Crepitation

Coarse crepitation
-เกิดจาก movement of fliud or secretion in airway
-ได้ยินทั้ง inspire and expire crep
-change with respiration
– พบใน Tracheobronchitis Bronchiectasis

Late crepitation
-Alveoli process

Early crepitation
-end before end inspiration
-indicate small airway

มันเลยเหมือนสาเหตุคนละตำแหน่งเ​ลยไม่มี Late coarse crepitation
มีแต่ Early coarse crepitaion (^^)

Trachea examination

Tracheal tug = ให้ผู้ป่วยก้มหัวเล็กน้อย กด cricothyroid space ดันขึ้น trachea and larynx move upward 1-2 cm if not move = mediastinal fix (most common from CA TB)

Oliver’s sign = cricothyroid move pulsatile พบใน aortic arch aneurysm

Campbell’s sign = thyroid cartilage move downward ตามการหายใจ associated with COPD

http://www.mediscuss.org/showt​hread.php?p=983

http://www.youtube.com/watch?v=Y7odujnNG8k&feature=related

http://www.youtube.com/watch?v=hAVyMMtrbiM

Abdominal paradox

pseudo paradoxical movement = delay excursion of diaphragm
may be due to emphysema

abdominal paradox = Diaphragmatic fatigue, sign of type2 respiratory failure
pseudo paradox = Force expiration by squeezing rectus abdominis for release air trapping
pseudo-pseudo paradox = bilateral diaphragmatic paralysis

Diaphragmatic Excursion

Diaphragmatic Excursion

Find the level of the diaphragmatic dullness on both sides.
Ask the patient to inspire deeply.
The level of dullness (diaphragmatic excursion) should go down 3-5cm symmetrically

causes of diaphragmatic paralysis
unilat – most common metastatic lung cancer invade phrenic n. about30%, surgical trauma, c-spond, herpes zoster
bilateral – most common motor neuron disease->ALS, post polio syndrome, MS, myopathies, acid maltase def.

HOOVER sign

inward movement of the lower rib cage during inspiration,[2] implying a flat, but functioning, diaphragm, often associated with COPD.[3] COPD, and more specifically emphysema, often lead to hyperexpansion of the lungs due to air trapping. The resulting flattened diaphragm contracts inwards instead of downwards, thereby paradoxically pulling the inferior ribs inwards with its movement.

http://www.youtube.com/watch?v​=8ywOTa4ZFXA

Clubbing finger

Schamroth’s test or Schamroth’s window test (originally demonstrated by South African cardiologist Dr Leo Schamroth on himself ตรวจ Clubbing

Profile sign

Clubbing เกิดที่นิ้วโป้งและนิ้วชี้ก​่อน
sign ที่พบตอนแรกๆ คือ floating and profile sign

Kehr’s sign

Kehr’s sign: refer pain to tip of scapula