Clinical Examination Respiratory System F Y BAMS

1
Examination of Respiratory System

• Dr. Lalit. V. Vithalani
• M.D.(Kriya-Sharir)
• B.S.Ayurved college, Sawantwadi
• drlalit.vithalani_at_gmail.com

2
A- Respiratory Rate (RR)(Ideally Rate, depth,
Rhythm and Type Should be examined)

• Aim- To determine Respiratory Rate of Given
  Subject.
• (The respiration rate is the number of breaths a
  person takes per minute.)
• 2. Instrument- Subject
• 3. Normal rate in adult person - At rest ranges
  from 12-20 breaths /min

3

• 4. Procedure for Counting Rate-
• The RR is usually measured when a person is at
  rest and simply involves counting the number of
  breaths for one minute by counting how many times
  the chest rises.
• Respiratory rate should be counted
  surreptitiously (hidden/sneaky) while keeping the
  finger on the radial pulse.
• Observe RRPR 14 (Normally)

4

• 5. Respiratory Rate Before and after exercise-
• RR increases after exercise so as to fulfil
  the increased demand of oxygen at cellular level.
• ______________________________
• ______________________________

5
6.Types of Breathing

• Depends on Age and Sex-
• Thoracic breathing- In Women
• The movements of the chest are greater than
  those of abdomen.
• b)Abdominal Breathing- In Male
• (Diaphragm is more freely used than
  intercostal muscles)
• Children- Abdominal breathing
• (Various combinations- thoraco-abdominal,
  abdomino-thoracic)

6
7.RR increased in conditions (Tachypnea)
Tachypnea (tak-ip-NE-a tachy- rapid -pnea
breath - Rapid breathing

• Normal RR Quoted 12-20 breaths/min
• RR greater than 20/min Tachypnea
• (Children have higher RR)
• Physiological Tachypnea-
• Exercise Exertion
• labour during pregnancy

7

• Patho-physiological causes of tachypnea-
• Pain, Fever, Obesity, Matabolic acidosis
• CO poisoning Oxygen delivery to the
  tissues and organs is blocked.
• Lung diseases- COPD, Tuberculosis, Pneumonia
  Etc
• heart diseases- Myocardial Infarction
• Anemia Anxiety
• Various Poisoning
• Shock Dehydration
• Hyperthyrodism

8
8.RR decreased in conditions (Bradypnea)

• Bradypnea (Greek) Bradys- Slow, Pnoia-Breath
• Abnormally slow breathing rate.
• Causes -
• Aging, Alcohol Abuse
• Hypothyrodism, Electrolyte Imbalance,
• Degeneration of heart tissue because of
  aging, sleep apnoea, Medications- such as drugs
  for heart diseases, psychosis(sleeping pills).
• Brain Tumours etc.

9
9.Conclusion-

• _________________________________________________
  __________________________________________________
  ____________

10
B) Examination of Breath Sounds

1. Aim- Auscultation for determination of
   characteristic of various breath sounds and their
   clinical interpretation.
2. Instruments- Stethoscope, Subject
3. Procedure for auscultation- Auscultation is done
   all over the lungs front, axillary regions and
   back. Sounds at corresponding points on the two
   sides are compared.

11
3.Procedure cont...

• Since breath sounds during quiet breathing are
  insufficient for study, the patient is asked to
  breath deeply through open mouth.
• (best to show the patient how to do it.)
• Adopt zigzag pattern for auscultation

12
(No Transcript)
13
(No Transcript)
14
Order of auscultation
15
(No Transcript)
16
a)Type and character of breath sounds

• Whether vesicular or bronchial
• Vesicular breath sounds
• -Produced by passage of air in the medium
  and large bronchi
• - they get filtered and attenuated while passing
  through millions of air filled alveoli before
  reaching the chest wall.

17
Vesicular breath sounds cont

• -Heard both during inspiration and expiration.
• Inspiratory sound-
• Low pitched, rustling in character.
• always longer than expiratory sound.
• Expiratory sound-
• Softer and shorter, flows without a pause,
• heard during early part of expiration.

18

• I E
• Vesicular breath sounds.

19

• Normally, breathing over most areas of the chest
  is vesicular.
• Most typically so in the axillary and
  infrascapular region.

20
2.Bronchial Breath Sounds

• Bronchial breath sounds originates probably in
  the same medium and large bronchi.
• They replace vesicular sounds when the lung
  tissue between them and the chest wall becomes
  airless as a result of consolidation (as in
  pneumonia), tuberculosis, carcinoma and fibrosis.
• There is no filtration and attenuation of sound
  as they dont pass through air filled alveoli.

21
Bronchial breath sounds cont.

• Bronchial breath sounds are loud, clear, hollow
  or blowing in character and of high frequencies.
• Inspiratory sound becomes inaudible just before
  the end of inspiration
• Expiratory sound is heard throughout the
  expiration.

22
Areas where the bronchial sound can normally be
heard

• Trachea and larynx- harsher , louder sounds
• Interscapular regions and apex of right lung-
• more bronchial element than vesicular because
  trachea and bronchi come near to the surface.
• Right infraclavicular, over the lower cervical
  vertebrae.

23

• I E
• Bronchial breath sounds.

24
B. Intensity of breath sound

• Whether diminished or absent

25
C. Added or adventitious sounds.

• Crepitations-(or moist sounds)
• discontinuous bubbling or crackling sounds
  produced by passage of air through fluid in small
  airways. Crepitations may be fine or coarse.
  (Fine creps- rub hair)
• Ronchi- dry sounds- produced by the passage of
  air through narrowed or partially blocked
  respiratory passages.

26
Added or adventitious sounds cont....

• Pleural Rub- (friction sound)
• creaking or rubbing sound produced by friction
  between two layers of inflamed or roughened
  pleura.
• Produced mainly during deep inspiration.
• It disappears when there is accumulation of fluid
  in pleural cavity.