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Thorax/Lungs History

Chest and Lung History taking

Substernal notch AKA the fossa jugularis sternalis, is a large, visible dip between the neck and the two collarbones
Manubrium of sternum the broad upper part of the sternum. It has a quadrangular shape, narrowing from the top, which gives it four borders
Sternal angle AKA angle of Louis is the angulation of the transverse joint between the body of the sternum and the manubrium. The angle is named after the French Physician Antoine Louis. This manubriosternal joint marks the 2nd pair of costal cartilage level and is found in line with the intervertebral disc between thoracic vertebrae 4 and 5.
Costochondral junctions the joints between the ribs and costal cartilage in the front of the rib cage. They are hyaline cartilaginous joint
Costal angle the angle made by the ribs and the lowermost section of the sternum or breastbone in the chest where the ribs attach to the sternum.
Landmark for insertion space for tension pneumothorax the 2nd intercostal space
Landmark for the lower margin of the endotracheal tube on a chest x-ray T4, behind the sternum
Costocartilage of the first 7 ribs articulate with the sternum
The cartilages of the 8th, 9th, and 10th ribs articulate with the costal cartilages
The 11th and 12th ribs are floating ribs that have no anterior attachments
Neurovascular structures run under each rib, so needles and tubes should be placed... just superior to the rib margins
Landmark for a thoracentesis the T8 - T9 (base of lung but above the diaphram)
When the neck is flexed the most protruding process is usually the vertebra of C7
Anteriorly, the lower border of the lung crosses... the 6th rib at the MCL and the 8th rib a the midaxillary line
Posteriorly, the lower border of the lung is at the level of the 10th spinous process and descends further upon inspiration
The oblique (major) fissure runs from the T3 spinous process obliquely down and around the chest to the 6th rib at the MCL
The right lung is divided by the horizontal (minor) fissure that anteriorly runs close to the 4th rib and meets the oblique the fissure in the midaxillary line near the 5th rib
The right lung is divided into the upper, middle and lower lobes
The left lung only has two lobes; upper and lower
Supraclavicular above the clavicles
Infraclavicular below the clavicles
Interscalpular between the scapulae
Infrascalpular below the scapulae
The trachea bifurcates into its mainstem bronchi at the levels of the sternal angle anteriorly and the T4 spinous process posteriorly
The visceral pleura covers the outer surface of the lung
The parietal pleura covers the inner rib cage and the upper surface of the diaphragm
pleural fluid lubricates the pleural surfaces
Transudate a fluid that passes through a membrane, which filters out all the cells and much of the protein, yielding a watery solution. It's a filtrate of blood. It is due to increased pressure in the veins and capillaries that forces fluid through the vessel walls or to a low level of protein in blood serum
Pleural effusions maybe transudates seen in atelectasis, heart failure and nephrotic syndrome
Atelectasis a complete or partial collapse of the entire lobe of the lung. It occurs when the alveoli becomes deflated or possibly filled with alveolar fluid. It is one of the most common respiratory complications after surgery
Exudate any fluid that filters from the circulatory system into lesions or areas of inflammation. It can be a pus-like or clear fluid. When an injury occurs, leaving skin exposed, it leaks out of the blood vessels and into nearby tissues. The fluid is composed of serum, fibrin, and white blood cells
Exudate is seen in numerous conditions including pneumonia, TB, pulmonary embolus, pancreatitis and malignancy
During inspiration, the diaphragm contracts, descends into the chest and expands the thoracic cavity compressing the abdominal cavity and pushing out the abdominal wall
During expiration, the diaphragm the chest wall and lungs recoil and the diaphragm relaxes and rises passively. As the air flow out, the chest and abd return to their resting position
The scalene muscles are 3paired muscles (anterior, middle, posterior), located in the lateral aspect of the neck. They form part of the floor of the posterior triangle of the neck. They also act as accessory muscles of respiration
As the thorax expands, intrathoracic pressure decreases, drawing air thru the tracheobronchial tree into the alveoli, filling the expanding lungs
oxygen diffuses intothe adjancet pulmonary cavities as CO2 exchnages from the blood into the alveoli
Created by: cljohnson2000



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