Lungs and Thorax
Bates Video Viewing Guide: Lungs & Thorax
• PRINT for note taking during viewing
• Keep textbook handy to compare diagrams or pictures
• Each video clip last ~1-2 minutes.
• Every clip has SOUND,
Video clip #1 Initial Assessment Posterior Thorax
INSPECTION:
A. Brief survey- observations: 5
12345(answers) rate, rhythm, depth, effort, audible sounds
B. Normal findings123( answer- easily quietly and regularly 14 – 20 times per minute)
C. Inspect- neck for: _______________________________
(answer) supraclavicular or sternomastoid muscles contractions which if present
demonstrates effort and difficulty in respiration.
NORMAL - absent
D. Examine posterior thorax
Inspection for:
1.shape
2.symmetry
3.deformities
4. overlying skin
Video clip # 2: Assess Posterior Thorax (continued)
A. PALPATE - to locate pain or tenderness, lesions or abnormalities
B. Assess respiratory (chest) expansion- How is this performed?
(1) Place thumbs close to spine at level of 10th rib (T9-T10).
(2) Spread hands lightly over posterior thorax.
(3) Ask the patient to: ____________________ (take a deep breath, inhale deeply and
exhale fully )
(4) Look for your thumbs to move and feel for: range and symmetry of movement
(5) Normal: thumbs move apart smooth, symmetrical expansion
ABNORMAL: Lag in expansion on one side, unequal,
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Why is one side moving more that the other? Possible atelectasis, pneumonia or
fractured ribs, pneumothorax Pain if pleurae inflamed.
C. PALPATE:
• Technique: Using the pattern, systematically palpate for tactile fremitus
• What is Tactile Fremitus? __________________________________(tactile means Vocal
and Fermitus is a palpable vibration)
• Use what part of hand __________ (palmar base or ball of fingers).
• Ask pt to: _____________________________________(repeat the word, 99 since this
generates strong vibrations)
Assess systematically side to side down the thorax
• Palpate and compare - look for increase, decrease or absence of fremitus.
• Normal: KEY is symmetry of the vibrations.
• Abnormal: ________________________________( lack of symmetry side to sidedecrease fremitus obstruction of transmission of vibrations and increased fremitus with
increased density or consolidation of lung tissue)
________________________________________________________
Video clip # 3 Assess Anterior Thorax
• Pt position ______________ ( lie supine ))
• Tell pt and instructions ___________( breath normally
• Inspection for:
1.shape
2.symmetry
3.deformities
4. overlying skin
5. respiratory movement
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PALPATE - what are you looking for?
o normal
o abnormal- (tenderness, lesions )
Assess respiratory (chest) expansion- How is this performed?
(1) Place thumbs along the costal margins
(2) Spread hands lightly pointing upward
(3) Ask the patient to: ____________________ (take a deep breath)
(4) Look for your thumbs to move and feel for: range and symmetry of movement
(5) Normal: thumbs move apart – smooth, symmetrical expansion
ABNORMAL: Lag in expansion on one side, Unequal, why is one side moving more that
the other? Possible atelectasis, pneumonia or fractured ribs, pneumothorax or
postoperative guarding. ____________
Palpate for tactile fremitus: compare sides in 3 locations- look for increase, decrease or
absence of fremitus.
Normal: KEY is symmetry of the vibrations.
Video Clip # 4 : Normal and Adventitious Sounds -- LISTEN
Lungs and Thorax
What are the NORMAL or expected sounds?
What are the locations for each sound? .
Which is longer? Inspiration or expiration?
Carefully look at these charts. Can you hear the differences?
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Bronchial sounds (loud, high pitch, short inspiration & long expiration) Location:
Trachea and larynx- anterior neck and tape of neck posterior
Bronchovesicular sounds (moderate pitch, inspiration and expiration equal.)
Location: over Bronchi tree- anterior 1-2 interspaces and posterior between scapula
Vesicular ( soft, low pitch, long inspiration & short expiration)
Location: Over peripheral lung fields
Video Clip # 5: Auscultation Technique- Anterior Thorax
Sites for placement of stethoscope
Watch her technique- symmetrical, comparison of side to side
Start : _____
Remember: lateral sides
Listen for duration, intensity, .pitch
Ignore heart sounds and concentrate on lung sounds
If hear bronchial or bronchovesicular voice sounds where should not be located, listen for
transmitted voice sounds.
Video Clip # 6: Auscultation Technique- Posterior Thorax
NOTE THE TECHNIQUE and placement of stethoscope.
Auscultation- assesses air flow throughout upper airways and lungs.
Stand behind the person.
Begin at _______ (apices or top) and go downwards ( to bases - ~ T-10) and move stethoscope
systematically side to side- compare side to side..
NOTE location of sites to listen (remember: laterally from axilla down to 7-8 rib)
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USE: diaphragm
Listen to one entire cycle at each location
Listen to duration, pitch and intensity
Listen to inspiratory and expiratory
Note type and location
Tell pt to: ___________________________ (breath deep thur mouth.
LISTEN and WATCH the technique demonstrated- note sites, sounds and pace.
Refer to text for location confirmation as seen in this video. IMPORTANT
Transmitted voice sounds- also called vocal resonance.
Key Points:
• Normal: Transmission of vocal sounds thru healthy lung tissue is normally muffled.
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Abnormal: Consolidation or compression of lung tissue will enhance voice sounds
making the words more distinct or clear. Suggest- air filled lung is airless!
If bronchial or bronchovesicular sounds are heard in the wrong place, this is ABNORMAL. So
you need to listen for transmitted voice sounds. .
• While you listen with stethoscope- instruct the pt:
• Say ‘99’- bronchophony = louder or clearer than normal
• Say ‘EEE’ I if sounds like AAA with nasal component = egophany
• WHISPER ‘1,2,3’ – if louder and clearer than normal = whisper pectoriloquy
Video Clip # 7 : Adventitious Sounds (added breath sounds on top of the normal breath sounds)
LISTEN & Note: Quality, pitch, location and timing as important characteristics.
DisContinuous- result from air bubbling thru moisture in the alveoli or collapsed alveoli popping
open.
Crackles (intermittent, non musical, brief, like dots in time)
• fine- soft, high pitch, very brief
• coarse- louder, lower pitch, longer
Continuous- caused by narrowing of airways by spasm, inflammation, mucus secretions or a solid
tumor.
These sounds last longer and sound musical
• wheezes - high pitch, hissing or shrill quality,
• rhonchi – lower pitch, snoring quality
Can you tell the differences when you listen??
Video Clip # 7 -8 : Percussion - Posterior and Anterior
VIEW for awareness of techniques but percussion is not an expected skill