In order to correctly collect an anamnesis, students learn for years to question, examine and measure the patient. It is a whole art to quickly and efficiently fill out the primary card so that even a doctor who has never met with your patient can understand everything right away. One of the stages of collecting anamnesis is an anthropometric study, which includes determining the size of the chest, the volume of respiratory movements, their symmetry and frequency, participation in the act of breathing muscles.
Chest shape
What does the doctor strive for during the examination? First of all, this is the identification of the characteristics of the chest at rest and during movement, along with spirometry indicators, for example, such as inspiratory volume, expiratory rate and volume, and many others. Their relationship will help to differentiate pulmonary pathology from neurological, from trauma or pulmonary edema.
First of all, with a visual inspection, we can see the shape of the chest. Distinguish between correct orwrong variation. Next, we look at the symmetry of both its halves and the uniformity of respiratory movements.
Chest type
In clinical anatomy, the following possible scenarios are distinguished:
- Normosthenic, when the ratio of width and depth is correct, the supraclavicular and subclavian fossae are moderately depressed, the ribs go obliquely, the distance between them is normal, the shoulder blades are not tightly pressed to the chest, and the epigastric angle is straight.
- Asthenic type most often occurs in slender people. The size representing the depth of the chest is smaller, due to this it gives the impression that it has an elongated shape. Most often, the pits near the collarbone are pronounced, the skin over them sinks. The ribs are more vertical than at an angle, the angle formed by the xiphoid process is acute. In such people, the muscles of the shoulder and back are most often poorly developed, and the lower edge of the ribs is easily palpable on palpation.
- Hypersthenic type, corresponds to what type of physique. The chest is slightly cylindrical, the depth and width are the same, the gaps between the ribs are narrow, they are almost parallel. The supraclavicular and infraclavicular fossae stand out slightly, the epigastric angle is obtuse.
- Emphysematous chest occurs in patients with COPD and bronchial asthma. It is similar to hypersthenic, but it has fairly wide intercostal spaces, the course of the ribs is horizontal, practically without a slope, the shoulder blades are located close to the ribs, there is no obvious selectionsupraclavicular and subclavian fossae.
- The paralytic chest is similar in appearance to the asthenic chest. It occurs in patients with tuberculosis, chronic diseases of the lungs, pleura, in severely malnourished, cachexic people and in genetic pathology - Morfan's syndrome.
- Rachitic, or keeled chest - occurs mainly in children. Its distinctive features are a depression in the central part in the region of the xiphoid process of the sternum. As well as the presence of a symptom of a rosary, thickening at the junction of the bone part of the rib to the cartilage due to improper osteogenesis.
Breathing method
Excursion of the chest depends not only on its type and shape, but also on how a person breathes: through the mouth or nose. In this regard, different types of breathing are distinguished.
Breast - occurs mainly in women. With this type, the main load falls on the intercostal muscles and the diaphragm. The abdominal type of breathing is more typical for men. Their anterior abdominal wall actively participates in the act of breathing.
There are also breathing rhythm (rhythmic or arrhythmic), depth (deep, medium or shallow) and frequency (number of breaths per minute).
Symmetrical
Respiratory excursion of the chest is normally symmetrical. In order to check this sign, you need to look at the movement of the lower corners of the shoulder blades during deep inspiration and expiration. If one of the shoulder blades does not keep pace with the other, this indicates a violation of the function of external respiration and maytestify to inflammatory processes, such as pleurisy. In addition, asymmetry can be observed after surgical interventions on the chest, with wrinkling of the lung due to malignant neoplasms or necrosis.
Another case where chest excursion can be impaired is a pathological enlargement of the lung. This situation can be observed with emphysema, bronchiectasis, effusion or exudative pleurisy, closed pneumothorax.
Measuring technique
How to determine chest excursion? Pretty simple: by measurements and simple calculations.
The subject is asked to stand facing the doctor and spread his arms to the sides. It is desirable that the upper part of the body be freed from clothing. The doctor then takes the measuring tape and positions it so that it passes over the corners of the shoulder blades. The subject is asked to take a deep breath and hold the breath. At this point, the first measurement is made. After that, the patient can exhale and hold his breath again so that the doctor can measure the circumference of the chest again. Actually, it was a chest excursion. How to measure the frequency of breaths or their depth in liters? It is also quite simple if you have additional equipment, such as a clock and a peak flow meter.
Chest deformity
Excursion of the chest should normally be symmetrical over all areas, but sometimes unevenresistance of its walls to air pressure. And then protrusions or retractions are formed. Retraction is usually due to fibrosis or atelectasis of the lung. A unilateral bulging of the chest may indicate the accumulation of fluid or air in this place.
To check the symmetry, the doctor should put his hands on the back of the patient on both sides of the spinal column and ask to take a few deep breaths. Lagging one of the halves may tell the doctor that a person is developing pleurisy or pneumonia, and a uniform decrease or absence of lung excursion may suggest emphysema.
Normal performance
In fact, there are no clear criteria for what a chest excursion should be. The norm (cm) is quite relative and depends on the age, physique, gender of the person. On average, it ranges from one to three centimeters. Chest circumference is also a relative value, only for children there are special tables that reflect the dynamics and harmony of their development.
Respiration rate
When the chest excursion is determined, the doctor counts the breaths. At this point, it is important to distract the patient to something else, otherwise he may distort the results, breathe more often or, conversely, less often.
Therefore, imperceptibly for the patient, the specialist places his hand on the surface of the chest. This is convenient to do when you count the pulse andcount the number of movements per minute. Normal chest excursion involves twelve to twenty breaths. If the patient does not reach the lower limit of the norm, then most likely he will soon develop neurological symptoms, but if the frequency is much higher, then the probable diagnosis is associated with pathologies that prevent a person from breathing deeply (fluid, broken ribs, neuralgia, etc.).). In addition, increased breathing can be observed due to a labile psycho-emotional state, at the height of fever or in preagony.
Excursion of the chest (the difference in its circumference between inhalation and exhalation) is not always included in the priority study of emergency doctors or somatic hospitals. This is considered a routine activity, although not deservedly so. Previously, when ultrasound, MRI and CT machines were not yet ubiquitous, doctors could reveal hidden pathology simply by placing their hand on the patient's chest.
