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1:2 ✔✔Normal ratio of inspiration:expiration
35 - 40 ✔✔Normal newborn RR range
Chronic bronchitis ✔✔CXR findings: cardiomegaly, white haziness
Emphysema ✔✔CXR findings: increased black area, flattened diaphragm and ribs, narrow mediastinum
Bullae ✔✔Dilated air space in the lung
Requires surgery to avoid pneumothorax
Extrinsic ✔✔Asthma attack due to allergic factors
Bronchiectasis ✔✔CXR findings: dilated airways, dark lung fields, flattened diaphragm, may or may not see areas of consolidation or atelectasis
High resolution CT more commonly used to help Dx
Interstitial pulmonary fibrosis ✔✔CXR findings: small contracted lungs, raised diaphragms, diffuse reticular markings
High resolution CT more commonly used
Pneumothorax ✔✔CXR findings: blackened area around lungs, flattened hemi-diaphragm
Pleural effusion ✔✔CXR findings: white in area of increased fluid, contralateral tracheal deviation, may see elevated hemidiaphragm
Pneumonia ✔✔CXR findings: air bronchograms, opacities in surrounding alveoli
Pulmonary edema ✔✔CXR findings: cardiomegaly, enlarged pulmonary vessels, white fluffy/hazy airspace, Kerley B lines
1:3 ✔✔Ratio of inspiration:expiration in obstructive diseases
I:E 3:
Heard over peripheral lung tissue
Bronchovesicular breath sounds ✔✔Inspiration is soft, low, pitched, expiration is loud, high- pitched
I:E 1:
Heard over main stem bronchi in 1st and 2nd intercostal spaces and posteriorly between the scapulae
Bronchial breath sounds ✔✔Loud, high-pitched, hollow quality
Louder on exhalation
I:E 1:1 or 1:
Distinct pause between I and E
Heard over trachea and manubrium
Crackles (rales) ✔✔Short, explosive breath sounds
Can be inspiratory or expiratory, and coarse or fine
Coarse ✔✔(Coarse/fine) crackles heard in the presence of sputum/secretions (i.e. pneumonia)
Fine ✔✔(Coarse/fine) crackles heard over fluid (i.e. in pulmonary edema), also heard in atelectasis and fibrosis
Wheezes (ronchi) ✔✔Musical breath sounds
Can be affected by coughing
Classified by pitch, timing, duration and notes
Pleural friction rub ✔✔Long, low-pitched, leathery creaking sound
Pain may be associated
Heard in pleural effusion
Stridor ✔✔Loud, musical, high-constant pitch breath sounds
Audible from a distance without a stethoscope
Most prominent during inspiration
Vital capacity (VC) ✔✔The maximum amount of gas that can be expired from the lungs following a maximum inspiration
= VT + IRV + ERV
Inspiratory capacity (IC) ✔✔The maximum amount of gas that can be inspired from the resting expiratory level
= VT + IRV
Functional residual capacity (FRC) ✔✔The amount of gas remaining in the lungs at the resting expiratory level
= ERV + RV
Forced vital capacity (FVC) ✔✔The total volume of air that can be expired after a maximal inhalation (independent of time)
Forced expiratory volume (FEV) ✔✔The maximum volume of air that can be expired from maximal inhalation in x seconds
<70 ✔✔FEV1/FVC% that indicates obstructive disease
Obstructive ✔✔FEV1 and FEV1/FVC% are both low in (obstructive/restrictive) diseases
Restrictive ✔✔FVC is low in (obstructive/restrictive) diseases
Diffusion Capacity of Carbon Monoxide (DLCO) ✔✔Tests which measure the functioning gas exchange from the lungs (alveoli) to the blood (pulmonary capillary bed)
Either ✔✔Low DLCO: problem with (pulmonary/circulatory) system?
Circulatory ✔✔High DLCO: problem with (pulmonary/circulatory) system?
