Thorax, lungs and cvc system

Introduction to Clinical Skills

Thorax, Lungs and CVC systemUniversidad Iberoamericana UNIBE


Teaching Staff Dra Elizabeth Peralta Dr Marcos Núñez Dra Cristina Páez C Dr Juan Carlos Mariñez Dra Wayna Greo Dra Yun Pey Lee


Chest Exam: anterior and posterior Landmarks Muscle skeletal Mediastinum Lungs Heart


Chest Exam: anterior and posterior Landmarks

C7 Louis angle Tip of scapula


Chest Exam: anterior and posterior Landmarks


Chest Exam: anterior and posterior Muscle skeletal Exam

Pectoralis major…………….. Trapezius ……………….. M0 to M5


Chest Exam: anterior and posterior Surface Anatomy


Chest Exam: anterior and posterior Surface anatomy


Chest Exam: anterior and posterior Mediastinum

Heart and great vessels


Chest Exam: anterior and posterior The Lungs

The Trachea and major bronchi The Pleurae Lungs , Fissures and Lobes Breathing


Chest Exam: anterior and posterior The Health History

Chest pain Myocardium, Pericardium, Aorta Trachea and large bronchi, Pleura (parietal) Chest wall Esophagus Extrathoracic : Gallbladder, Stomach

Shortness of breath (dyspnea) Wheezing Cough Blood-streaked sputum (hemoptysis)


Chest Exam: anterior and posterior Health Promotion and Counseling

Tobacco cessation CAD, Stroke, PVD COPD Cancer

Immunizations Influenza Neumococcus

Introduction to Clinical Skills Chest Exam: anterior and posterior

Techniques of Examination Assess patient Color Observe and Listen patient´s breathing

Rate, Rythm, Depth and Effort of breathing Inspect the neck Observe shape of the Chest


Chest Exam: anterior and posterior Techniques of Examination

Inspection Palpation Percussion Auscultation


Chest Exam: anterior and posterior Techniques of Examination: Inspection

Introduction to Clinical Skills Chest Exam: anterior and posterior

Techniques of Examination: Palpation Diaphragm mobility Tactile fremitus


Chest Exam: anterior and posterior Techniques of Examination: Percussion

Resonance



Dullness




Chest Exam: anterior and posterior Techniques of Examination: Auscultation


Chest Exam: anterior and posterior The Thorax and Lungs. Recording findings

“Thorax is symmetric with good expansion. Lungs resonant. Breath sounds vesicular, no rales, wheezes, or rhonchi. Diaphragms descend 4 cm bilaterally”.


Chest Exam: anterior and posterior Heart and Cardiovascular System

Surface projections of Heart and Great vessels Cardiac chambers, valves and circulation Events in the Cardiac Cycle Splitting of Heart Sounds Heart murmurs Auscultatory findings to the chest wall The conduction system Arterial pulses and Blood Pressure Jugular venous pressure



Surface projections of Heart and Great vessels



Cardiac chambers, valves and circulation



Events in the Cardiac Cycle



Events in the Cardiac Cycle



Splitting of Heart Sounds



Turbulence = Heart murmurs (physiologic) http://www.wilkes.med.ucla.edu/intro.html



Auscultatory findings to the chest wall



The conduction system



Arterial pulses and Blood Pressure


Chest Exam: anterior and posterior Factors Influencing Arterial Pressure

Left Ventricular stroke volume Distensibility of the aorta and the large arteries Peripheral vascular resistance, particularly at the arteriolar level Volume of blood in the arterial system



Jugular venous pressure



Jugular venous pressure



Jugular venous pulsations


Chest Exam: anterior and posterior Heart and Cardiovascular System The Health History

Chest pain Palpitations Shortness of breath

Dyspnea Orthopnea Paroxysmal dyspnea

Swelling or edema


Chest Exam: anterior and posterior Heart and Cardiovascular System Health Promotion and Counseling

Screening for hypertension Screening for coronary heart disease and stroke Screening for dyslipidemias Promoting lifestyle modification and risk - factor reduction


Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination

Jugular Venous Pressure and Pulsations The Carotid Pulse The Heart Functional Murmurs


Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination: JVP and pulsations


Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination: The Carotid pulse


Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination: The Heart


Chest Exam: anterior and posterior


Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination: The Heart

Heart and Cardiovascular System Techniques of Examination: The Heart


Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination

Functional Murmurs


Chest Exam: anterior and posterior Heart and Cardiovascular System Recording your Findings

“ The Jugular venous pulse is 3 cm above the sternal angle with the head of the bed elevated to 30°. Carotid upstrokes are brisk, without bruits. The point of maximal impulse is tapping, 7 cms lateral to the midsternal line in the 5th intercostal space. Crisp S1 and S2. At the base S2 is greater than S1 and physiologically split, with A2 > P2. At the apex S1 is greater than S2 and constant. No murmurs or extrasounds.”

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Thorax, lungs and cvc system