PEMERIKSAAN FISIK CPX.ppt

7/17/2019 PEMERIKSAAN FISIK CPX.ppt

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PEMERIKSAAN FISIS PARU

Dr. Mirsyam Ratri Wiratmoko,

Sp.P, FCCP

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Z = airway generationBR = bronchusBL = bronchioleTBL = terminal bronchioleRBL = resp. Bronchiole

AD = alveolar ductAS = alveolar sac.


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TRACHEATRACHEA

Dari kartilago krikoid spDari kartilago krikoid sp

sudut sternal (depan) atausudut sternal (depan) atau

prosesus spinosus T4prosesus spinosus T4

(belakang),(belakang),

Dibagi 2 abang !aituDibagi 2 abang !aitu

bron"us uta#a kanan danbron"us uta#a kanan dan

kirikiri

$edikit bergeser ke kanan$edikit bergeser ke kanan


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TULANG-TULANG IGA

Di bagia !"pa !i#it$g k" ba%a# m$&aiiga k" '

T"r!apat (' t$&ag iga !a (( s"&a iga

Di bagia post"rior s$!$t i)"rior skap$&a

s"*a*ar iga k" +

%


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&


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ANATMI PRMUAAN PARU

PARU KANAN

!im$&ai !ari/ 0m !iba%a# k&a1ik$&a p!&i"a mi!0&a1i0$&a kaa t$r$s"pa*ag &i"a parast"ra& kaa s!kosta k" 2 p! &i"a mi!0&a1i0$&a kosta 3p! &i"a mi! aksi&aris k" kosta (4

bagia post"rior

s! &i"a 1"rt"bra&is


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1

Di#ulai dari 3 # diba*a"Di#ulai dari 3 # diba*a"

kla+ikula pd lineakla+ikula pd linea

#idla+iula kanan#idla+iula kanan

turun sepanang lineaturun sepanang linea

parasternal kananparasternal kanan sdsd

kosta ke % pd lineakosta ke % pd linea#idla+iula#idla+iula kosta ' pdkosta ' pd

linea #id aksilarislinea #id aksilaris keke

kosta 1 bagian posteriorkosta 1 bagian posteriorsd linea +ertebralissd linea +ertebralis


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ANATMI PRMUAAN PARU

PARU KIRIDari s$!$t Lo$is, m"gik$ti margi &$ar

*at$g m"$*$ kosta 2 p! &i"ami!0&a1i0$&a kiri

APEX PARUM$!a# !ipa&pasi p! !a"ra# 5r$ag6 s$pra0&a1i0$&a

T$mor Pa0oast !a T7 s"rig t"r*a!i !i!a"ra# ii.

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APEX PARUAPEX PARU

-uda" dipalpasi pd daera" (ruang) supra-uda" dipalpasi pd daera" (ruang) supra

la+iulala+iula

Tu#or .anoast dan T/ sering teradi diTu#or .anoast dan T/ sering teradi didaera" ini0daera" ini0

PARU KIRIPARU KIRI

Dari sudut ouis, #engikuti #arginDari sudut ouis, #engikuti #argin

luar antungluar antung #enuu kosta % pd#enuu kosta % pdlinea #idla+iula kirilinea #idla+iula kiri


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issura oblius dpt diga#barkan dgnissura oblius dpt diga#barkan dgn

garis darigaris dariosta % linea #idla+iulaosta % linea #idla+iula keke

kosta 5 pd linea #idaksilarkosta 5 pd linea #idaksilar sepanangsepanang

#argin #edial sapula ( dengan tgn pasien#argin #edial sapula ( dengan tgn pasienada di kepalaada di kepala)) ke proessus spinosus 3ke proessus spinosus 3

issura trans+ersal dapat diga#barkanissura trans+ersal dapat diga#barkan

dgn garis dari osta 5 pd lineadgn garis dari osta 5 pd linea

#idla+iula ke osta 4 bagian anterior0#idla+iula ke osta 4 bagian anterior0 obus ba*a" sebagian besar ada diobus ba*a" sebagian besar ada di

belakang obus atas ada di depanbelakang obus atas ada di depan

$e#ua lobus tenga" ada di depan$e#ua lobus tenga" ada di depan00

.d kondisi aksilla diangkat, se#ua lobus.d kondisi aksilla diangkat, se#ua lobus

dapat terli"atdapat terli"at


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MDIASTINUM

A!a&a# r$ag atar k"!$a par$,!im$&ai !aris$prast"ra& k"ba%a# sampai !"ga8ip#ist"r$m

