditions for a fluid vein, so that the sound heard over the lung by the observers may after all have been a sound transmitted from the trachea. Another experiment to which, perhaps, most importance was attached was as follows:-The pneumo-gastric nerve of a horse was cut through; on listening over the thorax and trachea respectively, the inspiratory murmur was found to have disap- peared over the thorax, while the tracheal murmur remained. From this it was assumed that the muscular walls of the bron- chioles were paralysed, and hence opened into the infundibula by wide funnel-shaped mouths, and no fluid vein was formed (Pye-Smith and Fagge, op.
Load more

Recommended publications
  • Download Article
    ...& more SELF-TEST Respiratory system challenge Test your knowledge with this quick quiz. 1. Gas exchange takes place in the 8. Which continuous breath sounds are 14. Wheezes most commonly suggest a. pharynx. c. alveoli. relatively high pitched with a hissing a. secretions in large airways. b. larynx. d. trachea. or shrill quality? b. abnormal lung tissue. a. coarse crackles c. wheezes c. airless lung areas. 2. The area between the lungs is b. rhonchi d. fine crackles d. narrowed airways. known as the a. thoracic cage. c. pleura. 9. Normal breath sounds heard over 15. Which of the following indicates a b. mediastinum. d. hilum. most of both lungs are described as partial obstruction of the larynx or being trachea and demands immediate 3. Involuntary breathing is controlled by a. loud. c. very loud. attention? a. the pulmonary arterioles. b. intermediate. d. soft. a. rhonchi c. pleural rub b. the bronchioles. b. stridor d. mediastinal crunch c. the alveolar capillary network. 10. Bronchial breath sounds are d. neurons located in the medulla and normally heard 16. Which of the following would you pons. a. over most of both lungs. expect to find over the involved area b. between the scapulae. in a patient with lobar pneumonia? 4. The sternal angle is also known as c. over the manubrium. a. vesicular breath sounds the d. over the trachea in the neck. b. egophony a. suprasternal notch. c. scapula. c. decreased tactile fremitus b. xiphoid process. d. angle of Louis. 11. Which is correct about vesicular d. muffled and indistinct transmitted voice breath sounds? sounds 5.
    [Show full text]
  • Study Guide Medical Terminology by Thea Liza Batan About the Author
    Study Guide Medical Terminology By Thea Liza Batan About the Author Thea Liza Batan earned a Master of Science in Nursing Administration in 2007 from Xavier University in Cincinnati, Ohio. She has worked as a staff nurse, nurse instructor, and level department head. She currently works as a simulation coordinator and a free- lance writer specializing in nursing and healthcare. All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text shouldn’t be regarded as affecting the validity of any trademark or service mark. Copyright © 2017 by Penn Foster, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner. Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515. Printed in the United States of America CONTENTS INSTRUCTIONS 1 READING ASSIGNMENTS 3 LESSON 1: THE FUNDAMENTALS OF MEDICAL TERMINOLOGY 5 LESSON 2: DIAGNOSIS, INTERVENTION, AND HUMAN BODY TERMS 28 LESSON 3: MUSCULOSKELETAL, CIRCULATORY, AND RESPIRATORY SYSTEM TERMS 44 LESSON 4: DIGESTIVE, URINARY, AND REPRODUCTIVE SYSTEM TERMS 69 LESSON 5: INTEGUMENTARY, NERVOUS, AND ENDOCRINE S YSTEM TERMS 96 SELF-CHECK ANSWERS 134 © PENN FOSTER, INC. 2017 MEDICAL TERMINOLOGY PAGE III Contents INSTRUCTIONS INTRODUCTION Welcome to your course on medical terminology. You’re taking this course because you’re most likely interested in pursuing a health and science career, which entails ­proficiency­in­communicating­with­healthcare­professionals­such­as­physicians,­nurses,­ or dentists.
