In order to correctly collect an anamnesis, students study for years, learn to interview, examine and measure the patient. It is a whole art to quickly and accurately fill out the primary card so that even a doctor who has never met your patient will immediately understand everything. One of the stages in collecting an anamnesis is an anthropometric study, which includes determining the size of the chest, the volume of respiratory movements, their symmetry and frequency, and the participation of muscles in the respiratory act.
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 flow rate and volume, and many others. Their relationship will help to differentiate pulmonological pathology from neurological, from trauma or pulmonary edema.
First of all, during a visual examination, we can see the shape of the chest. Distinguish between right or wrong variations. 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 identified:
- Normostenic, when the ratio of width and depth is correct, the supra- and subclavian fossae are moderately depressed, the ribs go obliquely, the distance between them remains normal, the shoulder blades are loosely pressed to the chest, and the angle of the epigastrium is straight.
- The asthenic type most often occurs in slender people. The size, representing the depth of the chest is smaller, due to this it creates the impression that it has an elongated shape. Most often, the fossa near the clavicle is sharply expressed, the skin over them sinks. The ribs are located more vertically 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 palpated upon palpation.
- Hypersthenic type, corresponds to what type of physique. The chest is slightly similar to a cylinder, the depth and width are the same, the gaps between the ribs are narrow, they are located almost parallel. The supra- and subclavian fossae are weakly distinguished, the epigastric angle is obtuse.
- Emphysematous chest is found in patients with COPD and bronchial asthma. It is similar to hypersthenic, but has rather wide intercostal spaces, the course of the ribs is horizontal, practically without a slope, the scapula is closely adjacent to the ribs, there is no obvious selection of the supra- and subclavian fossae.
- The paralytic chest in appearance is similar to asthenic. It occurs in patients with tuberculosis, chronic diseases of the lungs, pleura, in severely malnourished, cachexic people, and with genetic pathology - Morphan's syndrome.
- Rickety, or keeled chest - occurs mainly in children. Its distinctive features are a depression in the central part in the xiphoid process of the sternum. As well as the presence of a symptom of beads, thickenings at the place of transition of the bone part of the rib to the cartilage due to improper osteogenesis.
Way of breathing
Excursion of the chest depends not only on its type and shape, but also on how a person breathes: 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. Abdominal breathing is more common in men. They have an anterior abdominal wall actively participating in the act of breathing.
They also distinguish breathing rhythm (rhythmic or arrhythmic), depth (deep, medium depth or superficial) and frequency (number of respiratory movements per minute).
Symmetry
The chest breathing excursion is normally symmetrical. In order to check this symptom, you need to look at the movement of the lower corners of the shoulder blades during deep inhalation and exhalation. If one of the shoulder blades does not keep up with the other, this indicates a violation of the function of external respiration and may indicate 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 a chest excursion may be impaired is a pathological enlargement of the lung. This situation can be observed with emphysema, bronchiectasis, effusion or exudative pleurisy, closed pneumothorax.
Measurement technique
How to determine chest excursion? Pretty simple: through measurements and simple calculations.
The examinee is asked to stand facing the doctor and spread his arms to the sides. It is advisable that the upper part of the body is freed from clothing. Then the doctor takes a centimeter tape and positions it so that it passes through the corners of the shoulder blades. The researcher is invited to take a deep breath and hold his breath. At this moment, the first measurement is made. Then the patient can exhale and hold his breath again, so that the doctor can once again measure the circumference of the chest. Actually, this was a tour of the chest. How to measure the frequency of breaths or their depth in liters? It is also quite simple if there is additional equipment, such as a watch and a pick-up meter.
Chest deformity
Excursion of the chest should normally be symmetrical over all areas, but sometimes there is uneven resistance of its walls to air pressure. And then bulges or retractions are formed. Retraction is usually a consequence of fibrosis or lung atelectasis. A one-sided swelling of the chest may indicate an accumulation of fluid or air in this area.
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 for a few deep breaths. The lag of one of the halves may tell the doctor that a person develops pleurisy or pneumonia, and a uniform decrease or absence of lung excursion may lead to the thought of 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. The circumference of the chest is also a relative value, only for children there are special tables that reflect the dynamics and harmony of their development.
Breathing rate
When a chest excursion is determined, the doctor is engaged in counting 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, unnoticed by the patient, the specialist places his hand on the surface of the chest. This is convenient to do when you count the pulse and count the number of movements per minute. A normal chest excursion involves twelve to twenty respiratory movements. If the patient does not reach the lower limit of the norm, then, most likely, he will soon manifest neurological symptoms, if the frequency is much higher, then the probable diagnosis is associated with pathologies that prevent a person from breathing deeply (fluid, fracture of ribs, neuralgia, etc. .). In addition, rapid breathing can be observed due to a labile psychoemotional state, at the height of a fever, or in predagonia.
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 routine, although not deservedly. Previously, when ultrasound, MRI and CT machines were not yet widely distributed, doctors could detect hidden pathology simply by putting a hand to the patient’s chest.