At"rior 9 !ibatasi &i"a parast"ra& Post"rior 9 !ibatasi &i"a 1"rt"bra&is

P"mbagia

M"!iati$m s$p"rior 9 m"mb"tag k" &"#"r: !is"b$t r$ag 0"r1i0o-m"!iastia&

M"!iasti$m i)"rior 9 t"rbagi atas at"rior5!"pa *at$g6, mi!!&" 5*at$g6 : post"rior

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Dib"t$k !ari iga (4

!"ga 0arti&ago Costa"

!a

8ip#ist"r$m !i t"ga#Norma& s$!$t sim"tris pa!a

k"!$a sisi

P"r$ba#a ;o&$m" pa!a

masig' #"mit#ora8 ab.

9


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Hal-hal yang perlu diperhatikan

Probandus:

Tapa pakaia atas 5masi# pakai pakaia

ba%a#6

D$!$k !i $*$g m"*a p"riksa

Ruang pemeriksaan#ar$s t"ag

$t$k p"rk$si !a a$sk$&tasi

bser!asi keadaan umum pasien9

*ari *ari, s"&ap$t m$kosa, p"rapsaya

P"m"riksaa s"s$iaka aatomi

>sio&ogi par$1%


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Isp"ksi P"r#atika9

Fr"k$"si, irama, !a&amya !a $sa#aapas

apa )as" p"rapasaya !ip"rpa*ag

Apaka# t"r!"apat r"traksi !a bat$aotot p"rapasa

Apaka# !a!a sim"tris

D"garka s$ara apasya P"r#atika posisi tra0#"a !"ga garis

t"ga#

1&


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Fr"k$"si apas !a b"t$kp"rapasa

T$*$a 9 m"g"1a&$asi sa&a# sat$ ta!a

1ita&

M"to!"

Proba!$s ti!ak ta#$ ba#%a kita s"!ag

m"g#it$g )r"k$si apasya


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Normal :

Fr"k$"si apas (4-(2 8 p"r m"it,

r"g$&"r !a b"rapas !"ga "ak

5?(4@bra!ip"$, '4 takip"$6

Di!ig par$ m"g"mbag saatispirasi !a sim"tris

P"rio!" p"rapasa !a&am ,B m"it

1


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Abnormal Finding

Pattern :

Cheyne-stokes breathing

Periodi breathing------! Cylial inrease and

derease in de"th o# res"iration $C%F&

Cerebro'as(lar ins(##iieny)

K(ssma(l breathing

Slo* dee" breathing: $Ketoaidosis)

+iot,s breathing:

otally irreg(lar *ith no "attern:$CNS in.(ry)

Sighs

Periodi dee" breathing: : $An/iety state)


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P"gamata pa!a !a!a

T$*$a9

m"g"1a&$asi !i!ig !a!a !asim"trisitas #"mitoraks

M"i&ai t"kaa "gati) !a&am r$agp&"$ra

M"to!a9

7"r!iri !"ga $*$g kaki !a p"r#atikasim"trisitas #"mit#oraks

Amati s"&$r$# !i!ig !a!a, proba!$s!$!$k

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P"r#atika r$ag it"r0osta,

)ossas$pra0&a1ik$&a, !a p"rg"raka

tra0#"a saat p"rapsa biasa

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ectus !arinatum ectus "#cavatum


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Abnormal Finding

Chest asymmetry

Ky"hosoliosis

0arger hemithora/ :

