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depth, and can be caused by hypoxia, pain, fever, or anxiety. Consider PE, foreign body aspiration, anaphylaxis, pneumothorax, heart failure, asthma, or pneumonia* Bradypnea: Slower than 20 breaths per minutesSymptoms associated with intrathoracic infectionSymptoms associated with intrathoracic infection* Dyspnea * tachypnea * Pleuritic chest pain * Fever* Cough with green/rusty sputum* Chills * Anorexia * Malaise * Altered mental statusPercussion techniques when examining the lungs
Percussion techniques when examining the lungs* Tap sharply and consistently from the wrist without excessive force* Compare all areas bilaterally using one side as a control for the other* Move systematically through posterior thorax, right lateral thorax, left lateral thorax,and anterior thorax* Have the patient sitting with head bent forward and arms folded. This moves scapulae laterally, exposing more of the lung* Have patient raise arms overhead to percuss the lateral and anterior chest.* For all positions percuss at 4-5 cm intervals over the intercostal spaces, moving systematically from superior to inferior and medial to lateralExamination findings when percussing the lungsPart 31.Examination of findings when percussing the lungsTone type:i. ResonantIntensity-Loud Pitch- Low Duration-Long Quality- Hollowii.FlatIntensity- Soft Pitch-High Duration-Short Quality-Very dulliii.DullIntensity-Medium Pitch-Medium to high Duration- Medium Quality-Dullthudiv. TympanicIntensity-loud Pitch- High Duration- Medium Quality-Drumlikev. Hyperresonant Intensity-Very loud Pitch-Very low Duration-Longer Quality- BoomingCardiac examination findings for a patient with rheumatic fever
- May result in serious cardiac valvular involvement of mitral or aortic valve, then valves become stenotic and regurgitation. Children ages 5-15 are commonly affected. Patient may present with chest pain, palpitations, and shortness of breath. Objective findings upon examination include: Murmurs of mitral regurgitation and aortic insufficiency, cardiomegaly, friction rub of pericarditis, signs of congestive heart failure, and prolonged PR interval on ECG.Grading of heart murmurs3. Grading of heart murmursGrade I-Barely audible in a loud room Grade II-Quiet but not clearly audibleGrade III-Moderately loud Grade IV-Loud, Associated with thrill Grade V-Very loud, thrill easily palpableGrade VI-Very loud, audible with stethoscope not in contact with chest, thrill palpable and visibleEvaluation of ECG tracingsEvaluation of ECG tracings (Seidel’s guide to physical examination 8th edition, p. 298)* ECG is a graphic record of electrical activity during a cardiac cycle.* ECG records depolarization (spread of stimulus through the heart muscle) and repolarization (return of stimulated heart muscle to a resting state.* Electrical activity is recorded in the ECG as specific waves;* P-Wave: First upward movement of ECG tracing. It is the spread of stimulus through the atria (atrial depolarization). It indicates that the atria are contracting and pumping blood into ventricles* PR interval: it is the time from the initial stimulus of the atria to the initial stimulation of the ventricles, usually 0.12 to 0.20