Assessing the thorax and lungs

1. Observation 視診

~Tracheal Position

~Chest Shape /Size e.g. Pectus Excavatum(funnel chest 漏斗胸); Pectus Carinatum(pigeon chest 白鴿胸); Barrel Chest 桶形胸; Scoliosis 脊椎側彎; Kyphosis 駝背

~Secondary Respiratory Myo
~Respiration rate 呼吸率(兒童: 24-28/mins; 成人: 16-18/mins)

~Respiration Depth 呼吸深度

~Respiration Rhythm 呼吸節率 e.g.

1. Cheyne-Stokes: Regular pattern of gradually increasing / decreasing tidal volume interspersed with periods of apnea (常見於顱內出血及中樞功能遲緩)

2. Biots: Complete irregularity of breathing, with irregular pauses & increasing periods of apnea

3. Ataxic: Complete irregularity of breathing, with irregular pauses & increasing periods of apnea

2. Palpation 觸診

~Tactile Fremitus 觸覺震顫

~Chest expansion

3. Percussion 叩診

~Resonance 反響

~Diaphragmatic excursion

4. Auscultation 聽診

~Crackles 爆裂音 (??pneumonia 肺炎)

~Rhonchi 濕囉音

~Wheezes 喘嗚音 (??asthma 哮喘)

~Pleural Friction Rub

Lung fields

1. Anterior: Apices to 6-7th ribs

2. Lateral: Axilla to 8-9th ribs

3. Posterior: Apices 10-12th ribs

Diaphragm

~Quiet inspiration moves ½"

~Forced inspiration 1 ½"