$Pne(mothora/& Ple(ral e##(sion)

Smaller hemithora/:

$Ateletasis& Ple(ral #ibrosis& Agenesis

o# 0(ng)

Inreased "le(ral negati'e "ress(re:

Unilateral$air*ay obstr(tion) or

bilateral$C1P2& 2IF& Asthma)

Interostal and s("rala'i(lar #ossa

retration

2o*n*ard mo'ement o# trahea

*ith 3(iet ins"iration


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Abnormal Finding

Ple(ra

P(sh:

Pne(mothora/

Ple(ral e##(sion

P(ll:

Ple(ral #ibrosis

Mediastinal masses and thyroid t(mors

Ky"ho-soliosis

Ab l Fi di


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Abnormal Finding

Skin and so#t tiss(e

P(nt(re sites and Sars

$-horaentesis& FNA+&Chest t(be& S(rgial sars)

Prominent ollateral 'eins

$S4C syndrome)

S*elling $Reentthoraentesis& Em"yema&

Mesothelioma& Em"yema

neessitatis& Cysti hygroma)

Erythema $Em"yema) 5armth $Em"yema)

-enderness $ Em"yema& Rib and

hest *all lesions )

S(b(taneo(s nod(les $Metastasis)


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PSISI TRA


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Abnormal Finding

raheal de'iation ----! E6 the diseases o# :

0(ng

Ple(ral

Mediastinal

Chest *all

0(ng : P(ll: $ 0oss o# l(ng 'ol(me)

Ateletasis

Fibrosis

Agenesis

S(rgial resetion

P(sh: $S"ae o("ying lesions)

0arge mass lesions


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SPANSI DADA

Ut$k m"g"ta#$i p"g"mbaga par$pa!a saat ispirasi

Ut$k m"g"ta#$i bagia yag

m"ga&amio k"&aia MTD PMRISAAN 9

(. M"g$k$r "kspasi !a!a

L"takka pita m"g"&i&igi !a!a,m"&"%ati papi&&a mamma". Uk$r saatak#ir ispirasi : "kspirasi !a&am

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'. Sim"tri "kspasi !a!a

Posisika pasi" p! k"a!aa b"r!iri ata$!$!$k !"ga &"ga p! k"!$a sisi

L"takka k"!$a taga a!a p! !a!a atas

5ap"86,rasaka sim"tris ti!akyap"g"mbaga par$ saat ispirasi :"kspirasi

Lak$ka #a& yag sama pa!a !a"ra# !a!a

!"pa Lak$ka #a& yag sama pa!a !a"ra#

post"rior

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TRANSMISI SUARA

"E#$E PE"ERIK%AAN

S$r$# pasi" m"g$0apka kt E('/E E

Pa!a saat yag sama, &"takka tagaa!a ata$ !"garka s$ara

P"r#atikaTa0ti&" )r"mit$s 9 g"tara p! *ari ata$

taga a!a

;o0a& r"soasi 9 !"garka !"gast"toskop 33


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Abnormal Finding

2ereased:

$Ple(ral e##(sion& Pne(mothora/&

Ateletasis& Mass)

Inreased: $onditions gi'ing

bronhial breathing) +ronho"hony: $Normal)

5his"ering "etoroli3(y $ Normal )

7(alitati'e: Ego"hony

Bronchopony $ormal %hispering $ormal "gophony


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PRUSI PARU

Ut$k m"g"ta#$i *$m&a# $!ara!a&am par$


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PRUSI PARU

P"rk$si !i!ig !a!a s"s$ai !"ga po&ayag !it$*$kka p! gambar

S"&a&$ ba!igka kaa !a kiri $t$k

m"g"ta#$i k"sim"trisa Ta!ai p"rb"!aa s$ara yag a!a

!apatka

S$r$# pasi" m"arik apas !a&am $t$k

m"g"ta#$i p"$r$a !ia)ragma 5orma&9 / B 0m, sim"tris6

3%


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NRMAL Par$ t"risi $!ara 56 s#g !i!apaka

s$ara soor Soor b"r$ba# r"!$p kar"a 9

A!a *at$g

A!a #"par Soor b"r$ba# m"*a!i timpai p!

