Chapter 16: LUNG & THORAIC
Upper Airway:
❖ Nose
❖ Mouth
❖ Pharynx (throat):
➢ oropharynx (back of mouth)
➢ nasopharynx (back of nose)
❖ Larynx (voice-box)
Lower Airway:
❖ Trachea (wind-pipe)
❖ Lungs
➢ RIGHT Lung: 3 lobes
▪ Higher than left bc of liver
▪ Right bronchus risk of aspiration & unintended intubation bc of higher up
➢ LEFT Lung: 2 lobes
▪ Narrower bc of heart
❖ Bronchi
❖ Bronchioles
❖ Alveoli
*Bifurcation into the right & left lung happens at the CARINA (cough
reflex)
*GAS EXCHANGE happens in the ALVEOLI
* TOP of LUNG called APEX : BOTTOM called BASE
Pleurae:
❖ Visceral Pleura
➢ Lines the outer surface of lungs
❖ Parietal Pleura
➢ Lines thoraic wall, mediastinum & diaphragm
Respirations:
❖ MAIN trigger for BREATHING: increased CO2 in the blood
➢ Occurs in brainstem: pons & medulla oblongata
➢ INHALATION occurs by:
▪ Diaphragm flattens creating vacuum pressure (NEGATIVE PRESSURE)
pulling air in
➢ EXHALATION is:
▪ PASSIVE: muscle relax pushing air out
Lung Sounds:
Normal Lung Sound
❖ VESICULAR:
➢ Soft, low pitched
➢ Heard over finer airways near where gas exchange occurs in alveoli field
➢ Heard over lung periphery (over most of lungs)
❖ BRONCHOVESICULAR:
➢ Intermediate
➢ Heard over the Bronchi
➢ Inspiratory & expiratory equal
➢ Heard over front 1st & 2nd Intercostal Space (ICS) between Scapula
❖ BRONCHIAL:
➢ Loud, high pitched
➢ Heard over Trachea & Larynx
*Larger Airways, breath sounds: louder & coarser
*Smaller Airways, Breath sounds: softer & finer
*Auscultate by listening TOP to BOTTOM, placed stethoscope directly on SKIN
Adventitous Lung Sound
❖ RHONCHI:
➢ Low pitched
➢ Like snoring bc secretions moving around in the airways
➢ *Can clear with coughing in the morning when pts just wake up
➢ Heard in pt with pneumonia, edema, chronic bronchiits
❖ COARSE CRACKLES:
➢ Low pitched
➢ Fluid in Alveoli (smaller airways)
➢ Heard on inspiration mostly
➢ Sounds like velcro opening
➢ Heard in pts with edema, fluid, COPD
❖ WHEEZES:
➢ High pitched: air is squeezing thru a narrow airway
➢ Expiratory wheeze indicates mild to moderate Asthma
➢ Expiratory & inspiratory indicate severe Asthma
➢ Heard in pts with Asthma, Bronchitis & Emphysema
❖ STRIDOR:
➢ Loud, high pitched
➢ Heard over Trachea & Larynx due to spasm
➢ Due to aspiration of foreign object or epiglottis (medical emergency)
❖ PLEURAL FRICTION RUB:
➢ Loud, low pitched grating sound (like squeaky door)
➢ Heard in Lower Anterolateral thorax
➢ Pts with pleuritis
*To assess Bronchophony, have pt say “99” while auscultating, if sound is loud
& clear, this means (+) bronchophony. Pneumonia is present 96-99% of (+) pts
Common Respiratory Conditions
❖ ASTHMA
➢ Hyper-sensitivity to allergens
➢ Low pitched wheeze due to narrow airway causing bronchospasm
➢ Diminished BS
➢ Percussion: occasional hyperresonance
❖ ATELECTASIS
➢ Collapsed section of alveoli
➢ Dyspnea
➢ Decreased or absent BS
➢ Confirmed by chest x-ray
❖ BRONCHITIS
➢ Inflammation of Bronchi
➢ Can be from infection or chronic COPD
➢ Confirmed by chest x-ray
➢ Percussion: resonance
❖ PNEUMOTHORAX
➢ Air in thoraic space caused by trauma
➢ Absent BS over effective area
➢ Dyspnea
➢ Confirmed by chest x-ray
❖ PLEURAL EFFUSION
➢ Fluid overload
➢ Decreased BS
❖ CONGESTED HEART FAILURE (CHF)
➢ Fluid overload, high BP
➢ Pink Frothy secretions
➢ Dyspnea, edema, weight gain
Reference Lines: ANTERIOR (front)
❖ MIDSTERNAL LINE
➢ Runs vertically (top to bottom) center of sternum
❖ MIDCLAVICAL LINE
➢ Runs vertically from each clavical between sternoclavicular & acromioclavicular
joints
❖ ANTERIOR (front) AXILLARY LINE
➢ Vertically (top to bottom) of anterior (front) axillary fold
Reference Line: POSTERIOR (back)
❖ VERTEBRAL LINE
➢ Runs vertically down center of spinal cord process
❖ MIDSCCAPULAR LINE
➢ Runs parallel to vertebral line thru middle of each scapula