Examination of the Lungs (Paramedic)

00:01 Welcome to my lecture.

00:02 Today, I would like to introduce the lung examination, specifically focusing on the methods of auscultation and percussion.

00:10 Before we watch the technique video, I will first go over the theoretical basics with you. We will discuss where the lungs are located, what happens during breathing, and how to perform auscultation and percussion. Let's start with the anatomical position of the lung. The lungs consist of a total of five lobes. The right lung has three lobes, while the left only has two. The left has two because the left sided heart is taking up some space in the left thorax. The lungs are located beneath the pleural space of the thoracic wall.

00:48 Superiorly, the lungs extend to the first rib with the lung dome even extending into the neck viscera.

00:58 Inferiorly, the lung rests against the diaphragm.

01:05 Viewed from the front, it is slightly deeper than when viewed from the back.

01:10 That means if you look at the person from the side, the lungs are somewhat slanted from front to back.

01:17 Now, what happens during breathing? The diaphragmatic domes form the lower limit of the lungs and, at maximum expiration, sometimes only reach the level of the fourth rib.

01:31 This is very high up and is often missed on auscultation of the lungs.

01:36 During inspiration or inhalation, the diaphragm tenses and expands downward, causing the lungs to extend down to about the seventh rib. That's usually still above the xiphoid process, a concept that is also sometimes missed by practitioners.

01:55 So, contrary to popular belief, the lungs do not fill the entire chest cavity. These landmarks can obviously vary from patient to patient, so the provider must use their stethoscope to adjust to the respective conditions and the patient's respiratory effort.

02:16 Percussion is another examination tool that can be used in conjunction with auscultation. It is primarily used to locate lung boundaries, a process that has been largely overtaken by modern ultrasound techniques.

02:31 Nevertheless, it remains to be a common basic measure of medicine and should be mastered by every diagnostic physician, as they may not have access to a stenography device in their own practice.

02:44 In addition to the actual assessment of the lung volume, percussion is particularly suitable for detecting pathology of the lung parenchyma, including atelectasis, mucus consolidations, or effusion.

02:57 Because sound is transmitted differently through any affected areas, even things like a pneumothorax can be detected in this way.

03:05 During lung percussion, a resonating sound suggests normal tissue.

03:12 Pathological findings, on the other hand, are expressed as being hyper-resonate or dull-sounding. This distinction is often difficult to discern, so you should practice percussion frequently so that you can train your ear to differentiate normal from pathologic sounds.

03:30 Now let's take a look in the technique video to see where the lungs, auscultation points are located, how they are auscultated, and what providers should recognize.

03:39 After that, we will do the same with lung percussion.

03:45 This patient is suffering from acute respiratory distress and mild stridor. Initially, elevating the torso can help provide some relief.

03:57 After this basic measure, the provider can do a more thorough exam.

04:05 It begins with the auscultation of the lungs.

04:08 The patient's chest is exposed a nd provider begins to auscultate ventrally, assessing both the trachea and large airways. This is then followed assessing the two main bronchi along the right and left para sternal borders at the second intercostal space.

04:31 While auscultating, the patient is asked to breathe in and out deeply through an open mouth.

04:44 For a complete examination of the lungs, dorsal auscultation as necessary . The patient should be placed in a seated position or they may lean forward.

05:00 Again, complete disrobing of the torso is preferred.

05:05 Auscultation is then performed in a side to side manner on either side of the spine. The patient is encouraged to breathe deeply in and out with the mouth open, w hich helps reduce turbulence from nasal breathing .

05:26 The right middle lobe is stated on the right side in the area of the axilla at the level of the fifth intercostal space.

05:54 To assess thoracic movements for symmetry, the provider places their hands flat against the sides of the chest while the patient breathes deeply.

06:20 This exam is then followed by lung percussion.

06:23 As mentioned, it is an older method of examining lung tissue and determining lung boundaries. Although sonography is preferentially used in most clinics today, it remains a good basic instrument for lung assessment.

06:36 The examination ends with the evaluation of tactile fremitus.

06:40 This occurs when vibrations of the lung tissues are transmitted to the thoracic wall.

06:45 To assess this, the provider places their hands flat on the patient's back and asks them to speak low-frequency words like "99".

06:54 Based on the vibrations, different pathological patterns can be detected if tactile fremitus is attenuated, a pleural disorder is present.

07:03 This would include pathologies like a pleural effusion or pneumothorax.

07:07 Conversely, increased tactile fremitus can indicate a pulmonary infiltration.

07:13 I would like to summarize the main concepts of this presentation.

07:16 The two lungs are located on either side of the bony thorax.

07:20 They usually extend from above the clavicles to between the fifth and seventh ribs when viewed from the front.

07:29 When viewed dorsally, the base of the lung extends approximately to the ninth rib.

07:34 Breath sounds are caused by turbulence in the airways.

07:37 These sounds can be assessed with a stethoscope placed on the chest wall.

07:42 Changes in lung tissue, such as with a telectasis or an effusion, alter breath sounds in a way that can give you important diagnostic clues.