!a"ra# &amb$g

t"risi &"bi# bayak $!ara

3&

Ab l Fi di


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Abnormal Finding

0(ngs #ields

2(llness:$Mass& Ateletasis&

Consolidation& Ple(ral e##(sion) %y"er-resonane:$Em"hysema& Asthma&

Pne(mothora/& +lebs)

Inreased resonanes :

an be noted either d(e to l(ngdistention

in asthma& em"hysema& b(llo(s disease

or d(e to Pne(mothora/8

2ereased resonane :

"le(ral e##(sion

2ia"hragmati motion

2ereased dia"hragmati e/(rsion:

$Em"hysema& "aralysed dia"hragm)


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AUSULTASI

T$*$a M"i&ai $!ara yag mas$k k" !a&am par$

M"i&ai obstr$ksi 5s$mbata6 *a&a apas

M"to!a p"m"riksaa Pasi" b"rapas orma&, m$&$t !ib$ka.

A$sk$&tasi par$ !i !a"ra# ap"k, t"ga#!a ba%a# !i bagia at"rior, post"rior

!a &at"ra& 7"rgatia !a ba!igka pa!a masig-

masig sisi

3


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G$aka bagia !ia)ragma pa!ast"toskop

D"garka pa&ig s"!ikit ( sik&$sp"rapasa pa!a masig masig !"ra#

4


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Lokasi auskultasi

Physical Examination in Respiratory System


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AUSULTASI

(. P"r#atika k$a&itas s$ara !asaryag a!a !"gar

'. P"r#atika apaka# a!a s$aratamba#a

/. Pa!a $m$mya )as" ispirasi &"bi#pa*ag !a &"bi# *"&as !ari

"kspirasi

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Teknik Pemeriksaan Auskultasi

Posisi 9 b"rbarig ma$p$ !$!$k

Ara# 9 ap"ks sampai basa& par$

M"mba!igka kaa !a kiri Fok$s 9 ispirasi "kspirasi

Post"rior skap$&a rotasi k" at"rior


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SUARA DASAR PARU

&' %uara !esikulerS$ara par$ orma&, ispirasi "kspirasi

(' %uara bronkhial

"kspirasi &"bi# pa*ag !a *"&as, s"p"rtis$ara !"kat trak#"a

)' *ronkho!esikuler!iatas ma$bri$m st"ri !a !i atas

r"gio it"rs0ap$&a, "kspirasi &"bi#pa*ag !a *"&as,t"r!"gar p! oragyag sagat k$r$s !a p! aak k"0i&.

45

H W#""ig


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H. W#""ig T"r*a!i bi&a a!a p"y"mpita sa&$ra

apas, )as" ispirasi

p"!"k, )as" "kspirasi !ip"rpa*agB. Am+orik

s"p"rti b$yi yag !itimb$&ka ka&a$ kitam"i$p !iatas m$&$t boto& kosog, s"rigpa!a 0a1"ra"

2. ,ogheel

Fas" Ispirasi t"r#"ti s"saat, b$ka

pato&ogis+. "etamorphosing

P"r$ba#a k$a&itas s$ara s"0ara tiba-tiba.

