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호흡기내과 (Clinical Findings (Auscultation (Adventitial sounds…
호흡기내과
Clinical Findings
Signalment & History
Auscultation
Lung sounds
BV sounds
normal sounds, but increased/decreased, or abnormal location implies dz
Decreased
공기의 흐름이 적을 때 eg. shallow breath
폐 위축 eg. atelectic lung
음파의 희석 : air between the lung and the chest wall eg. pneumothorax
반향(reflection) : sth dense(fluid, mass, etc.) between lung and chest wall eg. diaphragmatic hernia
Increased
wet lungs - fluid(edema), pus(pneumonia), blood(contusions)
water inside or outside the lung
quiet room, at least two cycles
panting(dogs), purring(cats)
Adventitial sounds
Crackles(Rales)
alveoli or tiny airways popping open 'discontinuous' sounds ← edema, pneumonia, fibrosis(loudest)
generally loudest on inspiration(usually at the end)
may be worse after a cough → post-tussive crackles
Heart failure should be considered.
fine(high pitch) vs coarse(low pitch)
Wheezes(Rhonchi)
narrowed or collapsed airways
continuous or musical sounds ← asthma, mucus-filled airways, COPD
generally loudest on expiration
may improve w/ bronchodilators
often. crackles present too
Friction rubs
kind of creaky
pleural or pericardial dz
often mistaken for crackles
least common adventitial sound in small animals
Physical exam : attitude(pneumonia vs KC), body condition, coat and skin(Blastomycosis), membrane color, cardiac exam, other body systems
Cough(not created equal) : productive/non-productive, soft, harsh, hacking, honking, moist, dry, stimulated, nocturnal
Palpation : symmetry, SQ emphysema, cardiac murmur(PMI), thrill(grade 5/6 murmur), chest compressibility
Percussion : hypo resonance(fluid or mass), hyper resonance(air) ← 환축이 작을수록 덜 유용
Respiratory rate & depth
rapid - restriction to breathing → fast, shallow breaths
slow - obstruction to breathing → slow, deep breaths
Panting : anxiety, exercise, thermoregulation, acid/base balance, anemia or RBC defects, drug administration, metabolic and endocrine dz
Dyspnea
Inspiratory
Upper airway - noisy
Pleural space - quiet
Expiratory : lower airway
Mixed : pulmonary parenchyma
Exceptions
can have dz in > 1 place.
Pulmonary fibrosis(parenchyma dz) looks inspiratory. - restrictive due to scarring(can't expand lungs)
Asthma can be too fast to see expiratory effort.
신체검사가 가장 큰 단서를 주지만, 확진을 위한 추가 검사가 항상 필요
8 universal sources of respiratory distress
Upper airway : laryngeal paralysis, tracheal collapse, brachycephalic airway syndrome, foreign body
Lower airway : asthma
Pulmonary parenchyma : pneumonia, ARDS, pulmonary fibrosis
Pleural space : pneumothorax, hydrothorax, pyothorax, hemothorax, chylothorax, diaphragmatic hernia
Chest wall : flail chest
Pulmonary thromboembolism : Cushing, IMHA, PNE/N, SIRS
Abdominal distension : ascites, organomegaly, fat
Look alike : behavior(stress, pain), metabolic(fever), environmental(hyperthermia)
Breathing terms & patterns
Breathing terms
Apnea : not breathing
Dyspnea : desperate(labored breathing)
Hyperpnea : deep breath
Tachypnea : increased rate
Orthopnea : unable to lie down
Breathing noises
No stethoscope required
Stertor
sonorous breathing, like a snore
localizes to the upper airway
most common w/ intranasal obstruction, pharyngeal dz
Stridor
harsh, high pitched sound typically heard on inspiration
localizes upper airway
most common w/ laryngeal dz
Stethoscope needed
Bronchovesicular breath sounds
Adventitious breath sounds(abnormal)
Crackles(rales)
Wheeze(ronchi)
Friction rubs
Patterns of breathing
often suggest localization of dz → inspiratory, expiratory, mixed
specific named patterns associated w/ specific conditions and dz → apneustic breathing, Cheyne-Stokes respiration, Kussmaul breathing, etc.
Functional terms : tidal volume, residual volume, vital capacity, etc.
Ventilation
Hyperventilation(too much) : increased volume of air breathed. not equivalent to panting(dead space movement)
Hypoventilation(low) : decreased volume of air breathed
*Respiratory rate : 12~18bpm at rest, 30 at hospital
*Cyanosis : <66% of SPO2, <5g/dl of Hgb, <15% of Hct
*Paradoxical movement of chest/abdomen : 숨을 들이쉴 때 배가 들어감. lower airway dz, pleural space dz
*Nasal deformity : dental problem, nasal neoplasia, infection (cats)