Assessment

jsmritiphysio@gmail.com
CARDIOPULMONARY
ASSESSMENT
Dr. Smriti A. Gupta
Assistant Professor
Dr. D. Y. Patil College of Physiotherapy
D. Y. Patil Vidyapeeth

ASSESSMENT

PERCUSSION
• Percussion is art of tapping on a surface in order
to evaluate the underlying structures
• Percussion of chest wall generates sound and
leads to production of standing waves on the chest
wall
• The sound waves produced on the chest wall can
travel down to a depth of 5-7cm

• Position of the patient---- the sitting posture is the best position
• Supine position is not desirable because of the alteration of the
percussion note by the underlying structure on the patient lies
• Anterior percussion--- the patient sits erect with hands by his
side
• Posterior percussion ---the patient bends his head forward and
keeps his hands over the opposite shoulder
• Lateral percussion ---- the patient sits with his hands helds
over the head

Cardinal rules of Percussion
• The pleximeter ----the middle finger of the examiners left hand
should be opposed tightly over the chest wall over the
intercostal spaces. The other fingers should not touch the chest
wall
• The plexor ----- the middle or the index finger of the examiner
right hand is used to hit the middle phalanx of the pleximeter
• The percussion movement should be sudden, originating from
the wrist.

Percussion….
• Should be done systematically and compare area on the both
sides
• Bony structures and breast should be avoided
• Unilateral and diffuse changes in resonance should be made
out ( hyper resonant, normal resonant, tymphanitic , dullness,
stony dullness)
• Obesity and muscular chest wall are limitations for percussion.
Percussion cannot detect small abnormalities and lesions
below 5cm from the chest wall.

• Increased resonance indicates excessive air
trapped in the pleural space or lungs
• Decreased resonance indicates fluid in the
pleural space or consolidation in the lung.

Methods of Percusssion

Diaphragmatic excursion
• The range of diaphragm movement may be
estimated by percussion and is assessed best on
the posterior chest wall
• For the examiner to estimate diaphragm
movement, the patient first is instructed to take a
deep, full inspiration and to hold it
• The examiner then determines the lowest margin
of resonance by percussing over the lower lung
field and moving downward in small increments
until a definite change in the percussion note is
detected

• The patient then is instructed to exhale
maximally, holding this position while the
percussion procedure is repeated.
• The normal diaphragmatic excursion during a
deep breath is approximately 5 to 7 cm

Auscultation
• The stethoscope includes four basic parts; a
bell ,a diaphragm, tubing, and ear pieces
• The bell detects a broad spectrum of sounds
and is of particular value in listening to low-
pitched heart sounds
• The diaphragm piece is used most often in
auscultation of lungs, because most lung
sounds are high frequency

• The ideal tubing should be thick enough to
exclude external noises and should be
approximately 25 to 35 cm in length.

Procedure
• The patient should be sitting upright in a relaxed
position when possible.
• The patient is instructed to breathe a little deeper
than normal with a mouth open
• It is recommended that examiner begin at the
bases, compare side with side, and work toward
the lung apices
• The examination begins at the lung bases, because
certain abnormal lung sounds that occur primarily
in the dependent lung sounds may be altered by
several deep breaths

• Four characteristics of breath sounds are o be
identified first, the pitch (vibration frequency)
is identified. Second, the amplitude or intensity
(loudness) is noted. Third, the examiner listens
for the distinctive characteristics . Fourth, the
duration of inspiratory sound is compared with
that of expiration

• Lung sounds------ wheezes
• Possible mechanism------ rapid airflow through
obstructed airways caused by bronchospasm,
mucosal edema
• Characteristics----- high-pitched, most often
occur during exhalation
• Causes---- asthma, congestive heart failure,
bronchitis

• Lung sounds----- stridor
• Possible mechanism----- rapid airflow through
obstructed airway caused by inflammation
• Characteristics ------ high-pitched; often occurs
during inhalation
• Causes--- postextubation , URTI etc.

• Lung sounds------ crackles
• Possible mechanism------- excess airway
secretions moving with airflow (inspiratory
and expiratory crackles)
• Characteristics------ coarse and often clear
with cough
• Causes------ bronchitis, respiratory infections

• A pleural friction rub is a creaking or grating
type of sound that occurs when the pleural
surfaces become inflamed and roughened
edges rub together during breathing,
• It may be heard only during inhalation but
often is identified during both phases of
breathing

Vocal resonance
• It is a voice sound heard with the chest piece
of the stethoscope
• Bronchophony;----- voice sounds appear to be
heard near the earpiece of stethoscope and
words are unclear
• Example------- consolidation, cavity
communicating with a bronchus, above level
of pleural effusion

• Egophony ;----- voice sounds has a nasal or
bleating quality. On saying E it will be heard as A
(E to A sign)
• Example----- consolidation, cavity, above the
level of pleural effusion,
• Whispering pectoriloquy;-----the patient is asked
to whisper words at the end of expiration, and this
whispered voice is transmitted without distortion
so that the individual syllables are recognised
clearly. example-----pneumonic consolidation

Assessment

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