THORACIC

• Thorax


  Contains thoracic cage (sternum, ribs, muscle, ligaments) and thoracic cavity
• Parts of the sternum


  • Manubrium
  • Manubriosternal angle (angle of louis)
  • Body of sternum
  • Xiphoid process
• Located at the back of angle of louis is where the trachea divides into left and right primary bronchi
• Ribs


  • 7th to 10th rib is attached to the rib superior to them. They form the costal margin (costal angle)
  • 11th to 12th rib is not connected to any rib or sternum anteriorly (floating rib)
• Vertical reference lines


  • Anterior (Sternum and clavicle reference point)
  • Posterior (Vertebrae and scapula reference point)
  • Lateral (Axilla reference point)
• Apex of the lungs


  Located above the first rib and clavicle
• Base of the lungs

  Located at the 6th rib anteriorly, 8th rib laterally, 10th rib posteriorly
• COPD


  Chronic obstructive pulmonary disease. Group of disease that cause airflow blockage.
• CHF


  Congestive heart failure. Clinical syndrome that result from any structural or functional impairment of ventricular filling or ejection of blood.
• Hypoxia


  Decrease level of tissue oxygenation
• Hypoxemia


  Decrease level of oxygen partial pressure
• Emphysema


  Chronic lung disease. Destruction of alveoli. Causes hyperinflation of the lungs.
• Polycythemia


  Increased level of RBC. Caused by decrease in blood oxygenation. Causes purple complexion.
• Pallor


  Paleness of the skin
• Cyanosis


  Bluish discoloration
• Early clubbing


  180-degree angulation of clubbing
• Late clubbing


  More than 180-degree angulation of clubbing
• Intercostal spaces bulging is caused by difficulty breathing, air trap/over inflation in emphysema
• Intercostal spaces retracting is caused by lung collapse (atelectasis)
• Chest asymmetry can be caused by scoliosis, kyphosis, or barrel chest
• Labored respiration uses accessory muscles (trapezius, sternomastoid, clavicle)
• Tripod position is evident in patients with emphysema
• Barrel chest (>1:2 AP:T ratio) is evident in patients with emphysema
• Pectus excavatum is depression of the sternum and surrounding cartilages
• Pectus carinatum is bulging of the sternum and surrounding cartilages
• Normal respiration


  14-20/min and regular
• Tachypnea


  >24/min and shallow. Caused by fever, anxiety, exercise, respiratory insufficiency, alkalosis, pneumonia, and pleurisy.
• Bradypnea


  <10/min and regular. Caused by respiratory depression, diabetic coma and neurologic damage.
• Hyperventilation


  Increased rate and depth. Caused by CNS disorders, fear, anxiety, and salicylate overdose.
• Hypoventilation


  Decreased rate and depth, irregular pattern. Caused by narcotic and anesthetic overdose.
• Cheyne-Strokes respiration


  Regular pattern characterized by alternating periods of deep, rapid breathing followed by periods of apnea (absence of breathing). Caused by severe CHF, drug overdose, increased ICP, and renal failure.
• Biot's respiration


  Irregular pattern characterized by varying depth and rate of respirations followed by periods of apnea. Caused by meningitis and severe brain damage.
• Kussmaul respiration


  Rapid, deep, and labored. Caused by diabetic ketoacidosis.
• Percussion notes: Dull (dense organs and muscle), Flat (bones), Resonance (air filled lungs), Tympanic (abdominal area)
• Diaphragmatic excursion is limited in pregnant patients
• Bronchial breath sounds


  Hollow lung sounds that can be heard over trachea. It is abnormal when heard over the lung fields.
• Vesicular breath sounds


  Normal breath sounds. Low-pitch sounds air flows through an open airway.
• Crackles (Rales)


  Short, explosive, lung sounds that are commonly heard in small or middle airways of the lungs. Associated with fluid or secretions in the lungs. Velcro (coarse) and hair strand/wood fire (fine).
• Wheezes


  High-pitched abnormal breath sounds that are heard as air flows through a narrowed airway.
• Ronchi or Sonorous wheezes


  Can be heard when air moves through larger airways that have excess amounts of mucus or secretions.