It may be heard in both inspiration and expiration. Expirations that are prolonged and musical are characteristic of wheezing.įriction: This sound is produced by the rubbing together of roughened pleural surfaces. Harsh inspiratory sounds are typical of stridor, a medical emergency. It is heard in bronchiectatic cavities or pneumothorax when the opening to the lung is patulous in the consolidation area near a large bronchus and sometimes over a lung compressed by a moderate effusion. The pitch of amphoric breathing is slightly higher than that of the cavernous type, and may be imitated by blowing over the mouth of an empty jar. These sounds are normally heard only over the bronchi and trachea.Īmphoric and cavernous breathing: These two nearly identical sounds are loud, with a prolonged, hollow expiration. They are produced by air passing in and out of the airways.īronchial and tracheal breath sounds: These are higher-pitched and louder than vesicular sounds, and are produced by air passing over the walls of the bronchi and trachea. These sounds are called vesicular breath sounds when heard over the lungs. Normal breath sounds: In the healthy person, breath sounds are low-pitched and have a frequency of 200 to 400 cycles per second (cps) frequency rarely exceeds 500 cps. The hollow character of the resonance sometimes is exaggerated in emphysematous lungs or in pneumothorax, and muffled by pleural effusions or pulmonary consolidation. Percussion: Tapping on the chest wall over healthy lung results in a hollow resonant sound. Fremitus abnormalities may be felt in chronic obstructive lung diseases or obesity, in which the vibration is diminished, and in pneumonia, in which it is increased over the infected lobe. Palpation: In health, the chest and lung transmit a vibration, called fremitus, during speech. Sleep apnea is characterized by episodes of stalled breathing followed by periods of respiratory compensation. Retractions of the intercostal and supraclavicular spaces are visible during inspiration. Dyspneic patients breathe rapidly, often laboring to draw breath even when at rest. While counting the respiratory rate, the examiner can observe other breathing characteristics. In adults a normal respiratory rate at rest is about 12 breaths per minute. Inspection: The examiner determines the respiratory rate by unobtrusively watching the patient’s chest rise and fall and counting the number of breaths per minute. CHEST EXAMINATION – (2) Exams + Lung Workup Supplement
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