External examination of the chest

External chest examination is to examine the main tissues and organs of the chest, including chest wall, thoracic, pleural and pleural cavity, breast, trachea, bronchus, lung, heart, blood vessels, lymph nodes, esophagus, mediastinum and diaphragm. The order of chest examination is front chest → side chest → back chest (back). According to the consultation, palpation, percussion, and auscultation. The focus of the examination is on the lungs and heart. Basic Information Specialist Category: Respiratory Examination Category: Other Inspections Applicable gender: whether men and women apply fasting: not fasting Tips: Poor rest, improper diet, excessive fatigue. Normal value First, the bone symbol (1) Skeletal signs on the front chest wall 1. The sternum is located in the middle of the thoracic anterior, connecting the ribs and the clavicle on both sides, and is divided into three parts: the sternum, the sternum, and the xiphoid. (1) The numb stalk (manubriumsterni) is located in the upper part of the sternum and has a slightly hexagonal shape. The middle part of the upper edge of the sternum stem is the jugular vein incision. In the adult, the intervertebral disc below the second thoracic vertebra, the ovoid articular surface on the outer side of the upper edge, called the clavicle notch, is connected with the sternum end of the clavicle, and the lower edge is The sternum is connected. (2) The middle part of the sternum of the corpussterni, whose upper edge is connected to the sternum stem, and the lower edge is combined with the xiphoid process. Both sides of the lower part of the sternum are connected to the 7th to 10th costal cartilage. (3) The xiphoid process is a protruding part of the lower end of the sternum, which is triangular, and its bottom is connected with the sternum. 2. The sternal angle (also known as the Louis angle). It is formed by a slight extension of the joint between the sternum stem and the sternum. The sternal horn marks the bifurcation of the trachea, the upper edge of the aortic arch, and the height of the fourth thoracic vertebra. The sternal angle is connected to the second costal cartilage and is an important marker for counting ribs. 3. Intercostal space The gap between the two ribs. The horizontal position of the anterior chest wall is usually represented by a rib or a rib gap, the gap between the first and second ribs is the first rib gap, and so on. (2) Skeletal signs on the back chest wall (back) 1. Bone prominence between each vertebrae on the median line of the spine processus (processusspinosus). It is the sign of the back center line. The 7th cervical spine located at the base of the neck is the most prominent, and the lower part is the starting point of the thoracic vertebra. It is commonly used here as a marker for counting the thoracic vertebrae. 2. A total of 12 pairs of ribs. Twelve pairs of ribs are connected to the thoracic vertebrae in the back. The first to tenth ribs are connected to the costal cartilage at the front of the chest, and the costal cartilage is connected to the sternum to form a bony bracket. The 11th and 12th ribs are floating ribs. 3. Spine scapula (Scapula) triangular flat bones on both sides of the spine. Located between the 2nd to 8th ribs of the posterior chest wall. Divided into shoulders, shoulders and shoulders. Down the medial edge of the scapula, the end is the shoulder angle. When the examinee takes the upright position and the upper limbs naturally sag, the lower scapula angle is equal to the level of 7-8 ribs or equal to the level of the eighth thoracic vertebrae, which is an important sign of the back examination. 4. The costalspinal angle is the angle between the twelfth rib and the spine. It is the area where the kidney and ureter are located. Second, the chest surface vertical line mark (1) Marking lines on the front and side 1. The anterior midline (anterior midline) is the midline of the sternum. A vertical line drawn through the midpoint of the sternum. 2. The midclavicular line (left and right) is the vertical line through the midpoint of the clavicle shoulder end and the sternum end. That is, the vertical line through the midpoint of the clavicle. 3. The sternal line (left and right) is a vertical line parallel to the anterior median line along the sternal edge. 4. The parasternal line (left and right) is the vertical line through the middle of the sternum line and the midline of the clavicle. 5. The anterioraxillaryline (left and right) is the vertical line made through the folds in front of the armpits. 6. The midaxillaryline (left and right) is the vertical line from the top of the armpit to the lower line between the anterior and posterior iliac crest. 7. The posterior axillary line (left and right) is the vertical line made through the folds after the armpit. (2) Marking line on the back 1. The posterior midline (posteriormidline) is the midline of the spine. A vertical line that descends through the spinous process of the vertebrae or along the midline of the spine. 2. Scapularline (left and right) is the vertical line passing through the lower corner of the shoulder when the arms are naturally drooping. Third, the natural dimples and anatomical regions of the chest 1. The supra-sternal fossa (suprasternalfossa) is a depression above the sternum stem with the trachea behind it. 2. The supraclavicular fossa (left and right) is the depression above the collarbone, which is equivalent to the upper part of the lung tip. 3. The infraclavicular fossa (left and right) is the depression below the collarbone, and the lower boundary is the lower edge of the third rib. It is equivalent to the lower part of the lung tip. 4. Axillary fossa (left and right) is the concave part of the upper part of the upper limb connected to the chest wall. 5. The suprascapular region (left and right) is the area above the scapula, and the outer upper boundary is the upper edge of the trapezius. It is equivalent to the lower part of the lung tip. 6. The infrascapular region (left and right) is the area between the line connecting the lower back of the shoulder and the horizontal line of the 12th thoracic vertebra. 7. The interscapular region (left and right) is the area between the shoulder blades. Clinical significance Abnormal result The anterior chest wall and the posterior chest wall have abnormal bone marks, abnormal marking lines on the front, side and back, and abnormal lacuna in the chest. People who need to be checked Patients with chest skeletal malformations or chest trauma. Precautions Taboo before the examination: poor rest, improper diet, excessive fatigue. Requirements for inspection: Actively cooperate with the doctor's work. 1. Warm and quiet environment; 2, good exposure; 3, stethoscope and hand warm; 4, breathing should be deep during auscultation; 5, before, side, then back; 6, left and right contrast, up and down contrast; 7, according to the touch. Inspection process The order of chest examination is front chest → side chest → back chest (back). According to the consultation, palpation, percussion, and auscultation. The focus of the examination is on the lungs and heart. Not suitable for the crowd Inappropriate crowd: None.

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