what are factors that may compromise the airway?
- tongue
- position of patient
- loose teeth or foreign objects, vomit
- infection of upper airway eg. epiglottitis, croup
- upper airway obstruction - laryngeal spasm, tumour, oedema
- Trauma - facial and oral bleeding soft tissue injury to neck or face fractures.
WHat muscles, if used at rest, indicate respiratory distress?
Sternocleidomastoid and intercostals
Tracheal tugging and tracheal deviation
what are some causes of course crackles?
due to consolidation
- chest infection
- gunk in lungs etc
Heard in both insp and exp, may be modified by coughing
What are some causes of fine crackles?
Alveoli popping open
- APO
acute - pnemonia
chronic - pulmonary fibrosis
fluid - pulmonary odema
What do wheezes signify?
opposing airway walls implying significant airway narrowing
Generally expiratory but can be on Insp when worsening
DO airways dilate or narrow on expiration?
Narrow
What does stridor indicate?
Inspiratory muslce wheeze heard loudest over trachea
Suggest obstructed trachea or larynx eg. Croup, anaphylaxis, obstruction
Sever resp distress category
What are some causes of stridor?
Obstruction within the lumen of airway
- Foreign body
- tumour
- bilateral vocal cord palsy
Obstruction within wall of airway
- oedeme from anaphylaxis
- tumour
- laryngospasm
- croup
- acute epiglotitis
- Amyloidosis
Extrensic obstructions
- Goitre
- Lymphoadenopathy
- Post-op
- Following neck surgery
What is bronchial breathing?
- adventitious sound in resp
- sounds hollow or bellowing
- ins and exp phase are equal in length and intensity
- signifies diseased of affected area has patent bronchus
What is a pleural (friction) rub?
- Creaking, course or grating sound
- Occurs at same moment of resp cycle insp and exp
Due to friction between inflames visceral and parietal pleura from pulmonary infarction, pneumonia of vascultis
Explain absent or diminshed breath sounds?
Can be generalised or localised
Generalised = obesity, hyperinflation or hypoventilation Localised = bronchial occlusion, pneumothorax, paralysis of diaphragm, pleural effusion
What are the different types of chest sounds?
- crackles
- wheezes
- stridor
- Bronchial breathing
- pleural rub or pleural crackles
- absent of diminished sounds
What is tactile fremitus?
An assessment of the patient.
- Get them to say “99” over again
- feel there chest for the vibration patterns
Basically vibrations from vocal chords during speech get transmitted down tracheobronchial tree and through alveoli to chest wall.
What does it suggest if there is increased fremitus?
Increased density of lung eg. Pneumonia, lung tumour or mass, atelectasis (alveolar collapse)
What does it suggest if there is decreased fremitus?
unilateral - bronchial obstruction due to mucous plug or FB, pneumothorax, pleural effusion
diffuse - COPD, muscular or obese chest wall
What is the Percussion technique?
place finger between intercostals and tap your finger listening for sounds
Evaluates lungs to depth of 5-7cm below chest wall
What sounds occur with percussion
Low pitch sounds, louder = increased resonance
- consolidation - oneumonia
- Atelectasis
- Pleural spaces filled with fluid
High pitch sounds - decreased resonance
- hyperinflation - asthma, copd, emphysemia, pneumothorax
What should a focused respiratory assessment include?
- Inspection
- Palpation
- Percussion
- Auscultation
