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PhysicalExaminationinRespiratorySystem

wangyingyan

.PhysicalExaminationinRespir11.Superficiallandmarks,imaginarylinesandregionsofthechest.1.Superficiallandmarks,imag2AnteriorlandmarkManubriumgladiolusXiphoidprocess.AnteriorlandmarkManubriumglad3AnteriorlandmarkSternalangle(louisangle)CosticartilageofsecondribBronchialbifurcationThesuperioredgeofcardiacatriumThejunctionofupperandlowermediastinumTheleveloffifththoracicvertebraeposterior.AnteriorlandmarkSternalangle4PosteriorlandmarkThescapularangle

sitorstand,armsattheside—seventhriborinterspaceorthelevelofeighththoracicvertebraTheseventhcervicalvertebralspine

prominentlyprotrudingScapulaeangleseventhcervicalvertebralspine.PosteriorlandmarkThescapular5AnteriorimaginarylinesAnteriormidlineMidclavicularlineAnteriormidlinedrawnthroughthemiddleofthesternumMidclavicularlinedrawnthroughthemiddleofthe

clavicle.AnteriorimaginarylinesAnteri6LateralimaginarylinesAnterioraxillarylinePosterioraxillarylineMidaxillarylineAnterioraxillarylinedrawnalongtheanterioraxillaryfoldsMidaxillarylinedrawnfromthevertexoftheaxillaePosterioraxillaryline

drawnalongtheposterioraxillaryfolds.LateralimaginarylinesAnterio7PosteriorimaginarylinesScapularlinePosteriormidlinePosteriormidline

drawnthroughthepos-teriorspinousprocessofvertebraeScapularline

drawnthroughthescapularangle.PosteriorimaginarylinesScapu8AnteriorfossaeEpigastricangle

InfraclavicularfossaSuprasternalfossaSupraclavicularfossa.AnteriorfossaeEpigastricangl9AxillaryfossaAxillaryfossa.AxillaryfossaAxillaryfossa.10PosteriorimaginaryregionInfrascapularregionInterscapularregionSuprascapularregion.PosteriorimaginaryregionInfr112.Thorax.2.Thorax.12Shape:symmetricalwithoutdeformityAnteroposterior/transversediameteris1:1.5.Shape:symmetricalwithoutde13Respiratoryrhythm：regularandsymmetricmodelAbdominalrespiratory—menandchildrenChestrespiratory—womenveintendernessorsubcutaneouscrepitus.Respiratory.144.Lung.4.Lung.15InspectionRespiratoryrate:14-18cyclesperminuteIntercostalspace:narrow,wide.InspectionRespiratoryrate:116PalpationChestexcursionHandsalongcostalmarginInspiredeeplyObservemovement.PalpationChestexcursion.17Vocalfremitus

placebothpalmortheunlarsideofthehandsonthesymmetricalpositionwithalighttouchrepeatword“yi”

comparevibration.Vocalfremitus.18PleuralfrictionrubsBreathedeeply,PlacepalmortheulnarsideofhandsontheinferioranteriorlateralportionofthechestLiketwopiecesofleatherrubbedHoldingbreathingdisappeared.Pleuralfrictionrubs.19Percussion.Percussion.201.PositionSitorlie,balancedbody,relaxmuscle,quietandevenbreathingAnterior：throwingouthischestanteriorlyLateral:armsslightlyabductedbeyondtheheadBack:pullingshoulderforward,armfoldedinfront,spineanteflexed,headlower.1.Position.212.MethodDirectpercussionStrikedirectlywithpalmartipsofrightmiddlethreefingersIndirectpercussion

Pleximeter:distalphalanxofleftmiddlefingerPlexor:rightmiddlefingertip,distalinterphalangealjointofpleximeterfingerSequence

Toptobottomanteriortoposterior,lateralthorax.2.MethodDirectpercussion.223.ClassificationResonanceNormalHyperresonanceEmphysemaTympanyCavityorpneumothorax,normalabdomen.3.ClassificationResonance.23DullnessPleuraleffusion,consolidationofthelung,FlatnessMassivePleuraleffusion,solidorgans.Dullness.244.NormalsoundLung’ssoundinpercussionResonanceSlightdullnessinsomeareas(upper,right,back)duetothicknessofmusclesandskeletons

.4.NormalsoundLung’ssoundi25Lowerborder6th,8th,10thintercostalspaceinmidclavicularline,midaxillaryline,scapularline,respectively5.Contents.Lowerborder5.Contents.26sAlongthescapularlinePercussingbottomoflung,markingAskingthepat.toinspiredeeplyandholdPercussingbottomoflung,markingAskingthepat.toexpiredeeplyandholdPercussingbottomoflung,markingMeasuringthedist.betweenupperandlowerlinesMovementoftheinferiorlungbase.sAlongthescapularlineMoveme27Auscultation

