呼吸系统体检.ppt

Physical Examination in Respiratory System Anterior imaginary lines and landmarks Lateral imaginary lines Posterior imaginary lines and landmarks Borders of Lung superior lung margin is top of the lung inferior lung margin is in the 6th ribs region at midclavicular line 8th ribs region at midaxillary line 10th ribs region at scapular line. Anterior view of lobes Posterior view of lobes Right lateral view of lobes Left lateral view of lobes Inspection Chest wall:veins,skin Thorax:shape,size The ratio of the anteroposterior(AP) diameter AP diameter decreases:long-term disorders AP diameter increases:barrel chest Breast:location,shape Thoracic deformity Thoracic deformity Inspection Respiratory movement Abdominal breathing: male adult and child Thoracic breathing: female adult Respiratory rate: 16-20 f/min Tachypnea: 24 f/min Bradypnea: 12 f/min Shallow and fast respiratory muscular paralysis, elevated intraabdominal pressure, pneumonia, pleurisy Deep and fast Agitation, intension Deep and slow Severe metabolic acidosis (Kussmaul’s breathing) inspection Three depression sign: The respiratory muscles contract with inspiration depressions in the suprasternal fossa , the supraclavicular fossae and the intercostal spaces appears in obstruction of the upper airway such as tracheal foreign body and tracheal carcinoma Inspiratory despnea delayed inspiration obstruction of the upper airway Expiratory despnea delayed expiration COPD asthma emphysema Inspection Respiratory rhythm Cheyne-Stokes’ breathing Biot’s breathing _____Decreased excitability of respiratory center Inhibited breathing Sudden cessation of breathing due to chest pain Pleurisy, thoracic trauma Sighing breathing Depression, intension Palpation Thoracic expansion Massive hydrothorax, pneumonia, pleural thickening, atelectasis Vocal fremitus (语音震颤) location,area Pleural f