Respiratory chest excursion: what is how to measure, the norm

In order to correctly collect an anamnesis, students learn for years learn to interview, examine and measure a patient. It's a whole art - quickly and qualitatively fill the primary card so that even a doctor who has never met your patient was immediately clear. One of the stages in the history of anamnesis is anthropometric research, 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 seek during the examination? First of all, this is to reveal the characteristics of the chest at rest and during movement, along with spirometry indicators, for example, such as inspiratory volume, speed and expiratory volume, and many others. Their relationship will help differentiate pulmonological pathology from neurological, from trauma or pulmonary edema.

First of all, with a visual examination, we can look at the shape of the chest. Distinguish right or wrong variations. Next, look at the symmetry of both of its halves and the uniformity of respiratory movements.

Chest type

In the clinical anatomy, the following possible variants of the development of events are distinguished:

1. Normostenic, when the ratio of width and depth is correct, the supra- and subclavian fossa are moderately impressed, the ribs go obliquely, the distance between them remains normal, the scapula is loosely pressed to the thorax, and the epigastrium angle is straight.
2. The asthenic type most often happens in slender people. Size, representing the depth of the chest is smaller, due to this is created by the impression that it has an elongated shape. Most often, the pits near the clavicle are expressed sharply, 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 usually weakly developed, and the lower edge of the ribs is easily palpated.
3. Hypersthenic type, corresponds to the same type of physique. The thorax is slightly similar to the cylinder, the depth and width are the same, the intervals between the ribs are narrow, they are almost parallel. Supra- and subclavian fossa are slightly prominent, the epigastric angle is blunt.
4. Emphysiematous thorax occurs in patients with COPD and bronchial asthma. It is similar to hypersthenic, but it has rather wide intercostal spaces, the course of the ribs is horizontal, practically without a slope, the scapulas are closely located with respect to the ribs, there is no obvious selection of supra- and subclavian pits.
5. The paralytic chest is outwardly similar to an asthenic one. It occurs in patients with tuberculosis, chronic lung diseases, pleura, in severely malnourished, cachectic people and in genetic pathology - Morphan syndrome.
6. Rickets, or keeled thorax - occurs mainly in children. Its distinctive features are an impression in the central part in the area of the xiphoid process of the sternum. And also the presence of the symptom of the beads, thickening at the site of the transition of the osseous part of the rib into the cartilaginous part due to incorrect osteogenesis.

Method 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 connection, different types of breathing are distinguished.

Breast - occurs mainly in women. In this type, the main load falls on the intercostal muscles and the diaphragm. Abdominal breathing is more common in men. They have an active abdominal wall in the act of breathing.

There is also a rhythm of breathing (rhythmic or arrhythmic), depth (deep, middle depth or superficial) and frequency (the number of respiratory movements per minute).

Symmetry

The respiratory excursion of the thorax is normally symmetrical. In order to check this sign, you need to look at the movement of the lower angles of the blades during a deep inspiration and exhalation. If one of the scapulae does not succeed in another, it indicates a violation of the function of external respiration and may indicate inflammatory processes, such as pleurisy. In addition, asymmetry can be observed after surgery on the chest, with the wrinkling of the lung due to malignant neoplasms or necrosis.

Another case where a chest excursion can be disturbed is a pathological increase in the lung. This situation can be observed with emphysema, bronchoectatic disease, exudative or exudative pleurisy, closed pneumothorax.

Measurement technique

How to determine the chest excursion? Quite simply: by measuring and simple calculations.

The examinee is asked to stand facing the doctor and spread his hands to the sides. It is desirable that the upper part of the trunk at the same time be freed from clothing. Then the doctor takes a centimeter tape and places it so that it passes through the corners of the scapula. The researcher is invited to take a deep breath and hold his breath. At this time, the first measurement is made. Then the patient can exhale and again hold his breath, so that the doctor can again measure the circumference of the chest. Actually, this was the excursion of the chest. How to measure the frequency of breaths or their depth in liters? Too simple enough if there is additional equipment, such as a clock and a picofluometer.

Deformation of the chest

A chest excursion should normally be symmetrical over all areas, but sometimes uneven resistance of its walls to air pressure is observed. And then protrusions or retractions are formed. Retraction is usually a consequence of fibrosis or lung atelectasis. A one-sided swelling of the chest can indicate the accumulation of fluid or air in this place.

To check the symmetry, the doctor must put his hands to the back of the patient on either side of the spinal column and ask for a few deep breaths. The lag of one of the halves can tell the doctor that a person develops pleurisy or pneumonia, and a uniform decrease or absence of a lung excursion may lead to an idea of emphysema.

Normal performance

In fact, there are no clear criteria, which should be a tour of the chest. The norm (cm) is quite relative and depends on the age, physique, sex of the person. On average, it ranges from one to three centimeters. Circumference of the chest - also a relative value, only for children there are special tables that reflect the dynamics and harmony of their development.

Breathing rate

When the chest excursion is determined, the doctor is engaged in counting the breaths-exhalations. At this moment it is important to distract the patient to something else, otherwise it can distort the results, breathe more often or, conversely, less often.

Therefore, unnoticed for the patient, the specialist has a hand on the surface of the chest. This is convenient when you count the pulse and count the number of movements per minute. A normal chest excursion involves twelve or twenty respiratory movements. If the patient does not reach the lower limit of the norm, then most likely, he will soon show neurologic symptoms, but 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, the rapidity of breathing can be observed because of the labile psychoemotional state, at the height of the fever, or in pre-teaching.

Excursion of the chest (the difference in its circumference between inspiration and exhalation) is not always included in the priority study of emergency physicians or somatic hospitals. This is considered a routine activity, although it is not deserved. Earlier, when ultrasound, MRI and CT machines were not widely used, doctors could reveal a hidden pathology, simply putting a hand to the patient's breast.