    [Show full text]
  • Auscultation 4
    Post-Acute COVID-19 Exercise & Rehabilitation (PACER) Project Cardiovascular and Pulmonary Examination By: Morgan Johanson, PT, MSPT, Board Certified Cardiovascular and Pulmonary Specialist Disclaimer • This course is intended for educational purposes and does not replace mentorship or consultation with more experienced cardiopulmonary colleagues. • This content is current at time of dissemination, however, realize that evidence and science on COVID19 is revolving rapidly and information is subject to change. Introduction and Disclosures • Morgan Johanson has no conflicts of interest or financial gains to disclose for this continuing education course • Course faculty: Morgan Johanson, PT, MSPT, Board Certified Cardiovascular and Pulmonary Specialist – President of Good Heart Education, a continuing education company providing live and online Cardiovascular and Pulmonary Therapy and Rehabilitation training and mentoring services for Physical Therapist studying for the ABPTS Cardiovascular and Pulmonary Specialty (CCS) Examination. – Adjunct Faculty Member, University of Toledo, Ohio – Practicing at Grand Traverse Pavilions SNF in Traverse City, MI – Professional Development Chair, CVP Section of the APTA Disclosures • Any pictures contained in the course that are not owned by Morgan Johanson were obtained via Google internet search engine and are references on the corresponding slide. Morgan Johanson does not claim ownership or rights to this material, it is being used for education purposes only and will not be reprinted or copied (so
    [Show full text]
  • Johns Hopkins School of Nursing BURPS List
    1 Welcome to the School of Nursing at the Johns Hopkins University! As a faculty who coordinates one of your first semester courses I am making available to you some helpful and useful information. I have included it below for your reading pleasure! There are two documents: the “B.U.R.P.S.” list (Building and Understanding Roots, Prefixes and Suffixes) and Talk like a Nurse. This document lists many (not all) of the medical terms used in your first semester classes and I believe will ease your transition into a new way of speaking. THE B.U.R.P.S LIST Purpose: To become proficient in Building and Understanding Roots, Prefixes and Suffixes Rationale: Building and understanding medical terminology is simpler when the words are broken down into roots, prefixes and suffixes. Steps: Review the B.U.R.P.S. tables and try to determine the definitions of the examples Notice the overlap among the three groups of roots, prefixes and suffixes Make new words by changing one part of the word. For example, if an appendectomy is the removal of the appendix, then a nephrectomy is the removal of a kidney. Tachycardia is a fast heart rate and tachypnea is a fast respiration rate. Helpful Note: R/T means “related to” TALK LIKE A NURSE Purpose: To become familiar with acronyms commonly used by health care providers Rationale: Different professions have unique languages; medicine and nursing are no exceptions. The acronyms below are used in verbal and written communication in health care settings. Steps: Review the attached list of acronyms (then you can start to critique shows like “House” and “Gray’s Anatomy” for accuracy!) Notice that some acronyms have two different meanings; e.g., ROM stands for “range of motion” and “rupture of membranes” - be careful when using abbreviations Take the Self Assessment after reading the approved terms, found in Blackboard NOTE: All institutions have a list of accepted and “do not use” abbreviations.
    [Show full text]
  • Gas Exchange and Respiratory Function
    LWBK330-4183G-c21_p484-516.qxd 23/07/2009 02:09 PM Page 484 Aptara Gas Exchange and 5 Respiratory Function Applying Concepts From NANDA, NIC, • Case Study and NOC A Patient With Impaired Cough Reflex Mrs. Lewis, age 77 years, is admitted to the hospital for left lower lobe pneumonia. Her vital signs are: Temp 100.6°F; HR 90 and regular; B/P: 142/74; Resp. 28. She has a weak cough, diminished breath sounds over the lower left lung field, and coarse rhonchi over the midtracheal area. She can expectorate some sputum, which is thick and grayish green. She has a history of stroke. Secondary to the stroke she has impaired gag and cough reflexes and mild weakness of her left side. She is allowed food and fluids because she can swallow safely if she uses the chin-tuck maneuver. Visit thePoint to view a concept map that illustrates the relationships that exist between the nursing diagnoses, interventions, and outcomes for the patient’s clinical problems. LWBK330-4183G-c21_p484-516.qxd 23/07/2009 02:09 PM Page 485 Aptara Nursing Classifications and Languages NANDA NIC NOC NURSING DIAGNOSES NURSING INTERVENTIONS NURSING OUTCOMES INEFFECTIVE AIRWAY CLEARANCE— RESPIRATORY MONITORING— Return to functional baseline sta- Inability to clear secretions or ob- Collection and analysis of patient tus, stabilization of, or structions from the respiratory data to ensure airway patency improvement in: tract to maintain a clear airway and adequate gas exchange RESPIRATORY STATUS: AIRWAY PATENCY—Extent to which the tracheobronchial passages remain open IMPAIRED GAS
