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Thorax, lungs and cvc system

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  • 1. Introduction to Clinical Skills Thorax, Lungs and CVC system Universidad Iberoamericana UNIBE
  • 2. 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
  • 3. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Landmarks
      • Muscle skeletal
      • Mediastinum
      • Lungs
      • Heart
  • 4. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Landmarks
        • C7
        • Louis angle
        • Tip of scapula
  • 5. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Landmarks
  • 6. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Muscle skeletal Exam
        • Pectoralis major……………..
        • Trapezius ………………..
        • M0 to M5
  • 7. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Surface Anatomy
  • 8. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Surface anatomy
  • 9. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Mediastinum
        • Heart and great vessels
  • 10. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • The Lungs
        • The Trachea and major bronchi
        • The Pleurae
        • Lungs , Fissures and Lobes
        • Breathing
  • 11. 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)
  • 12. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Health Promotion and Counseling
        • Tobacco cessation
          • CAD, Stroke, PVD
          • COPD
          • Cancer
        • Immunizations
          • Influenza
          • Neumococcus
  • 13. 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
  • 14. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Techniques of Examination
        • Inspection
        • Palpation
        • Percussion
        • Auscultation
  • 15. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Techniques of Examination: Inspection
  • 16. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Techniques of Examination: Palpation
        • Diaphragm mobility
        • Tactile fremitus
  • 17. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Techniques of Examination: Percussion
        • Resonance
  • 18. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Techniques of Examination: Percussion
        • Dullness
  • 19. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Techniques of Examination: Percussion
  • 20. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Techniques of Examination: Auscultation
  • 21. 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”.
  • 22. 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
  • 23. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
        • Surface projections of Heart and Great vessels
  • 24. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
        • Cardiac chambers, valves and circulation
  • 25. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
        • Events in the Cardiac Cycle
  • 26. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
        • Events in the Cardiac Cycle
  • 27. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
        • Splitting of Heart Sounds
  • 28. 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
  • 29. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
        • Auscultatory findings to the chest wall
  • 30. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
        • The conduction system
  • 31. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
        • Arterial pulses and Blood Pressure
  • 32. 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
  • 33. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
        • Jugular venous pressure
  • 34. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
        • Jugular venous pressure
  • 35. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
        • Jugular venous pulsations
  • 36. 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
  • 37. 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
  • 38. 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
  • 39. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
      • Techniques of Examination: JVP and pulsations
  • 40. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
      • Techniques of Examination: The Carotid pulse
  • 41. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
      • Techniques of Examination : The Heart
  • 42. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
  • 43. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
      • Techniques of Examination: The Heart
  • 44.
      • Heart and Cardiovascular System
      • Techniques of Examination: The Heart
  • 45.  
  • 46. Introduction to Clinical Skills
    • Chest Exam: anterior and posterior
      • Heart and Cardiovascular System
      • Techniques of Examination
        • Functional Murmurs
  • 47. 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.”
  • 48.