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Thorax and Lungs - Coggle Diagram

- - - - too fast (tachypnea)
      - too deep (hyperpnea)
        
        Causes: anxiety, CNS injury, metabolic disease
      - Kussmaul: Fast and deep- metabolic acidosis
      - Cheyne-Stokes: crescendo/
        decrescendo with apnea
        
        may be normal variant in children, elderly
        
        seriously ill, esp brain damage
        
        drug-associated respiratory compromise
        
        Severe CHF
      - Biot/ataxic: irregular respirations varying in depth and interrupted by intervals of apnea
        
        associated with increased ICP
        
        drug poisoning
        
        brain damage at level of medulla: poor prognosis
    - - head/neck
        
        alae nasi flaring: sign of air hunger
        
        pursing of the lips: increased respiratory effort
        
        cyanosis
        
        Fruity breath: DKA
      - clubbing fingers/toes
        
        emphysema
        
        lung ca
        
        congenital heart disease
        
        cirrhosis
        
        cystic fibrosis
      - Supernumerary nipples: clue to congenital abnormalities
    - - Pectus carinatum (pigeon chest)
      - Pecuts excavatum (funnel chest)
      - Barrel Chest
      - Kyphosis (spine deviated posteriorly)
      - Scoliosis (spine deviated laterally)
  - - - Decreased of absent
        
        excess air in the lungs
        
        emphysema
        
        pleural thickening or effusion
        
        bronchial obstruction
      - Increased
        
        Increased, coarser, rougher
        
        fluids or solid mass, consolidation
        
        nonobstructive bronchial secretions
        
        compressed lung
    - - deviates towards affected lung
  - - - Heard over most of lung field, low pitch, soft and short expirations. More prominent in thin and children
    - - Heard over main bronchus area and over right upper posterior lung field; medium pitch, expiration = inspiration
    - - Heard over trachea; high pitch/loud and long expirations
    - - Crackles: inspiration,
      - Rhonchi: expiration, rumbling. In general, disappear after coughing
      - Wheezes: bilat=bronchospasm
        (asthma), unilateral = foreign body
      - Friction rub: may be normal variant if heard over liver/spleen; over heart=pericarditis; over lungs=pleurisy
      - Mediastinal cruch: mediastinal emphysema
      - Egophony: increased resonance (e-to-a changes)
      - Bronchopnony: clear transmission of sound (99)
      - whispered pectoriloquy: increased loudness of whispering
    - - Infants
        
        Periodic apnea is normal variant;
        cyanosis is cause for concern
        
        Paradoxical breathing is common
        
        Xiphoid process is more mobile/prominent
        
        Stridor: obstruction high
        in the respiratory tree, I:E may be 4:1.
        
        floppy epiglottis
        
        congenital defects
        
        croup
        
        edamatous response to
        
        infection
        
        allergen
        
        smoke
        
        chemicals
        
        aspirated foreign body
        
        Children
        
        Use intercostal musculature by age 6/7
        
        Persistence of barrel chest past
        age 2 could be obstructive dx like cystic fibrosis
- - - - prolonged expiration
      - wheezes
      - diminished lung sounds
    - - Acute: fever, chest pain- infection
      - Chronic: productive cough d/t irritant exposure (smoking)
    - - Subjective: sudden onset chest pain when taking a breath
      - Objective: rapid show breaths,
        friction rub can be auscultated, fever?
    - - Lung a abscess: poorly defined,
        irregular wall, vessels not displaced
        
        Aspiration of food,
        
        subjective: malaise
        
        objective: percussion is dull, distant breat sounds, +pleural rub
      - Empyema: well-defined, smooth wall, vessels displaced: from adjacent infected tissues (pneumonia, fistula)
        
        Subjective
        
        febrile, tachypneic, cough, appears ill
        
        productive cough
        
        blood
        
        sputum
        
        Objective: distant breath sounds, dull percussion
    - - Subjective
        
        bacterial: rapid onset: cough, pleuritic chest pain, dyspnes
        
        fungal: insidious onset
        
        Chills, fever, rigors
      - Objective
        
        febrile, achypneic, tachycardic
        
        crackles, ronchi
        
        egophony, brochophony, whispered pectoiloquy
    - - latent: asymptomatic, no findings
      - Active: fever, cough, weight loss,
        consolidation, hemoptysis, positive
    - - d/t bacterial invasion (HEB, staph, and group A beta Srep)
      - Sudden, no cough, difficulty swallowing
      - sits straight up with neck extended, anxious, ill-appearing, high fever, beefy red epiglottis
  - - - Sujective: degree of respiratory distress can vary from slight to extreme
      - bowel sounds heard in chest, heart displaced to right, tachypnea, retraction, grunting
    - - Thick mucus, bronchiectasis with cyst formation
      - Subjective: cough with sputum in <5 YO, salt loss in sweat, bulky stools, poor weight gain, frequent infection
      - Objective: Bronchiectasis, barrel chest, nasal polyps, low body mass, clubbing, pulmonary hypertension, cor pulmonale (enlargment of r ventricle)
    - - Subjective: noisy breathing, inspiratory stridor
      - Objective: stridor, respiratory distress d/t airway collapse
    - - Caused by RSV
      - Subjective: URI, poor feeding, v/d, lethargy, difficult expiration
      - Objective: rapid short breaths, dim breath sounds, AMS, increased AP diameter, hyperresonant percussion
  - - - Emphysema
        
        Most patients have extensive smoking hx, gas is trapped and gas exchange is compromised
        
        Subjective: Dyspnea even at rest, infrequent cough
        
        Objective: barrel chest, diminished breath sounds, hyperresonant on percussion
        
        Ephysema: lungs lose elasticity and alveoli enlarge
      - Bronchiectasis: chronic dilation of
        bronchi or bronchioles d/t obtruction
        
        Seen in cystic fibrosis
        
        Subjective: cough with large amounts of sputum
        
        Objective: tachypnea, clubbing, crackles/ronchi
      - Chronic Bronchitis: large airway inflammation
        d/t chronic irritant exposure (smoking)
        
        Recurrent bacterial infections are common
        
        Subjective: dyspnea may be present but not severe
        
        Objective: wheezing, crackles, my result in right ventricular failure with dependent edema
- - - - Chest circumference is same as head until 2 YO
      - Chest wall thinner, more cartilaginous
    - - Lower ribs flare
      - diaphragm rises 4 cm
      - Increased tidal volume
    - - Barrel Chest from loss of muslce strength, kyphosis, loss of lung resiliency, stiffening of chest wall
      - Alveoli less elastic, increase in residual volume
      - Dry mucous membranes