Thorax and Lungs

The points at which the ribs join their cartilages. They are not palpable.

Defined by the sternum, 12 pairs of ribs and 12 thoracivertebrates

U shaped depression above the sternum, in between the clavicles

The breastbone which contains manubrium, body and xiphoid process

Articulation of the manubrium and body of the sternum that is continuous with the second rib. Useful place to start counting ribs.

Where the right and left costal margins form an angle where they meet at xiphoid process of 90 degrees or less. This angle increases when rib cage is chronically overinflated, as in emphysema.

Most prominent bonspirit protruding at base of neck is C7 and the lower nose is T1

Count down knobs on vertebrae which stack together to form the spinal column. They align with their same numbered ribs down to T4. After T4 they angle downward from their vertebral body and overlie vertebral body and rib below.

Located symmetrically in each hemithorax. Lower tip is usually at 7th or 8th rib

Midway between spine and persons side

Middle section of the thoracic cavity containing esophagus, trachea, heart and great vessels.

Located on either side of the mediastinum and contain the lungs

Highest point of lung tissue 3-4 cm above the inner third of the clavicles

Rests on diaphragm at about 6th rib in the midclavicular line. T10!

Crosses 5th rib in midaxillary line and terminates at the 6th rib in midaxillary line

Divides the right upper and middle lobes

Serous membranes that form an envelope between lungs and chest wall

Lines the outside of the lungs, dipping down into the fissures 

Lines inside of the chest wall and diaphragm

Inside of the envelope which is a potential space filled only with a few ml of lubricating fluid.

Potential space when it fills with air or fluid, it compromises lung expansion

Bifurcates just below sternal angle into the right and left main bronchi. At level of t4/t5

Transport gases between the environment and lung parenchyma. "Dead space" that is filled with air but is not available for gas exchange

Protects alveoli from small particulate matter in the inhaled air

Lined wigo goblet cells that secrete mucus and cilia which sweep particles up 

Functional respiratory unit that consists of bronchioles, alveolar ducts, alveolar sacs, and the alveoli

Where does gaseous exchange occur?

Clustered like grapes creating a surface area for gas exchange that is as large as a tennis court

What are the four major functions of  the respiratory system?

Increase of carbon dioxide in the blood

Decrease of oxygen in the blood increasing respirations

Increased vertical diameter with the diaphragm descending and ribs elevating as it contracts

Decrease vertical diameter when ribs depress and diaphragm domes up

When does the diaphragm elevate 4 cm? 

Maximum amount of air that a person can expel from the lungs after first filling the lungs to max

Amount of air remaining in lungs even after the most forceful expiration

Coughing up blood

Difficulty breathing when supine

Awakening from sleep with shortness of breath

Placing hands on posterolateral chest wall with thumbs at level of T9 and T10. Pinch fold of skin and ask person to breathe. Thumbs should move apart symmetrically 

Ap diameter equal to transverse diameter. Ribs are horizontal with chest appearing as if held in continuous inspiration.

Palpable vibration. "Ninety Nine"

What factors affect the normal intensity of tactile fremitus?

Occurs when anything obstructs transmission of vibrations (Obstructed bronchus, pleural effusion, pneumothorax and emphysema). Any barrier that gets in the way of the sound and your palpating hand

Occurs with conditions that increase density of lung tissues, thereby making a better conducting medium for vibrations (pneumonia). There must be a patent bronchus and consolidation must extend to lung surface.

Vibration felt when inhaled air passes through thick secretions in the large. Bronchi. This may decrease by coughing.

Produced when inflammation of parietal or visceral pleura cause a decrease in normal lubricating fluid.

Coarse, crackling sensation palpable over skin surface. occurs in subcutaneous emphysema when air seascapes lung and enter subcutaneous tissue

Low pitched, clear, hollow sound that predominates in healthy lung tissue 

Lower pitched, booming sound found when too much air is present such as in emphysema or pneumothorax

Determhow's how far diaphragm moves when breathing. 3-5 cm in adults

High pitched, loud amplitude, inspiration is less than expiration, harsh hollow tubular quality located at trachea and larynx

Moderate pitch and amplitude, inspiration equals expiration, mixed quality and is located where fewer alveoli are located: posterior, between scapula, anterior

Low pitch, soft amplitude, inspiration greater then expiration, rustling quality, located over peripheral lung fields where air flows through smaller bronchioles and alveoli

When are their decreased or absent breath sounds?

Abnormal lung sounds

Not pathological! Short, popping, crackling sounds that sound like fine crackles but don't last beyond a few breaths. Sections of alveoli are not fully aerated and deflate slightly and accumulate secretions.

