009 OBHG Chest Auscultation-11- 2006
Transcript of 009 OBHG Chest Auscultation-11- 2006
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OBHG Education Subcommittee
ONTARIOBASE HOSPITAL GROUP
Mike Muir AEMCA, ACP, BHSc
Kevin McNab AEMCA, ACP
Reviewed- November 2006
Donna L. Smith AEMCA, ACP
References Emergency Medicine
2007 Ontario Base Hospital Group
ADVANCED ASSESSMENT
Chest Assessment and Auscultation
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EVALUATE THE PATIENT
LOOK FOR SIGNS OF DISTRESSVisual Assessment
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Workload
Position
Ability to speak
Check for surgical scars
General Appearance
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Normal 12-24
Respiratory pathologies may cause rate to be
increased and shallow
Rate of
Respirations
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Accessory Muscles=
Distress
Inspiratory
Sternocleidomastoids
Scalenes
Trapezius
Expiratory
Internal Intercostals
Abdominal Muscles
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Oxygen consumption with
breathing
Normal 5%
Distress 25%
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Resistance = Prolongation I:E Ratio
Purse-lip breathing
Prolonged expiratory phase
Inspiratory Expiratory
Ratio 2:3
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Bronchoconstriction/Wet Heavy Lungs
=
Increased workload of breathingdecreased gas exchange
leads to
LOA
NEED POSITIVE PRESSUREVENTILATION
LOA and workload of breathing
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Blue = Bad
(CYANOSIS)
Diaphoresis
=
Sympathetic Stimulation
Skin condition in distress
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Palpation
Predominantly used to find traumatic injuries
Tenderness, pain, crepitus
Subcutaneous emphysema
Physical Exam
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Breath Sounds
Produced by air passing through respiratory system
Sound on inspiration (louder)
Expiration (Quieter)
Auscultation
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Breath Sound Location I/E Ratio Description
Bronchial Heard over trachea I E Loud, Harsh
2 to 3 High pitched----------------------------------------------------------------------------------------------------------------
Broncho- Anteriorly: near I E Soft, Breezy
Vesicular 1st and 2nd IC spaces
Posteriorly: 1 to 1 Pitch is lower than BronchialBetween scapulas
----------------------------------------------------------------------------------------------------------------Vesicular Lungs periphery I E
Softer, swishy
Not over sternum Pitch is lower
over scapulas 3 to 1 than Broncho vesicular
Normal Breath
Sounds
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Breath sounds to the bases
Equal breath sounds
Inspiration
Expiration
Abnormal breath sounds
Absent or diminished breath sounds
Displaced bronchial breath sounds Adventitious breath sounds
Listen with intent for
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Most common cause air passing through fluid (other?)
Fine = Smaller airways
Coarse = Larger airways
Predominantly heard on inspiration
Can be equal both lungs
Can be isolated to one area
Crackles
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Produced by air forcing its way through narrowed airways
(bronchoconstricted)
High pitched musical sounds heard on expiration Can be heard on inspiration
Smooth Muscles Irritation = Bronchoconstriction
Wheezes
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High pitched continuous crowing sound that is heard
over the trachea and larynx
Stethoscope not normally needed Best heard over neck
Partial airway obstruction from:
Stridor
foreign objects, swelling
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Constant grating sound that is heard on inspiration
and expiration
Caused from parietal and visceral pleura rubbingtogether
Pleura inflamed (loss of serous fluid)
Usually localized
Pleural
Rub
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Attempt to place patient in sitting position
Attempt to minimize as much outside noise as
possible Encourage patient not to make any moaning and
groaning noises
*Auscultation should take place within the first 2minutes
Proper Auscultation
Procedure
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WHERE
SHOULDI
LISTEN?
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Posterior Chest
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Question # 1
Why do sick asthmatics often have very little wheezing?
A
B
C
D
Severe bronchoconstriction resulting in decreasedventilation and movement of air resulting in
decreased wheezingThe patient is faking it
The patient has used their Ventolin and no longerhas wheezes
Asthmatics have crackles
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Question # 1
Why do sick asthmatics often have very little wheezing?
A
B
C
D
Severe bronchoconstriction resulting in decreasedventilation and movement of air resulting in
decreased wheezingThe patient is faking it
The patient has used their Ventolin and no longerhas wheezes
Asthmatics have crackles
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You are called for a child choking. You note small toysaround the child. Which of the following breath soundsare you most likely to hear with a foreign body aspiration?
A
B
C
D
Question # 2
Crackles
Wheezing
Stridor
Friction rub
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You are called for a child choking. You note small toysaround the child. Which of the following breath soundsare you most likely to hear with a foreign body aspiration?
A
B
C
D
Question # 2
Crackles
Wheezing
Stridor
Friction rub
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A high pitched airway noise that results from lower airwaynarrowing is known as:
A
B
C
D
Question # 4
Rales
Stridor
Crackles
Wheezing
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A high pitched airway noise that results from lower airwaynarrowing is known as:
A
B
C
D
Question # 4
Rales
Stridor
Crackles
Wheezing
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End inspiratory sounds associated with fluid in the smallairways are known as:
A
B
C
D
Question # 5
Crackles
Vesicular
Wheezes
Stridor
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End inspiratory sounds associated with fluid in the smallairways are known as:
A
B
C
D
Question # 5
Crackles
Vesicular
Wheezes
Stridor
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Chest wall diameter may be increased in patients withwhat condition?
A
B
C
D
Question # 6
Pregnancy
Heart Disease
Rib fractures
Obstructive Pulmonary Disease
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Chest wall diameter may be increased in patients withwhat condition?
A
B
C
D
Question # 6
Pregnancy
Heart Disease
Rib fractures
Obstructive Pulmonary Disease
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During inspiration, the major muscle utilized in the healthynormal patient is the:
A
B
C
D
Question # 8
Diaphragm
Intercostals
Scalenes
Sternocleidomastoid muscles
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During inspiration, the major muscle utilized in the healthynormal patient is the:
A
B
C
D
Question # 8
Diaphragm
Intercostals
Scalenes
Sternocleidomastoid muscles
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When wanting to auscultate the chest at the bases, thebest location would be:
A
B
C
D
Question # 9
The eighth rib mid-axillary
The sixth rib anterior chest wall
T3 posterior chest wall
The eighth rib anterior chest wall
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When wanting to auscultate the chest at the bases, thebest location would be:
A
B
C
D
Question # 9
The eighth rib mid-axillary
The sixth rib anterior chest wall
T3 posterior chest wall
The eighth rib anterior chest wall
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Abnormal breath sounds can be:
A
B
C
D
Question # 10
Absent or diminished breath sounds
Displaced bronchial breath sounds
Adventitious breath sounds
All of the above
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Abnormal breath sounds can be:
A
B
C
D
Question # 10
Absent or diminished breath sounds
Displaced bronchial breath sounds
Adventitious breath sounds
All of the above
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ONTARIOBASE HOSPITAL GROUP
Ontario Base Hospital Group
Self-directed Education Program
Well Done!Well Done!
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