The type, frequency, depth and rhythm of respiration can be determined by carefully observing the chest and the abdomen. Respiration can be costal (thoracic), abdominal, or mixed type.
Thoracic (costal) respiratio. Respiratory movements are carried out mainly by the contraction of the intercostal muscles.
The chest markedly broadens and slightly rises during inspiration, while during expiration it narrows and slightly lowers.
Abdominal respiration. Breathing is mainly accomplished by the diaphragmatic muscles; during the inspiration phase the diaphragm contracts and lowers to increase rarefaction in the chest and to suck in air into the lungs.
Respiration rate may be determined by counting the movements of the chest or the abdominal wall, while the patient is being unaware of the procedure (during examination of his pulse, for example). In norm the respiration rate is within 16- 20 breathing movements a min. It is increased in dyspnea and rises in the case of inhibition of respiratory center.
Pathological changes of rhythm and depth of respiration are as follows:
N The type of respiration |
In which pathological |
|
|
disorder |
conditions it takes place |
1. |
Kussmaul’s respiration |
Deep coma |
2. |
Cheyne-Stoke’s |
Acute and chronic |
|
respiration |
insufficiency of cerebral |
|
|
circulation and brain |
|
|
hypoxia, heavy poisoning |
3. |
Biot’s respiration |
Meningitis, agony with |
|
|
disorders of cerebral |
|
|
circulation |
4. |
Grocco’s respiration |
Early stages of the same |
pathological conditions as (2)
Palpation of a chest
It is used for assessment of:
Pain
Elasticity of the chest
Assessment of vocal fremitus
Assessment of epigastric angle
Assessment of vocal fremitus
Intensifies on affected side:
Pulmonary tissue consolidation syndrome
Lessens on affected side:
Pneumosclerosis
Bronchial tumor with partial obstruction of bronchial lumen
Accumulation of small amount of fluid or air in pleural cavity
Pleural adhesions
Disappears on affected side:
Hydro- or pneumothorax
Lessens on both sides:
Pulmonary emphysema
Percussion of lungs
Comparative
Topographic
The rules of percussion (mediate):
The plessimeter is index or medial finger of the left lung.
2.Percussion strokes should be done with terminal phalange of medial finger of the right arm on the junction of medial and terminal phalange of plessimeter finger.
The nales should be cut, arms of a
doctor should be warm.
Comparative percussion
Nornal percussion sound is resonant (clear pulmonary sound)
Pathological sounds:
Dull sound (pulmonary tissue consolidation, hydrothorax)
Thympanic sound (abscess, cavern, pneumothorax)
Hyperresonance (bundbox sound): pulmonary emphysema