胸部查体英文课件

Physical Examination in Respiratory Systemwang yingyan.Physical Examination in Respir11.Superficial landmarks,imaginary lines and regions of the chest.1.Superficial landmarks,imag2Anterior landmarkManubriumgladiolusXiphoid process.Anterior landmarkManubriumglad3Anterior landmarkSternal angle (louis angle)lCosticartilage of second riblBronchial bifurcationlThe superior edge of cardiac atriumlThe junction of upper and lower mediastinumlThe level of fifth thoracic vertebrae posterior.Anterior landmarkSternal angle4Posterior landmarklThe scapular angle sit or stand,arms at the sideseventh rib or interspace or the level of eighth thoracic vertebralThe seventh cervical vertebral spine prominently protrudingScapulae angleseventh cervical vertebral spine.Posterior landmarkThe scapular5Anterior imaginary linesAnterior midlineMidclavicular linelAnterior midline drawn through the middle of the sternumlMidclavicular line drawn through the middle of the clavicle.Anterior imaginary linesAnteri6Lateral imaginary linesAnterior axillary linePosterior axillary lineMidaxillary linelAnterior axillary line drawn along the anterior axillary foldslMidaxillary line drawn from the vertex of the axillaelPosterior axillary line drawn along the posterior axillary folds.Lateral imaginary linesAnterio7Posterior imaginary linesScapular linePosterior midlinelPosterior midline drawn through the pos-terior spinous process of vertebraelScapular line drawn through the scapular angle.Posterior imaginary linesScapu8Anterior fossaeEpigastric angle Infraclavicular fossaSuprasternal fossaSupraclavicular fossa.Anterior fossaeEpigastric angl9Axillary fossaAxillary fossa.Axillary fossaAxillary fossa.10Posterior imaginary regionInfrascapular regionInterscapular regionSuprascapular region.Posterior imaginary regionInfr112.Thorax.2.Thorax.12n nShape:symmetrical without deformity Anteroposterior/transverse diameter is 1:1.5.Shape:symmetrical without de13n nRespiratory rhythm：regular and symmetric model n nAbdominal respiratorymen and childrenAbdominal respiratorymen and childrenn nChest respiratorywomenChest respiratorywomenn nvein n ntenderness or subcutaneous crepitus.Respiratory.144.Lung.4.Lung.15Inspection l lRespiratory rate:14-18 cycles per minutel lIntercostal space:narrow,wide.Inspection Respiratory rate:116Palpation n nChest excursionChest excursionn nHands along costal marginHands along costal marginn nInspire deeply Inspire deeply n nObserve movementObserve movement.Palpation Chest excursion.17n nVocal fremitus place both palm or the unlar place both palm or the unlar side of the hands on the side of the hands on the symmetrical position with a symmetrical position with a light touchlight touch repeat word“yi”repeat word“yi”compare vibration compare vibration.Vocal fremitus.18n nPleural friction rubsn nBreathe deeply,Breathe deeply,n nPlace palm or the ulnar side of hands on Place palm or the ulnar side of hands on the inferior anterior lateral portion of the the inferior anterior lateral portion of the chestchestn nLike two pieces of leather rubbedLike two pieces of leather rubbedn nHolding breathing disappeared Holding breathing disappeared.Pleural friction rubs.19Percussion.Percussion.201.Position n nSit or lie,balanced body,relax muscle,quiet and Sit or lie,balanced body,relax muscle,quiet and even breathingeven breathingn nAnteriorAnterior：throwing out his chest anteriorlythrowing out his chest anteriorlyn nLateral Lateral:arms slightly abducted beyond the:arms slightly abducted beyond the head head n nBackBack:pulling shoulder forward,:pulling shoulder forward,arm folded in front,arm folded in front,spine anteflexed,spine anteflexed,head lower head lower.1.Position.212.Methodn nDirect percussionDirect percussionn nStrike directly with palmar tips of right Strike directly with palmar tips of right middle three fingersmiddle three fingersn nIndirect percussionIndirect percussion n nPleximeter:distal phalanx of left middle Pleximeter:distal phalanx of left middle finger finger n nPlexor:right middle finger tip,distal Plexor:right middle finger tip,distal interphalangeal joint of pleximeter finger interphalangeal joint of pleximeter finger n nSequenceSequence l lTop to bottom Top to bottom l lanterior to posterior,lateral thoraxanterior to posterior,lateral thorax.2.MethodDirect percussion.223.Classificationn nResonancen nNormal n nHyperresonancen nEmphysema n nTympanyn nCavity or pneumothorax,normal abdomen.3.ClassificationResonance.23n nDullnessn nPleural effusion,consolidation of the lung,n nFlatnessn nMassive Pleural effusion,solid organs.Dullness.244.Normal soundn nLungs sound in percussionn nResonanceResonancen nSlight dullness in some areas(upper,right,Slight dullness in some areas(upper,right,back)due to thickness of muscles and skeletonsback)due to thickness of muscles and skeletons .4.Normal soundLungs sound i25n nLower bordern n6th,8th,10th intercostal space in midclavicular line,midaxillary line,scapular line,respectively 5.Contents.Lower border5.Contents.26sAlong the scapular linePercussing bottom of lung,markingAsking the pat.to inspire deeply and holdPercussing bottom of lung,markingAsking the pat.to expire deeply and holdPercussing bottom of lung,markingMeasuring the dist.between upper and lower linesnMovement of the inferior lung base.sAlong the scapular lineMoveme27Auscultation.Auscultation.28n nPosition:sit or supinen nMethod :n nTop to bottom,anterior to lateral to posteriorTop to bottom,anterior to lateral to posterior.Position:sit or supine.29Order of auscultation .Order of auscultation .30Normal breath soundn nBronchial breath soundBronchial breath soundn nsuprasternal fossa,around 6th,suprasternal fossa,around 6th,7th cervical vertebra,1st,2nd 7th cervical vertebra,1st,2nd thoracic vertebrathoracic vertebran nLonger,louder,higher pitch in Longer,louder,higher pitch in expiratory phaseexpiratory phasen nBronchovesicular breath soundBronchovesicular breath soundn n1st,2nd intercostal space beside of 1st,2nd intercostal space beside of sternum,the level of 3rd,4th sternum,the level of 3rd,4th thoracic vertebra in interscaplar thoracic vertebra in interscaplar areaarean nVesicular breath soundVesicular breath soundn nMost area of lungsMost area of lungsn nLonger,louder,higher pitch in Longer,louder,higher pitch in inspiratory phaseinspiratory phaseBronchovesicularBronchialBronchialBronchovesicular.Normal breath soundBronchial b31