重庆医科大学：《临床技能学》课程教学课件（PPT讲稿）呼吸系统查体 Physical Examination in Respiratory System

InspectionSSS>ss>>sRespiratory rhythmCheyne-Stokes'breathingBiot's breathingDecreased excitability ofrespiratory centerInhibited breathingSudden cessation of breathing dueto chestpain Pleurisy, thoracic traumaSighing breathingDepression,intension

Inspection 3. Respiratory rhythm  Cheyne-Stokes’ breathing  Biot’s breathing _Decreased excitability of respiratory center  Inhibited breathing ◼ Sudden cessation of breathing due to chest pain  Pleurisy, thoracic trauma  Sighing breathing ◼ Depression, intension

PalpationThoracicexpansionMassivehydrothorax,pneumoniapleuralthickening,atelectasisVocalfremitus(tactil fremitus)Pleural friction fremitusCellulose exudation in pleura duetopleurisyHolding breathing→disappearedTuberculous pleurisy,uremia, pulmoembolism

Palpation  Thoracic expansion ◼ Massive hydrothorax, pneumonia, pleural thickening, atelectasis  Vocal fremitus (tactil fremitus)  Pleural friction fremitus ◼ Cellulose exudation in pleura due to pleurisy ◼ Holding breathing disappeared ◼ Tuberculous pleurisy, uremia, pulmo embolism

Percussion

Percussion

1. MethodMediatePleximeter: distal inter-phalangealjoint of left middlefingerPlexor:rightmiddlefingertip福ImmediateOrderUptodown,anteriortoposterior

1. Method ◼ Mediate  Pleximeter: distal inter-phalangeal joint of left middle finger  Plexor: right middle finger tip ◼ Immediate ◼ Order  Up to down, anterior to posterior

2. Affected factorsThickness of thoracic wallCalcification of costal cartilageHydrothoraxContaining gas in alveoliA/veolartensionAlveolar elasticity

2. Affected factors ◼ Thickness of thoracic wall ◼ Calcification of costal cartilage ◼ Hydrothorax ◼ Containing gas in alveoli ◼ Alveolar tension ◼ Alveolar elasticity