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Pemeriksaan Thorax
Pemeriksaan Thorax
PSIK
FIKES UMM
Ribs, clavicles, sternum
Angle of Louis
(manubriosternal
angle): marker for:
Where second rib
meets sternum (count
ribs from here)
Carina of trachea
Arch of aorta
Anterior Surface of Thorax
Palpate the following
Sternum (3 parts)
Jugular notch
Sternal Angle (= 2nd
rib)
Clavicle
Costal margin
Infrasternal angle
Xiphosternal joint
IMAGINER LINE (Garis bayangan)
B. Posterior Chest
1. Percuss from side to side and top to bottom using the
pattern shown in the illustration. Omit the areas covered
by the scapulae.
2. Compare one side to the other looking for asymmetry.
3. Note the location and quality of the percussion sounds
you hear.
4. Find the level of the diaphragmatic dullness on both sides.
Interpretation
C. Anterior Chest Percussion Notes and Their
1. Percuss from side to side Meaning
and top to bottom using
the pattern shown in the Flat or liquid or solid
illustration. Dullness
1. Pleural Effusion
2. Compare one side to the
2. Lobar Pneumonia
other looking for
lung area full of pus
asymmetry.
Normal Healthy Lung or
3. Note the location and
Bronchitis
quality of the percussion
sounds you hear. Hyperresonant Emphysema or
Pneumothorax
4. AUSCULTATION
TUJUAN : mendengarkan suara nafas
Breath sounds are produced by turbulent air flow
A. Posterior Chest
1. Auscultate from side to side and top to bottom using the pattern
shown in the illustration. Omit the areas covered by the
scapulae.
2. Compare one side to the other looking for asymmetry.
3. Note the location and quality of the sounds you hear.
B. Anterior Chest
1. Auscultate from side to side and top to bottom using the pattern
shown in the illustration.
2. Compare one side to the other looking for asymmetry.
3. Note the location and quality of the sounds you hear.
Suara Nafas Normal
1. Trakeal : bunyi yang terdengar kasar, keras, dan
dengan tinggi nada tinggi pada bagian trakea
ekstratoraks
2. Bronkial : bunyi yang dengan tinggi nada tinggi,
seperti udara mengalir melalui pipa didengar di atas
manubrium sternal
3. Vesikular : bunyi yang terdengar lemah dengan tinggi
nada rendah seluruh lapang paru
4. Bronkovesikular : campuran bunyi bronkial dan bunyi
vesikular hanya terdengar pada ICS I dan II
Suara nafas tambahan (Adventitious (Extra) Lung
Sounds)
Crackles/ Rales : These are high pitched, discontinuous
sounds similar to the sound produced by rubbing your
hair between your fingers. signs of water in the alveoli
(heart failure), pus in the alveoli (pneumonia), or scarring
(pulmonary fibrosis)
Wheezes/Wheezing: These are generally high pitched
and "musical" in quality. Stridor is an inspiratory wheeze
associated with upper airway obstruction (croup). sign
of asthma or, if localized, of a tumor or foreign body
Rhonchi : These often have a "snoring" or "gurgling"
quality. Any extra sound that is not a crackle or a wheeze
is probably a rhonchi. originate in larger airways than
wheezes and are a sign of bronchitis
Friction rub is a dry, leathery sound heard in inspiration
and expiration. It is a sign of inflammation of the pleura.
SUARA UCAPAN
1. Bronchophony is increased clarity of words,
e.g. in area of pneumonia
2. Whispered pectoriloquy -- even a whisper is
clear to the stethoscope - is an extreme form
of bronchophony (Suara terdengar jauh
dan tidak jelas)
3. Egophony: patient says EE and stethoscope
hears A - is similar to increased tactile fremitus.
Egophony may be the only physical
examination abnormality in early pneumonia.
JANTUNG/CARDIO
Examination of the heart
includes:
Inspection: of jugular venous
pulse and point of maximal
impulse
Palpation: of point of
maximum impulse, and
precordium for lifts, heaves and
thrills
Auscultation: for valve closing
sounds (S1 and S2), extra
sounds (S3 and S4), murmurs,
clicks and rubs
AUSCULTATION OF THE HEART
be sure to use both sides of the stethoscope to examine
the heart
the diaphragm is best for hearing high-pitched sounds,
including S1, S2 and most heart murmurs
the bell is bests for hearing low-pitched sounds, including
S3, S4 and a few murmurs (e.g. mitral stenosis)
use LIGHT TOUCH when using the bell. Pressure turns it
into a diaphragm