4%


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Abnormal Finding +ronhial breathing

Consolidation

Ca'itation Mass inter"osed bet*een hest *all

and large air*ays

Am"hori breathing :

a'itary disease

Se'eral attem"ts ha'e been


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in the air*ays and l(ng

"arenhyma

related to the "(lmonary

'as(lat(re

those originating in the "le(ra8

Se'eral attem"ts ha'e been

made to standardi9e the

terminology o# abnormal

$ad'entitio(s) l(ng so(nds8

2isontin(o(s so(nds are

kno*n as raklesand may be

oarse or #ine8

Contin(o(s so(nds :

high "ithed ----!*hee9es

lo*er "ith-----!rhonhi8

In "ratie :

inonsistent

'ariable

e/"eted

interobser'er

'ariability

-o a'oid

terminology in aonsistent

#ashion----!their

origin


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Air*ays and 0(ng Parenhyma8

Crakles :

#ine :

relati'ely high-"ithed so(nds

(s(ally heard at the end o# ins"iration

as air enters the ainar (nit----! at the

l(ng bases

in "atient :

the in#lation o# ateletati aini or

the o"ening o# olla"sed basilar

bronhioles8

"ersistent----!"(lmonary edema&

"ne(monia& and interstitial #ibrosis8

Air*ays and 0(ng Parenhyma


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Crakles :

oarse

the lo*-"ithed

d(ring ins"iration& *hen air #lo* is

#aster

b(bbling so(nds that res(lt #rom the

a(m(lation o# seretions in larger

bronhi and the trahea

are heard as edema #l(id or e/(date

mo'es (" the bronhial tree

in "atients :

bronho"ne(monia& bronhietasis&

or hroni gran(lomato(s diseases

s(h as t(ber(losis or the myoses



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1riginate in the bronho"(lmonary tree------!

ontin(o(s:

*hee9es or rhonhi indiates "artial

obstr(tion o# a bronhial l(men:

lo(der d(ring e/"iration*hen the

air*ays are narro*er& altho(gh they may

also be heard in ins"iration8

not a""reiated d(ring 3(iet breathing---

---!a(dible *hen the rate o# air #lo* is

inreased $has little diagnosti

im"ortane):

d(ring #ast& dee" breathing

the air*ays are narro*ed d(ring

ma/imal e/"iration



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5hee9es :

may be heard at a distane *itho(tthe

aid o# a stethoso"e8

So(nds "rod(ed by t(rb(lent #lo* in

the large air*ays$"artial obstr(tion o#

the lo*er "art o# the trahea or main

bronh(s)

Stridor :

A "arti(lar #orm o# ontin(o(s so(nd

lo(d m(sial so(nd o# onstant "ith

E6 obstr(tion o# the laryn/ or trahea

be heard d(ring either ins"iration or

e/"iration or thro(gho(t the entire

res"iratory yle8



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*hee9e or rhonh(s :

is an im"ortant l(e to the "resene o#

air*ay disease8

I# they disa""ear or hange harater

*ith time or d(ring o(ghing----!a "artly

obstr(ting m(o(s "l(gsho(ld be

s(s"eted8

0oal *hee9es or rhonhi that do not

disa""ear *ith o(ghing sho(ld s(ggest

the "ossibility o# an endobronhial

neo"lasm8

*hee9ing res"irations ------!the

"ersistentins"iratory and e/"iratory

so(nds heard all o'er the hest ----!

bronhos"asm$asthma)


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P(lmonary 4as(lat(re8

A ontin(o(s m(rm(r heard on

a(s(ltation o'er the l(ng :

a "(lmonary arterio'eno(s #ist(la:

m(lti"le hereditary telangietasia

$1sler-5eber-Rend( disease)8

se'ere bronhietasis

Ple(ra


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Ple(ra8

Frition r(b

E6 in#lammation o# the "le(ra *ith the

#ormation o# a stiky& #ibrino(s e/(date

on their s(r#aes----!a r(bbing& ras"ing& or

leathery so(nd

be heard d(ring both ins"iration and

e/"iration& "arti(larly in areas in *hih

e/(rsion o# the thorai age is greatest

it disa""ears *hen #l(id #orms

indiati'e o# "rimary "le(ral disease E6:

tra(ma& neo"lasm& or in#lammation

seondary disease related to

(nderlying "(lmonary neo"lasia&

in#artion& or "ne(monia


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5%

he most im"ortant #(ntions

o# res"iratory system are:

o "ro'ide o/ygen to

the ;< deli'ery system

o get rid o# C;

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