    [Show full text]
  • Chest Auscultation: Presence/Absence and Equality of Normal/Abnormal and Adventitious Breath Sounds and Heart Sounds A
    Northwest Community EMS System Continuing Education: January 2012 RESPIRATORY ASSESSMENT Independent Study Materials Connie J. Mattera, M.S., R.N., EMT-P COGNITIVE OBJECTIVES Upon completion of the class, independent study materials and post-test question bank, each participant will independently do the following with a degree of accuracy that meets or exceeds the standards established for their scope of practice: 1. Integrate complex knowledge of pulmonary anatomy, physiology, & pathophysiology to sequence the steps of an organized physical exam using four maneuvers of assessment (inspection, palpation, percussion, and auscultation) and appropriate technique for patients of all ages. (National EMS Education Standards) 2. Integrate assessment findings in pts who present w/ respiratory distress to form an accurate field impression. This includes developing a list of differential diagnoses using higher order thinking and critical reasoning. (National EMS Education Standards) 3. Describe the signs and symptoms of compromised ventilations/inadequate gas exchange. 4. Recognize the three immediate life-threatening thoracic injuries that must be detected and resuscitated during the “B” portion of the primary assessment. 5. Explain the difference between pulse oximetry and capnography monitoring and the type of information that can be obtained from each of them. 6. Compare and contrast those patients who need supplemental oxygen and those that would be harmed by hyperoxia, giving an explanation of the risks associated with each. 7. Select the correct oxygen delivery device and liter flow to support ventilations and oxygenation in a patient with ventilatory distress, impaired gas exchange or ineffective breathing patterns including those patients who benefit from CPAP. 8. Explain the components to obtain when assessing a patient history using SAMPLE and OPQRST.
    [Show full text]
  • Community-Acquired Pneumonia in Adults: Diagnostic Reliability of Physical Examination Techniques and Their Teaching in Academia
    James Madison University JMU Scholarly Commons Physician Assistant Capstones The Graduate School Fall 12-14-2018 Community-acquired pneumonia in adults: Diagnostic reliability of physical examination techniques and their teaching in academia Amber Tordoff James Madison University Lauren A. Williams James Madison University Follow this and additional works at: https://commons.lib.jmu.edu/pacapstones Part of the Bacteria Commons, Bacterial Infections and Mycoses Commons, Diagnosis Commons, Investigative Techniques Commons, Medical Pathology Commons, Respiratory Tract Diseases Commons, Virus Diseases Commons, and the Viruses Commons Recommended Citation Tordoff AL, Williams LA. Community-Acquired Pneumonia in Adults: Diagnostic Reliability of Physical Examination Techniques and their Teaching in Academia. JMU Scholarly Commons Physician Assistant Capstones. https://commons.lib.jmu.edu/pacapstones/44/. Published December 12, 2018. This Presentation is brought to you for free and open access by the The Graduate School at JMU Scholarly Commons. It has been accepted for inclusion in Physician Assistant Capstones by an authorized administrator of JMU Scholarly Commons. For more information, please contact [email protected]. Community-Acquired Pneumonia in Adults: Diagnostic Reliability of Physical Examination Techniques and their Teaching in Academia Amber Tordoff, PA-S and Lauren Williams, PA-S, James Madison University, Harrisonburg, Virginia _____________________________________________________________________________________ ABSTRACT Background:
    [Show full text]
  • Chest and Lung Examination