.Auscultation.28Position:sitorsupineMethod:Toptobottom,anteriortolateraltoposterior.Position:sitorsupine.29Orderofauscultation.Orderofauscultation.30NormalbreathsoundBronchialbreathsoundsuprasternalfossa,around6th,7thcervicalvertebra,1st,2ndthoracicvertebraLonger,louder,higherpitchinexpiratoryphaseBronchovesicularbreathsound1st,2ndintercostalspacebesideofsternum,thelevelof3rd,4ththoracicvertebraininterscaplarareaVesicularbreathsoundMostareaoflungsLonger,louder,higherpitchininspiratoryphaseBronchovesicularBronchialBronchialBronchovesicular.NormalbreathsoundBronchialb31PhysicalExaminationinRespiratorySystem

wangyingyan

.PhysicalExaminationinRespir321.Superficiallandmarks,imaginarylinesandregionsofthechest.1.Superficiallandmarks,imag33AnteriorlandmarkManubriumgladiolusXiphoidprocess.AnteriorlandmarkManubriumglad34AnteriorlandmarkSternalangle(louisangle)CosticartilageofsecondribBronchialbifurcationThesuperioredgeofcardiacatriumThejunctionofupperandlowermediastinumTheleveloffifththoracicvertebraeposterior.AnteriorlandmarkSternalangle35PosteriorlandmarkThescapularangle

sitorstand,armsattheside—seventhriborinterspaceorthelevelofeighththoracicvertebraTheseventhcervicalvertebralspine

prominentlyprotrudingScapulaeangleseventhcervicalvertebralspine.PosteriorlandmarkThescapular36AnteriorimaginarylinesAnteriormidlineMidclavicularlineAnteriormidlinedrawnthroughthemiddleofthesternumMidclavicularlinedrawnthroughthemiddleofthe

clavicle.AnteriorimaginarylinesAnteri37LateralimaginarylinesAnterioraxillarylinePosterioraxillarylineMidaxillarylineAnterioraxillarylinedrawnalongtheanterioraxillaryfoldsMidaxillarylinedrawnfromthevertexoftheaxillaePosterioraxillaryline

drawnalongtheposterioraxillaryfolds.LateralimaginarylinesAnterio38PosteriorimaginarylinesScapularlinePosteriormidlinePosteriormidline

drawnthroughthepos-teriorspinousprocessofvertebraeScapularline

drawnthroughthescapularangle.PosteriorimaginarylinesScapu39AnteriorfossaeEpigastricangle

InfraclavicularfossaSuprasternalfossaSupraclavicularfossa.AnteriorfossaeEpigastricangl40AxillaryfossaAxillaryfossa.AxillaryfossaAxillaryfossa.41PosteriorimaginaryregionInfrascapularregionInterscapularregionSuprascapularregion.PosteriorimaginaryregionInfr422.Thorax.2.Thorax.43Shape:symmetricalwithoutdeformityAnteroposterior/transversediameteris1:1.5.Shape:symmetricalwithoutde44Respiratoryrhythm：regularandsymmetricmodelAbdominalrespiratory—menandchildrenChestrespiratory—womenveintendernessorsubcutaneouscrepitus.Respiratory.454.Lung.4.Lung.46InspectionRespiratoryrate:14-18cyclesperminuteIntercostalspace:narrow,wide.InspectionRespiratoryrate:147PalpationChestexcursionHandsalongcostalmarginInspiredeeplyObservemovement.PalpationChestexcursion.48Vocalfremitus

placebothpalmortheunlarsideofthehandsonthesymmetricalpositionwithalighttouchrepeatword“yi”

comparevibration.Vocalfremitus.49PleuralfrictionrubsBreathedeeply,PlacepalmortheulnarsideofhandsontheinferioranteriorlateralportionofthechestLiketwopiecesofleatherrubbedHoldingbreathingdisappeared.Pleuralfrictionrubs.50Percussion.Percussion.511.PositionSitorlie,balancedbody,relaxmuscle,quietandevenbreathingAnterior：throwingouthischestanteriorlyLateral:armsslightlyabductedbeyondtheheadBack:pullingshoulderforward,armfoldedinfront,spineanteflexed,headlower.1.Position.522.MethodDirectpercussionStrikedirectlywithpalmartipsofrightmiddlethreefingersIndirectpercussion

Pleximeter:distalphalanxofleftmiddlefingerPlexor:rightmiddlefingertip,distalinterphalangealjointofpleximeterfingerSequence

Toptobottomanteriortoposterior,lateralthorax.2.MethodDirectpercussion.533.ClassificationResonanceNormalHyperresonanceEmphysemaTympanyCavityorpneumothorax,normalabdomen.3.ClassificationResonance.54DullnessPleuraleffusion,consolidationofthelung,FlatnessMassivePleuraleffusion,solidorgans.Dullness.554.NormalsoundLung’ssoundinpercussionResonanceSlightdullnessinsomeareas(upper,right,back)duetothicknessofmusclesandskeletons

.4.NormalsoundLung’ssoundi56Lowerborder6th,8th,10thintercostalspaceinmidclavicularline,midaxillaryline,scapularline,respectively5.Contents.

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