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[email protected] CARDIOPULMONARY ASSESSMENT Dr. Smriti A. Gupta Assistant Professor Dr. D. Y. Patil College of Physiotherapy D. Y. Patil Vidyapeeth
| Date post: | 07-Aug-2015 |
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Health & Medicine |
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CARDIOPULMONARY ASSESSMENT
Dr. Smriti A. GuptaAssistant Professor
Dr. D. Y. Patil College of PhysiotherapyD. Y. Patil Vidyapeeth
PERCUSSION
• Percussion is art of tapping on a surface in order
to evaluate the underlying structures
• Percussion of chest wall generates sound and leads
to production of standing waves on the chest wall
• The sound waves produced on the chest wall can
travel down to a depth of 5-7cm
• Position of the patient---- the sitting posture is the best position
• Supine position is not desirable because of the alteration of the
percussion note by the underlying structure on the patient lies
• Anterior percussion--- the patient sits erect with hands by his side
• Posterior percussion ---the patient bends his head forward and
keeps his hands over the opposite shoulder
• Lateral percussion ---- the patient sits with his hands helds over
the head
Cardinal rules of Percussion
• The pleximeter ----the middle finger of the examiners left hand
should be opposed tightly over the chest wall over the intercostal
spaces. The other fingers should not touch the chest wall
• The plexor ----- the middle or the index finger of the examiner
right hand is used to hit the middle phalanx of the pleximeter
• The percussion movement should be sudden, originating from
the wrist.
Percussion….
• Should be done systematically and compare area on the both sides
• Bony structures and breast should be avoided
• Unilateral and diffuse changes in resonance should be made out
( hyper resonant, normal resonant, tymphanitic , dullness, stony
dullness)
• Obesity and muscular chest wall are limitations for percussion.
Percussion cannot detect small abnormalities and lesions below
5cm from the chest wall.
• Increased resonance indicates excessive air
trapped in the pleural space or lungs
• Decreased resonance indicates fluid in the
pleural space or consolidation in the lung.
Diaphragmatic excursion
• The range of diaphragm movement may be estimated by percussion and is assessed best on the posterior chest wall
• For the examiner to estimate diaphragm movement, the patient first is instructed to take a deep, full inspiration and to hold it
• The examiner then determines the lowest margin of resonance by percussing over the lower lung field and moving downward in small increments until a definite change in the percussion note is detected
• The patient then is instructed to exhale maximally, holding this position while the percussion procedure is repeated.
• The normal diaphragmatic excursion during a deep breath is approximately 5 to 7 cm
Auscultation
• The stethoscope includes four basic parts; a bell ,a diaphragm, tubing, and ear pieces
• The bell detects a broad spectrum of sounds and is of particular value in listening to low-pitched heart sounds
• The diaphragm piece is used most often in auscultation of lungs, because most lung sounds are high frequency
• The ideal tubing should be thick enough to exclude external noises and should be approximately 25 to 35 cm in length.
Procedure
• The patient should be sitting upright in a relaxed position when possible.
• The patient is instructed to breathe a little deeper than normal with a mouth open
• It is recommended that examiner begin at the bases, compare side with side, and work toward the lung apices
• The examination begins at the lung bases, because certain abnormal lung sounds that occur primarily in the dependent lung sounds may be altered by several deep breaths
• Four characteristics of breath sounds are o be identified first, the pitch (vibration frequency) is identified. Second, the amplitude or intensity (loudness) is noted. Third, the examiner listens for the distinctive characteristics . Fourth, the duration of inspiratory sound is compared with that of expiration
• Lung sounds------ wheezes• Possible mechanism------ rapid airflow
through obstructed airways caused by bronchospasm, mucosal edema
• Characteristics----- high-pitched, most often occur during exhalation
• Causes---- asthma, congestive heart failure, bronchitis
• Lung sounds----- stridor • Possible mechanism----- rapid airflow through
obstructed airway caused by inflammation • Characteristics ------ high-pitched; often
occurs during inhalation • Causes--- postextubation , URTI etc.
• Lung sounds------ crackles • Possible mechanism------- excess airway
secretions moving with airflow (inspiratory and expiratory crackles)
• Characteristics------ coarse and often clear with cough
• Causes------ bronchitis, respiratory infections
• A pleural friction rub is a creaking or grating type of sound that occurs when the pleural surfaces become inflamed and roughened edges rub together during breathing,
• It may be heard only during inhalation but often is identified during both phases of breathing
Vocal resonance
• It is a voice sound heard with the chest piece of the stethoscope
• Bronchophony;----- voice sounds appear to be heard near the earpiece of stethoscope and words are unclear
• Example------- consolidation, cavity communicating with a bronchus, above level of pleural effusion
• Egophony ;----- voice sounds has a nasal or bleating quality. On saying E it will be heard as A (E to A sign)
• Example----- consolidation, cavity, above the level of pleural effusion,
• Whispering pectoriloquy;-----the patient is asked to whisper words at the end of expiration, and this whispered voice is transmitted without distortion so that the individual syllables are recognised clearly. example-----pneumonic consolidation
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