    Chest and Lung Examination Statement of Goals Understand and perform a complete examination of the normal chest and lungs. Learning Objectives A. Locate the bony landmarks of the normal chest: • Ribs and costal margin, numbering ribs and interspaces • Clavicle • Sternum, sternal angle and suprasternal notch • Scapula B. Define the vertical "lines" used to designate chest wall locations. Use the bony landmarks and conventional vertical "lines" when describing a specific area of the chest wall. • Midsternal line • Midclavicular line • Anterior, mid and posterior axillary lines • Scapular line • Vertebral line C. Describe the location of the trachea, mainstem bronchi, lobes of the lungs and pleurae with respect to the surface anatomy of the chest. D. Prepare for an effective and comfortable examination of the chest and lungs by positioning and draping the patient. Communicate with the patient during the exam to enlist the patient’s cooperation. E. Describe and perform inspection of the chest including the following: • Rate, rhythm, depth, and effort of breathing • Shape and movement of the chest F. Describe and perform palpation of the chest including the following: • Identify tender areas • Chest expansion • Tactile fremitus G. Describe and perform percussion of the chest, distinguishing a dull sound (below the diaphragm) from a resonant sound (over normal lung.) Use percussion to demonstrate symmetric resonance of the lung fields and to measure diaphragmatic excursion. H. Describe and perform auscultation of the lungs including the following: • Symmetric examination of the lung fields, posterior and anterior. • Normal breath sounds (vesicular, bronchovesicular, bronchial and tracheal), their usual locations and their characteristics. I. Define terms for three common adventitious lung sounds: • Wheezes are high pitched, continuous hissing or whistling sounds.
    [Show full text]
  • Shortness of Breath. History of the Present Illness
    10/20/2006 Write-Up to be Graded Sarah Broom Chief Complaint: Shortness of breath. History of the Present Illness: Mr.--- is a previously healthy 56-year-old gentleman who presents with a four day history of shortness of breath, hemoptysis, and right-sided chest pain. He works as a truck driver, and the symptoms began four days prior to admission, while he was in Jackson, MS. He drove from Jackson to Abilene, TX, the day after the symptoms began, where worsening of his dyspnea and pain prompted him to go to the emergency room. There, he was diagnosed with pneumonia and placed on Levaquin 500 mg daily and Benzonatate 200 mg TID, which he has been taking for two days with only slight improvement. He then drove from Abilene back to Greensboro, where he resides, and continued to experience shortness of breath, right sided chest pain, and hemoptysis. He presented to an urgent care office in town today, and was subsequently transferred to the Moses Cone ER due to the provider’s suspicion of PE. The right-sided pain is located midway down his ribcage, below the axilla. This pain is sharp, about 7/10 in severity, and worsens with movement and cough. Pressing on the chest does not recreate the pain. He feels that the pain has improved somewhat over the past two days. The hemoptysis has been unchanged since it began; there is not frank blood, but his sputum has been consistently blood-tinged. The blood seems redder at night. The dyspnea has been severe, and it is difficult for him to walk more than across a room.
    [Show full text]
  • Diagnostic Value of the Physical Examination in Patients with Dyspnea
    REVIEW LEARNING OBJECTIVE: Readers will assess the diagnostic accuracy of physical signs in patients with dyspnea RICHARD A. SHELLENBERGER, DO BATHMAPRIYA BALAKRISHNAN, MD SINDHU AVULA, MD Associate Program Director, Internal Medicine Department of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St. Joseph Residency Program, St. Joseph Mercy Ann Arbor Henry Ford Hospital System, Mercy Ann Arbor Hospital, Ann Arbor, MI Hospital, Ann Arbor, MI Detroit, MI ARIADNE EBEL, DO SUFIYA SHAIK, MD Department of Internal Medicine, Department of Internal Medicine, St. Joseph Mercy Ann Arbor Hospital, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, MI Ann Arbor, MI Diagnostic value of the physical examination in patients with dyspnea ABSTRACT aennec’s stethoscope has survived more L than 200 years, much longer than some of We reviewed the evidence for the diagnostic accuracy his contemporaries predicted. But will it sur- of the physical examination in diagnosing pneumonia, vive the challenge of bedside ultrasonography pleural effusion, chronic obstructive pulmonary disease, and other technologic advances? and congestive heart failure in patients with dyspnea and The physical examination, with its roots found that the physical examination has reliable diagnos- extending at least as far back as Hippocrates, tic accuracy for these common conditions. may be at a crossroads as the mainstay of diag- nosis. Physical signs can be subjective and lack KEY POINTS sensitivity and specificity. Modern imaging and laboratory studies may already be more trusted. Asymmetrical chest expansion, diminished breath sounds, If the physical examination is to survive, it egophony, bronchophony, and tactile fremitus can be must be accurate, reproducible, and efficient.
