Pemeriksaan Fisik Thorax dan Respirasi

Summary

In this video, Dr. Dewi demonstrates a thorough thoracic examination on a patient, covering various steps of the process. The examination includes inspecting the chest shape, evaluating respiratory movements, and checking for abnormal breathing patterns or muscle retracements. It proceeds with palpation to assess any pain or tumors and fremitus to detect irregularities in lung vibrations. The procedure also involves percussion to evaluate lung sounds and auscultation for breath sounds. Key points include identifying conditions like emphysema or pneumonia, along with assessing boundaries of the lungs, heart, and liver. The video concludes with proper patient care and hygiene protocols.

Takeaways

• 😀 The thoracic examination begins with the introduction and obtaining consent from the patient.
• 😀 The physical examination consists of inspection, palpation, percussion, and auscultation.
• 😀 The normal chest shape is characterized by a 2:1 ratio between the transverse and anteroposterior diameters.
• 😀 Abnormal chest shapes include a nearly equal transverse-to-anteroposterior ratio, seen in emphysema, or a protruding sternum (pectus carinatum).
• 😀 The examination checks for any abnormal chest movements during breathing and the use of accessory muscles.
• 😀 The posterior chest is inspected for symmetry, skin color, and movement during respiration.
• 😀 Palpation checks for tenderness, masses, and assesses the expansion of the chest during breathing.
• 😀 Fremitus is assessed by asking the patient to say '77' to detect differences between the right and left sides of the chest.
• 😀 Percussion is performed to assess lung resonance, with normal findings being 'sonorous'. Abnormal findings may indicate conditions like pneumonia or emphysema.
• 😀 Auscultation is conducted using a stethoscope to listen for normal vesicular breath sounds and any abnormal sounds like wheezing or crackles.
• 😀 The anterior chest is also examined for abnormalities, such as gynecomastia or spider nevi, which may indicate liver disease.
• 😀 The examination concludes by reassessing the patient’s condition, ensuring all findings are recorded, and following proper hygiene protocols.

Q & A

What is the first step when performing a thoracic examination on a patient?

The first step is to introduce yourself to the patient and ask for permission to conduct the physical examination.

What is the normal shape of a chest according to the thoracic examination?

A normal chest shape has a transverse diameter that is approximately twice the size of the anteroposterior diameter.

What could abnormal chest shapes indicate in a thoracic examination?

Abnormal chest shapes may include a nearly equal transverse and anteroposterior diameter, which can be seen in patients with emphysema, or a protruding sternum, known as pectus carinatum. A sunken sternum is referred to as pectus excavatum.

How is the movement of the chest observed during the thoracic examination?

The movement of the chest is observed dynamically during breathing to ensure both sides of the chest rise and fall symmetrically. Any retraction of the chest muscles or involvement of accessory muscles in breathing is noted.

What is palpation used for in the thoracic examination?

Palpation is used to assess for tenderness, the presence of any masses or tumors, and the expansion of the chest wall. It also helps evaluate the optimal movement during inspiration and expiration.

How is fremitus assessed during the thoracic examination?

Fremitus is assessed by having the patient say '77' while the examiner places their hands on both sides of the chest. Fremitus is considered normal when it is equal on both sides, and variations in fremitus can indicate conditions like pneumonia (increased fremitus) or pleural effusion (decreased fremitus).

What is the normal sound expected during percussion of the chest?

The normal sound expected during percussion of the chest is 'sonorous' or resonant, which indicates the presence of air in the lungs.

What might a hypersonor percussion sound indicate?

A hypersonor percussion sound may indicate conditions like emphysema, where there is more air in the lungs than normal.

What is assessed during auscultation of the chest?

Auscultation assesses the sounds produced during breathing, which should generally be vesicular in nature. Additional sounds, such as wheezing or crackles, may indicate respiratory conditions like asthma or bronchitis.

How is the examination performed on the anterior chest wall?

On the anterior chest wall, the examiner checks for abnormalities such as gynecomastia (enlargement of male breast tissue) or spider nevi (a sign of liver disease). They also observe for any visible pulsations that may indicate cardiovascular abnormalities.