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Thorax, lungs and cvc system

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Thorax, lungs and cvc system

  1. 1. Introduction to Clinical Skills Thorax, Lungs and CVC system Universidad Iberoamericana UNIBE
  2. 2. Introduction to Clinical Skills <ul><li>Teaching Staff </li></ul><ul><ul><li>Dra Elizabeth Peralta </li></ul></ul><ul><ul><li>Dr Marcos Núñez </li></ul></ul><ul><ul><li>Dra Cristina Páez C </li></ul></ul><ul><ul><li>Dr Juan Carlos Mariñez </li></ul></ul><ul><ul><li>Dra Wayna Greo </li></ul></ul><ul><ul><li>Dra Yun Pey Lee </li></ul></ul>
  3. 3. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Landmarks </li></ul></ul><ul><ul><li>Muscle skeletal </li></ul></ul><ul><ul><li>Mediastinum </li></ul></ul><ul><ul><li>Lungs </li></ul></ul><ul><ul><li>Heart </li></ul></ul>
  4. 4. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Landmarks </li></ul></ul><ul><ul><ul><li>C7 </li></ul></ul></ul><ul><ul><ul><li>Louis angle </li></ul></ul></ul><ul><ul><ul><li>Tip of scapula </li></ul></ul></ul>
  5. 5. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Landmarks </li></ul></ul>
  6. 6. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Muscle skeletal Exam </li></ul></ul><ul><ul><ul><li>Pectoralis major…………….. </li></ul></ul></ul><ul><ul><ul><li>Trapezius ……………….. </li></ul></ul></ul><ul><ul><ul><li>M0 to M5 </li></ul></ul></ul>
  7. 7. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Surface Anatomy </li></ul></ul>
  8. 8. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Surface anatomy </li></ul></ul>
  9. 9. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Mediastinum </li></ul></ul><ul><ul><ul><li>Heart and great vessels </li></ul></ul></ul>
  10. 10. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>The Lungs </li></ul></ul><ul><ul><ul><li>The Trachea and major bronchi </li></ul></ul></ul><ul><ul><ul><li>The Pleurae </li></ul></ul></ul><ul><ul><ul><li>Lungs , Fissures and Lobes </li></ul></ul></ul><ul><ul><ul><li>Breathing </li></ul></ul></ul>
  11. 11. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>The Health History </li></ul></ul><ul><ul><ul><li>Chest pain </li></ul></ul></ul><ul><ul><ul><ul><li>Myocardium, Pericardium, Aorta </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Trachea and large bronchi, Pleura (parietal) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Chest wall </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Esophagus </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Extrathoracic : Gallbladder, Stomach </li></ul></ul></ul></ul><ul><ul><ul><li>Shortness of breath (dyspnea) </li></ul></ul></ul><ul><ul><ul><li>Wheezing </li></ul></ul></ul><ul><ul><ul><li>Cough </li></ul></ul></ul><ul><ul><ul><li>Blood-streaked sputum (hemoptysis) </li></ul></ul></ul>
  12. 12. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Health Promotion and Counseling </li></ul></ul><ul><ul><ul><li>Tobacco cessation </li></ul></ul></ul><ul><ul><ul><ul><li>CAD, Stroke, PVD </li></ul></ul></ul></ul><ul><ul><ul><ul><li>COPD </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cancer </li></ul></ul></ul></ul><ul><ul><ul><li>Immunizations </li></ul></ul></ul><ul><ul><ul><ul><li>Influenza </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Neumococcus </li></ul></ul></ul></ul>
  13. 13. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Techniques of Examination </li></ul></ul><ul><ul><ul><li>Assess patient Color </li></ul></ul></ul><ul><ul><ul><li>Observe and Listen patient´s breathing </li></ul></ul></ul><ul><ul><ul><ul><li>Rate, Rythm, Depth and Effort of breathing </li></ul></ul></ul></ul><ul><ul><ul><li>Inspect the neck </li></ul></ul></ul><ul><ul><ul><li>Observe shape of the Chest </li></ul></ul></ul>
  14. 14. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Techniques of Examination </li></ul></ul><ul><ul><ul><li>Inspection </li></ul></ul></ul><ul><ul><ul><li>Palpation </li></ul></ul></ul><ul><ul><ul><li>Percussion </li></ul></ul></ul><ul><ul><ul><li>Auscultation </li></ul></ul></ul>
  15. 15. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Techniques of Examination: Inspection </li></ul></ul>
  16. 16. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Techniques of Examination: Palpation </li></ul></ul><ul><ul><ul><li>Diaphragm mobility </li></ul></ul></ul><ul><ul><ul><li>Tactile fremitus </li></ul></ul></ul>
  17. 17. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Techniques of Examination: Percussion </li></ul></ul><ul><ul><ul><li>Resonance </li></ul></ul></ul>
  18. 18. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Techniques of Examination: Percussion </li></ul></ul><ul><ul><ul><li>Dullness </li></ul></ul></ul>
  19. 19. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Techniques of Examination: Percussion </li></ul></ul>
  20. 20. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Techniques of Examination: Auscultation </li></ul></ul>
  21. 21. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>The Thorax and Lungs. Recording findings </li></ul></ul><ul><ul><ul><li>“ Thorax is symmetric with good expansion. Lungs resonant. Breath sounds vesicular, no rales, wheezes, or rhonchi. Diaphragms descend 4 cm bilaterally”. </li></ul></ul></ul>