    [Show full text]
  • Physical Diagnosis the Pulmonary Exam What Should We Know About the Examination of the Chest?
    PHYSICAL DIAGNOSIS THE PULMONARY EXAM WHAT SHOULD WE KNOW ABOUT THE EXAMINATION OF THE CHEST? • LANDMARKS • PERTINENT VOCABULARY • SYMPTOMS • SIGNS • HOW TO PERFORM AN EXAM • HOW TO PRESENT THE INFORMATION • HOW TO FORMULATE A DIFFERENTIAL DIAGNOSIS IMPORTANT TOPOGRAPHY OF THE CHEST TOPOGRAPHY OF THE BACK LOOK AT THE PATIENT • RESPIRATORY DISTRESS • ANXIOUS • CLUTCHING • ACCESSORY MUSCLES •CYANOSIS • GASPING • STRIDOR • CLUBBING TYPES OF BODY HABITUS WHAT IS A BARRELL CHEST? • THORACIC INDEX – RATIO OF THE ANTERIORPOSTERIOR TO LATERAL DIAMETER NORMAL 0.70 – 0.75 IN ADULTS - >0.9 IS CONSIDERED ABNORMAL • NORMALS - ILLUSION •COPD AM J MED 25:13-22,1958 PURSED – LIPS BREATHING • COPD – DECREASES DYSPNEA • DECREASES RR • INCREASES TIDAL VOLUME • DECREASES WORK OF BREATHING CHEST 101:75-78, 1992 WHITE NOISE (NOISY BREATHING) • THIS NOISE CAN BE HEARD AT THE BEDSIDE WITHOUT THE STETHOSCOPE • LACKS A MUSICAL PITCH • AIR TURBULENCE CAUSED BY NARROWED AIRWAYS • CHRONIC BRONCHITIS CHEST 73:399-412, 1978 RESPIRATORY ALTERNANS • NORMALLY BOTH CHEST AND ABDOMEN RISE DURING INSPIRATION • PARADOXICAL RESPIRATION IMPLIES THAT DURING INSPIRATION THE CHEST RISES AND THE ABDOMEN COLLAPSES • IMPENDING MUSCLE FATIGUE DO NOT FORGET THE TRACHEA • TRACHEAL DEVIATION • AUSCULTATE - STRIDOR • TRACHEAL TUG (OLIVERS SIGN) – DOWNWARD DISPLACEMENT OF THE CRICOID CARTILAGE WITH VENTRICULAR CONTRACTION – OBSERVED IN PATIENTS WITH AN AORTIC ARCH ANEURYSM • TRACHEAL TUG (CAMPBELL’S SIGN) – DOWNWARD DISPACEMENT OF THE THYROID CARTILAGE DURING INSPIRATION – SEEN IN PATIENTS
    [Show full text]
  • Nursing Care in Pediatric Respiratory Disease Nursing Care in Pediatric Respiratory Disease
    Nursing Care in Pediatric Respiratory Disease Nursing Care in Pediatric Respiratory Disease Edited by Concettina (Tina) Tolomeo, DNP, APRN, FNP-BC, AE-C Nurse Practitioner Director, Program Development Yale University School of Medicine Department of Pediatrics Section of Respiratory Medicine New Haven, CT A John Wiley & Sons, Inc., Publication This edition first published 2012 © 2012 by John Wiley & Sons, Inc. Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing. Registered office: John Wiley & Sons Inc., The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 2121 State Avenue, Ames, Iowa 50014-8300, USA The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged. The fee codes for users of the Transactional Reporting Service are ISBN-13: 978-0-8138-1768-2/2012. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners.
    [Show full text]