7.35-7.45 ✔✔Normal pH range
35-45 ✔✔Normal PaCO2 range
22-26 ✔✔Normal HCO3- range
Hypertrophy + hyperplasia of mucous glands and goblet cells = increased mucous
Decreased # of cilia
Chronic inflammatory changes in bronchial walls
Decreased gas exchange
Chronic bronchitis ✔✔Inspection:
Obese and cyanotic
Mucus is white, yellow or green
Increased JVP and ankle edema due to association with RHF
Decreased/hyperresonant in areas of air trapping, increased/dull in areas of secretion retention ✔✔Chronic bronchitis tactile fremitus, percussion findings
Decreased breath sounds, inspiratory wet crackles ✔✔Chronic bronchitis auscultation findings
Cardiomegaly, white haziness ✔✔Chronic bronchitis CXR findings
Emphysema ✔✔Enlargement of the airway distal to the terminal bronchioles, accompanied by destruction of their walls
Centrilobar ✔✔More common form of emphysema
Affects respiratory bronchioles
Panlobar ✔✔Form of emphysema
Affects terminal and respiratory bronchioles
D/t alpha-antitrypsin deficiency
Emphysema ✔✔Pathophysiology:
Bullae may be found
Develops from an obstruction of air flow during expiration
Leads to hyperinflation --> destruction of alveolar walls --> decreased elastic recoil, increased dead space, decreased gas exchange
Emphysema ✔✔Inspection:
Thin and wasted, barrel chest
Asthma ✔✔Clinical findings include chest tightness, dyspnea, increased accessory muscle use and respiratory distress
Decreased, hyperresonant ✔✔Asthma tactile fremitus, percussion findings
Decreased breath sounds, wheezing ✔✔Asthma auscultation findings
Bronchiectasis ✔✔Irreversible, abnormal dilation of medium-sized bronchi and bronchioles resulting in airflow obstruction and secretion retention
Commonly associated with chronic inflammation and infection within these airways
Considered an extreme form of chronic bronchitis
Bronchiectasis ✔✔Pathophysiology:
Destruction of bronchial wall causing permanent dilation of airways
Ciliated walls replaced by non-ciliated, mucus-secreting cells
Pooling of infected secretions leading to recurrent infections
May cause atelectasis distal to obstruction
Bronchiectasis ✔✔Inspection findings include: thin and fatigued, clubbing, increased accessory muscle use, other signs of respiratory distress, severe cough and ++mucous that is foul-smelling, purulent and may contain blood
Decreased, hyperresonant ✔✔Bronchiectasis tactile fremitus, percussion findings
Decreased breath sounds, wheezing, possible coarse crackles ✔✔Bronchiectasis auscultation findings
Restrictive diseases ✔✔Diseases that restrict the lung from expanding fully
Difficult to get air IN
Interstitial pulmonary fibrosis (IPF) ✔✔Thickening of the interstitium of the alveolar walls which progress to fibrosis or scarring
Interstitial pulmonary fibrosis ✔✔Pathophysiology:
Decreased lung compliance
Increased elastic recoil
Acute respiratory distress syndrome (ARDS) ✔✔An acute lung injury which is characterized by respiratory distress, severe hypoxemia, and increased permeability of the alveolar-capillary membrane
Acute respiratory distress syndrome (ARDS) ✔✔Pathophysiology:
Increased permeability of capillaries d/t injury
Leads to edema in interstitial space and then into the alveoli
Decreased surfactant production leading to increased alveolar surface tension = decreased lung compliance
V/Q mismatch --> R/L shunt --> arterial hypoxemia
Rapid fibrosis in later disease progression
Increased, dull ✔✔ARDS tactile fremitus, percussion findings
Inspiratory crackles, diffuse wheezes ✔✔ARDS auscultation findings
Pneumothorax ✔✔An abnormal collection of air in the pleural space - loss of negative pressure in the pleural cavity causes expanded rib cage and/or collapsed lung
Spontaneous ✔✔Pneumothorax that develops suddenly d/t rupture in air containing structure
Most common in young tall men
Traumatic ✔✔Pneumothorax d/t penetrating or non-penetrating injury to the chest wall
Stabbing, GSW, contusion
Tension ✔✔Pneumothorax d/t tear in pleura that acts as a one-way valve
Air enters into pleural space during inhalation, but air doesn't leave during exhalation
Medical emergency
Pneumothorax ✔✔Inspection findings:
Signs of respiratory distress
Dyspnea
Increased RR
CHEST PAIN
Dry cough d/t irritation of pleural receptors
C3-C5 ✔✔Phrenic nerve innervation
T1-T12 ✔✔Intercostals innervation
T6-L1 ✔✔Abdominals innervation
Cystic fibrosis ✔✔Systemic hereditary disease of the exocrine glands of the body
Results in copious amount of thick secretions
Cystic fibrosis ✔✔Pathophysiology:
Most commonly manifests in lungs, liver, kidneys, and intestine
Ion transport dysfunction = increased electrolyte content in sweat
Increased obstruction of exocrine ducts by thick secretion
Increased secretion retention in lungs leads to recurrent lung infections, fibrosis/scarring
Malabsorption of nutrients
Cystic fibrosis ✔✔Inspection findings: low weight, copious amounts of mucopurulent, or purulent mucous, increased RR, barrel chest, clubbing, chronic productive cough
Decreased breath sounds, inspiratory/expiratory crackles, wheezes ✔✔Cystic fibrosis auscultation findings
Mixed ✔✔Cystic fibrosis tactile fremitus/percussion findings
Pneumonia ✔✔An acute inflammation of the lungs associated with alveolar filling by exudates (consolidation)
Common complication and cause of morbidity and mortality in hospitalized patients
Increased, dull ✔✔Pneumonia tactile fremitus, percussion findings
Wet inspiratory crackles, bronchial or bronchovesicular BS ✔✔Pneumonia auscultation findings
Productive, high ✔✔Cough & fever Sx in bacterial pneumonia