  22. 22. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><ul><li>Surface projections of Heart and Great vessels </li></ul></ul></ul><ul><ul><ul><li>Cardiac chambers, valves and circulation </li></ul></ul></ul><ul><ul><ul><li>Events in the Cardiac Cycle </li></ul></ul></ul><ul><ul><ul><li>Splitting of Heart Sounds </li></ul></ul></ul><ul><ul><ul><li>Heart murmurs </li></ul></ul></ul><ul><ul><ul><li>Auscultatory findings to the chest wall </li></ul></ul></ul><ul><ul><ul><li>The conduction system </li></ul></ul></ul><ul><ul><ul><li>Arterial pulses and Blood Pressure </li></ul></ul></ul><ul><ul><ul><li>Jugular venous pressure </li></ul></ul></ul>
  23. 23. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><ul><li>Surface projections of Heart and Great vessels </li></ul></ul></ul>
  24. 24. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><ul><li>Cardiac chambers, valves and circulation </li></ul></ul></ul>
  25. 25. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><ul><li>Events in the Cardiac Cycle </li></ul></ul></ul>
  26. 26. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><ul><li>Events in the Cardiac Cycle </li></ul></ul></ul>
  27. 27. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><ul><li>Splitting of Heart Sounds </li></ul></ul></ul>
  28. 28. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><ul><li>Turbulence = Heart murmurs (physiologic) </li></ul></ul></ul>http://www.wilkes.med.ucla.edu/intro.html
  29. 29. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><ul><li>Auscultatory findings to the chest wall </li></ul></ul></ul>
  30. 30. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><ul><li>The conduction system </li></ul></ul></ul>
  31. 31. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><ul><li>Arterial pulses and Blood Pressure </li></ul></ul></ul>
  32. 32. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Factors Influencing Arterial Pressure </li></ul></ul><ul><ul><ul><li>Left Ventricular stroke volume </li></ul></ul></ul><ul><ul><ul><li>Distensibility of the aorta and the large arteries </li></ul></ul></ul><ul><ul><ul><li>Peripheral vascular resistance, particularly at the arteriolar level </li></ul></ul></ul><ul><ul><ul><li>Volume of blood in the arterial system </li></ul></ul></ul>
  33. 33. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><ul><li>Jugular venous pressure </li></ul></ul></ul>
  34. 34. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><ul><li>Jugular venous pressure </li></ul></ul></ul>
  35. 35. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><ul><li>Jugular venous pulsations </li></ul></ul></ul>
  36. 36. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><li>The Health History </li></ul></ul><ul><ul><ul><li>Chest pain </li></ul></ul></ul><ul><ul><ul><li>Palpitations </li></ul></ul></ul><ul><ul><ul><li>Shortness of breath </li></ul></ul></ul><ul><ul><ul><ul><li>Dyspnea </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Orthopnea </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Paroxysmal dyspnea </li></ul></ul></ul></ul><ul><ul><ul><li>Swelling or edema </li></ul></ul></ul>
  37. 37. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><li>Health Promotion and Counseling </li></ul></ul><ul><ul><ul><li>Screening for hypertension </li></ul></ul></ul><ul><ul><ul><li>Screening for coronary heart disease and stroke </li></ul></ul></ul><ul><ul><ul><li>Screening for dyslipidemias </li></ul></ul></ul><ul><ul><ul><li>Promoting lifestyle modification and risk - factor reduction </li></ul></ul></ul>
  38. 38. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><li>Techniques of Examination </li></ul></ul><ul><ul><ul><li>Jugular Venous Pressure and Pulsations </li></ul></ul></ul><ul><ul><ul><li>The Carotid Pulse </li></ul></ul></ul><ul><ul><ul><li>The Heart </li></ul></ul></ul><ul><ul><ul><li>Functional Murmurs </li></ul></ul></ul>
  39. 39. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><li>Techniques of Examination: JVP and pulsations </li></ul></ul>
  40. 40. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><li>Techniques of Examination: The Carotid pulse </li></ul></ul>
  41. 41. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><li>Techniques of Examination : The Heart </li></ul></ul>
  42. 42. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul>
  43. 43. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><li>Techniques of Examination: The Heart </li></ul></ul>
  44. 44. <ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><li>Techniques of Examination: The Heart </li></ul></ul>
  45. 46. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><li>Techniques of Examination </li></ul></ul><ul><ul><ul><li>Functional Murmurs </li></ul></ul></ul>
  46. 47. Introduction to Clinical Skills <ul><li>Chest Exam: anterior and posterior </li></ul><ul><ul><li>Heart and Cardiovascular System </li></ul></ul><ul><ul><li>Recording your Findings </li></ul></ul><ul><ul><ul><li>“ 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.” </li></ul></ul></ul>

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