Under Pressure
What is a normal blood pressure?
<120/<80
Describe what can cause lateral displacement of the trachea
Masses and atelectasis will pull the trachea towards them.
Tension pneumothorax or large pleural effusion will push trachea away
What is the pulse pressure of a normal pulse rate?
30-40 mm Hg
What is an elevated BP?
120-129/<80
Describe abnormalities of the chest wall
1. Barrel chest: increase in Ap diameter
2. flail chest: multiple rib fractures may result in pericardial movements of the thorax
3. funnel chest: depression in lower portion of sternum
4. pigeon chest: sternum is displaced anteriorly, increasing AP diameter. costal cartilages adjacent to sternum are depressed
Describe small weak pulses
Pulse pressure is decreased, pulse feels weak and small
What is considered stage I hypertension?
120-139/80-89
Identify relevant surface anatomical landmarks of the chest wall
suprasternal notch, angle of louis, second intercostal space, fourth intercostal space, midsternal and mid-clavicular lines, axillary lines, lungs (lobes and fissures), tracheobronchial tree, the pleurae and pleural spaces
Define the relevant surface anatomical landmarks of the heart and great vessels
1. inferior border of the right ventricle
2. Apex of the heart
3. Origin of valve sounds
- Aortic area, R 2nd intercostal space
-Pulmonic, left 2nd intercostal space
-RV area, left sternal boarder
-LV area, cardiac apex
What is considered stage II hypertension?
140 or greater/90 or greater
Chest expands with inhalation and decreases with exhalation
Respiratory rate: 12-16 breaths per minute
Signs of distress: show intercostal or subcostal retractions, substernal retractions as accessory muscles are being used to help breath. Might see tripod pose or hear strider
Describe conditions that can cause a fast heart rate and the corresponding rate
1. Sinus tachycardia: 100-180
2. Supraventricular (nodal) tachycardia: 150-250
3. Atrial flutter w/ reg ventricular response: 100-175
4. Ventricular tachycardia: 110-250
What should a patient avoid 30 minutes prior to having BP checked?
Avoid: caffeine, exercise and smoking
Define what can cause the following:
1.Tachypnea
2. Hyperpnea
3. Bradypnea
Tachypnea: restrictive lung disease, pleuritic chest pain, elevated diaphragm
Hyperpnea: exercise, high altitudes, sepsis, anemia
Bradypnea: uremia, drug induced respiratory depression, increased intracranial pressure
Name the types of irregular rhythms and describe them.
1. Sporadic sinus: heart varies usually speeding up with inspiration and slows with expiration
2. Atrial/nodal premature contractions: beat of atrial nodal comes earlier than the next expected beat, a pause follows, and the rhythm resumes
3. Sporadic ventricular: beat of ventricular comes earlier than next expected normal beat, pause follows, rhythm resumes
4. Irregularly irregular (Afib, Aflutter): ventricular rhythm is irregular, although short runs of the irregular ventricular rhythm may seem normal