Post on 29-Aug-2014
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Introduction to Clinical Skills
Thorax, Lungs and CVC systemUniversidad Iberoamericana UNIBE
Introduction to Clinical Skills
Teaching Staff Dra Elizabeth Peralta Dr Marcos Núñez Dra Cristina Páez C Dr Juan Carlos Mariñez Dra Wayna Greo Dra Yun Pey Lee
Introduction to Clinical Skills
Chest Exam: anterior and posterior Landmarks Muscle skeletal Mediastinum Lungs Heart
Introduction to Clinical Skills
Chest Exam: anterior and posterior Landmarks
C7 Louis angle Tip of scapula
Introduction to Clinical Skills
Chest Exam: anterior and posterior Landmarks
Introduction to Clinical Skills
Chest Exam: anterior and posterior Muscle skeletal Exam
Pectoralis major…………….. Trapezius ……………….. M0 to M5
Introduction to Clinical Skills
Chest Exam: anterior and posterior Surface Anatomy
Introduction to Clinical Skills
Chest Exam: anterior and posterior Surface anatomy
Introduction to Clinical Skills
Chest Exam: anterior and posterior Mediastinum
Heart and great vessels
Introduction to Clinical Skills
Chest Exam: anterior and posterior The Lungs
The Trachea and major bronchi The Pleurae Lungs , Fissures and Lobes Breathing
Introduction to Clinical Skills
Chest Exam: anterior and posterior The Health History
Chest pain Myocardium, Pericardium, Aorta Trachea and large bronchi, Pleura (parietal) Chest wall Esophagus Extrathoracic : Gallbladder, Stomach
Shortness of breath (dyspnea) Wheezing Cough Blood-streaked sputum (hemoptysis)
Introduction to Clinical Skills
Chest Exam: anterior and posterior Health Promotion and Counseling
Tobacco cessation CAD, Stroke, PVD COPD Cancer
Immunizations Influenza Neumococcus
Introduction to Clinical Skills Chest Exam: anterior and posterior
Techniques of Examination Assess patient Color Observe and Listen patient´s breathing
Rate, Rythm, Depth and Effort of breathing Inspect the neck Observe shape of the Chest
Introduction to Clinical Skills
Chest Exam: anterior and posterior Techniques of Examination
Inspection Palpation Percussion Auscultation
Introduction to Clinical Skills
Chest Exam: anterior and posterior Techniques of Examination: Inspection
Introduction to Clinical Skills Chest Exam: anterior and posterior
Techniques of Examination: Palpation Diaphragm mobility Tactile fremitus
Introduction to Clinical Skills
Chest Exam: anterior and posterior Techniques of Examination: Percussion
Resonance
Introduction to Clinical Skills
Chest Exam: anterior and posterior Techniques of Examination: Percussion
Dullness
Introduction to Clinical Skills
Chest Exam: anterior and posterior Techniques of Examination: Percussion
Introduction to Clinical Skills
Chest Exam: anterior and posterior Techniques of Examination: Auscultation
Introduction to Clinical Skills
Chest Exam: anterior and posterior The Thorax and Lungs. Recording findings
“Thorax is symmetric with good expansion. Lungs resonant. Breath sounds vesicular, no rales, wheezes, or rhonchi. Diaphragms descend 4 cm bilaterally”.
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System
Surface projections of Heart and Great vessels Cardiac chambers, valves and circulation Events in the Cardiac Cycle Splitting of Heart Sounds Heart murmurs Auscultatory findings to the chest wall The conduction system Arterial pulses and Blood Pressure Jugular venous pressure
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System
Surface projections of Heart and Great vessels
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System
Cardiac chambers, valves and circulation
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System
Events in the Cardiac Cycle
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System
Events in the Cardiac Cycle
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System
Splitting of Heart Sounds
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System
Turbulence = Heart murmurs (physiologic) http://www.wilkes.med.ucla.edu/intro.html
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System
Auscultatory findings to the chest wall
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System
The conduction system
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System
Arterial pulses and Blood Pressure
Introduction to Clinical Skills
Chest Exam: anterior and posterior Factors Influencing Arterial Pressure
Left Ventricular stroke volume Distensibility of the aorta and the large arteries Peripheral vascular resistance, particularly at the arteriolar level Volume of blood in the arterial system
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System
Jugular venous pressure
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System
Jugular venous pressure
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System
Jugular venous pulsations
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System The Health History
Chest pain Palpitations Shortness of breath
Dyspnea Orthopnea Paroxysmal dyspnea
Swelling or edema
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System Health Promotion and Counseling
Screening for hypertension Screening for coronary heart disease and stroke Screening for dyslipidemias Promoting lifestyle modification and risk - factor reduction
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination
Jugular Venous Pressure and Pulsations The Carotid Pulse The Heart Functional Murmurs
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination: JVP and pulsations
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination: The Carotid pulse
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination: The Heart
Introduction to Clinical Skills
Chest Exam: anterior and posterior
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination: The Heart
Heart and Cardiovascular System Techniques of Examination: The Heart
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System Techniques of Examination
Functional Murmurs
Introduction to Clinical Skills
Chest Exam: anterior and posterior Heart and Cardiovascular System Recording your Findings
“ The Jugular venous pulse is 3 cm above the sternal angle with the head of the bed elevated to 30°. Carotid upstrokes are brisk, without bruits. The point of maximal impulse is tapping, 7 cms lateral to the midsternal line in the 5th intercostal space. Crisp S1 and S2. At the base S2 is greater than S1 and physiologically split, with A2 > P2. At the apex S1 is greater than S2 and constant. No murmurs or extrasounds.”