Purse lips in whistle position, tense, clubbing in nails

Suggests obstruction of respiratory tract or increased inspiratory effort is needed, as with atelectasis

Indicates trapped air as in the forced expiration associated with emphysemabout asthma

Measures lung health in chronic conditions such as asthma. 75% or greater means no significant obstruction of airflow is present 

Noninvasive method to assess arterial oxygen saturation. 95-100%

A markedly sunken sternum and adjacent cartilages. Depression begins at second intercostal space, becoming depressed most at junction of zip good with body of sternum

Forward protrusion of sternum, with ribs sloping back at either side and vertical depressions along costochondral junctions.

S shaped curvature of thoracic and lumbar spine, usually with involved vertebrae rotation. More prevalent in girls 

Exaggerated posterior curvature of thoracic spine that causes significant back pain and limited mobility. Could impair cardiopulmonary function.

Rapid, shallow breathing that's more than 20 a min. Normal response to fever, fear, exercise. Rate increases with respiratory insufficiency, pneumonia, alkalosis, pleurisy, and lesions in the pons

Slow breathing. Decreased by regular rate under 12 breaths per min. Drug induced depression of respiratory center in medulla, increased intracraniapresided and diabetic coma

Increase in both breathing rate and depth. Blows off carbon dioxide causing a decreased level in the blood. Occurs with exertion, fear or anxiety

Irregular shallow pattern caused by overdose of narcotics or anesthetics. Can also occur with prolonged bed rest or conscious splinting of chest to avoid respiratory pain

Cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing. Breathing period lasts 30-45 seconds with periods of apnea alternating. Most common cause is heart failure

Similar to cheyne-stokes except that the pattern is irregular. Seen with head trauma.

Discontinuous, high pitched, short crackling, popping sounds heard during inspiration that aren't cleared by coughing

Inhaled air collides with previously deflated airways

Sudden airway closing

Loud, low pitched, bubbling and gurgling sounds that start in early inspiration and may be present in expiration. Inhaled air collides with secretions in trachea and large bronchi. Pulmonary edema, pneumonia.

Superficial sound that is coarse and low pitched that is caused when pleural become inflamed and lose their normal lubricating fluid. Roughened surfaces rub together during respiration.

High pitched, musical sounds that predominate in expiration. Air is squeezed through passageways narrowed almost to closure by collapsing, swelling, secretions or tumors

Low pitched, single note, prominent on expiration. Airflow obstruction as described by vibrating reed mechanism

High pitched, monophonic, inspiratorty crowing sound that originates in larynx or trachea. Upper airway I obstruction from swollen, inflamed tissues.

Ask person to repeat 99. Normal voice transmission is soft, muffled and indistinct

You should hear "eeeee" not "aaaaaa" through stethoscope 

"1,2,3"
normal response is faint, muffled and almost inaudible

Collapsed shrunken section of alveoli or an entire Lunt as result of airway obstruction, the alveolar air beyond it is absorbed into pulmonary capillaries and alveolar walls cave in, compression on lung, lack of surfactant

Infection in lung parenchyma leaves alveolar membrane edematous and porous, so rbc's and wbc's pass from blood to alveoli. Alveoli fill up decreasing surface area of respiratory membrane causing hypoxemia.

Proliferation of mucus glands in the passageways, resulting in excessive mucus secretion. Inflammation of bronchi with partiaobstruction of bronchi by secretions

Caused by destruction of pulmonary connective tissue characterized by permanent enlargements of air sacs distal to terminal bronchioles and rupture of interalveolar walls. Increases airway resistance especially with expiration producing hyper inflated lungs

An allergic hypersensitivity to certain inhaled allergens, irritata, microbes, stress or exercise that produces a complex response characterized by bronchi spasm and inflammation, edema in walls of bronchioles and secretion of may us into airways

Collection of excess fluids in the infra pleural space with compression or overlying lug tissue. Effusion may contain watery capillary fluid, protein, purulent matter, or milky lymphatic fluid

Pump failure with incpressure pressure of cardiac overload causes pulmonary congestion or an increased amount of blood present in pulmonary capillaries. Dependent air sacs deflate, pulmonary capillaries engorged.

Free air in pleural space causes partial or complete lung collapse. Air in pleural space neutralizea the usual negative pressure present

Inhalation of tubercular bacilli into the alveolar wall starts

Undos solved materials originating in legs or pelvis detach and travel through venous system returning blood to right heart and lodge to occlude pulmonary vessels 

Acute, pulmonary insult damages alveolar capillary membrane, leading to increased permeability of pulmonary capillaries and alveolar epithelium and to pulmonary edema. Trauma, gastric acid aspirations, shock, sepsis.collapsed alveoli!