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Chest (Inspection (Tracheal deviation (Pneumothorax (trachea will be…

- - - - If the patient is using sternocleidomastoid and other accessory muscles
  - - - Barrel chest (Apparent increase in the anteroposterior (AP) diameter)
  - - - Signs
        
        patients tend to exhale with pursed lips. This is a form of self-administered positive end-expiratory pressure (PEEP)
        
        pursed lip breathing can lead to an increase in tidal volume, an increase in oxygen saturation, and a decrease in dyspnea. It reduces breathlessness by lengthening expiratory time and total time of the respiratory cycle
        
        patients with small-airway disease, tend to “breathe off the top.” (The accessory muscles help them do this.)
    - - most commonly owing to overwork in severe chronic obstructive lung disease, inspiration finds the helpless diaphragm being passively sucked upward as the intercostal muscles do the work of inspiration. Now the abdominal wall retracts during inspiration. This is called respiratory paradox. The patient may be in need of mechanical ventilation.
    - - Pleurisy
        
        Asymmetric chest expansion
      - Ankylosing spondylitis
        
        Symmetrically impaired chest expansion (<2.5 cm or 1 in.)
  - - - trachea will be pulled to the side opposite that of a pneumothorax, especially during inspiration
    - - trachea is pulled toward the side of the atelectasis
    - - trachea may be pushed away from a goiter
    - - trachea may be pulled toward the diseased side.
- - - - Fractures of ribs 1 through 3 may be associated with mediastinal injury (including the aorta).
    - - Fractures of the lower ribs, 2 through 12, may be associated with intra-abdominal injuries, especially if two or more fractures are present
    - - warm spot is a sign of empyema
- - - - normal sounds heard over the periphery of the lung fields both
        anteriorly and posteriorly
      - inspiratory phase is relatively long and pronounced, while the expiratory phase is shorter and almost inaudible
    - - also called tracheal breath sounds or bronchial breath sounds
      - Tubular breath sounds at the periphery of the lung tell you that there is a solid connection between the lung tissue under your stethoscope all the way to the trachea, a bronchus, or a very large bronchiole
      - The solid material may be intrinsic consolidation such as a tumor or pneumonia or more extrinsic consolidation such as abnormal lymph nodes, compression of lung by pleural fluid
      - both phases of respiration are audible
    - - Wheezes
        
        Timing
        
        Expiratory wheezes
        
        Wheezes generated within the thorax are more commonly heard in expiration
        
        Divided into two categories
        
        holoexpiratory wheezes
        
        If you hear expiratory wheezes that continue uninterrupted into apparent inspiration, you can say that ventilation in one part of the lung is out of synchrony with that in another part
        
        End-expiratory wheezes
        
        signify bronchiolar disease, either primary (because of structural change) or secondary (as in air trapping)
        
        Inspiratory wheezes
        
        Wheezes generated from the extrathoracic airway may also be heard in inspiration
        
        Divided into two categories
        
        holoinspiratory wheezes
        
        especially of the monotonal type in conjunction with expiratory monotonal wheezing (i.e., biphasic monotonal wheezing), is a sign of rigid stenosis, usually caused by a foreign body, tumor, or fixed scar (Forgacs, 1969), especially when it emanates from high up in the tracheobronchial system
        
        end-inspiratory wheezes
        
        A repetitive end-inspiratory wheeze immediately following some end-inspiratory crackles is almost always diagnostic of a delayed opening of small airways in deflated territories of the lungs
- - - - individually (unilaterally) pneumonia, carcinoma; bilaterally, bacterial pneumonia or disease involving the lymph nodes (especially tuberculosis)
    - - Superior segment
        
        anything
      - Basilar segments
        
        pneumonia or infarcts
    - - Posterior segment
        
        pneumonia, especially aspiration, or tuberculosis
      - Anterior segment
        
        Carcinoma or Pneumonia, especially that caused by aspiration
      - Apical segment
        
        Pancoast syndrome or tuberculosis