Cardiopulmonary

Physical Therapy
Dr.M Umer Atif
DPT (RIU)
MS-SPT (RIU)
Specilized Sports Physical Therapist
Certifid Hijama Therapist
Examination
 Examination

• Inspection
• Palpation
• Percussion
• Auscultation
 Shape of the Chest

Normal
Elliptical
Ratio of AP diameter to
transverse diameter is 1:2
 Shape of the Chest

• Kyphosis = normal flexion of the

thoracic spine is increased.
 Kyphoscoliosis

• Both lateral curvature of the spine

with vertebral rotation (scoliosis)
and an element of kyphosis.
• This causes a restrictive lung defect
 Funnel chest
• Pectus excavatum is a
congenital deformity
• Depression of the lower
portion of the sternum
• Complications
• Heart damage
• i Cardiac output
• Less effect on lung functions
 Pigeon chest
• Sternum protrudes
outward
• anterior-posterior
diameter h
• Causes = malformation
+ poorly controlled
Asthma in children
• Barrel chest
• over inflation of
lungs…chronic
obstructive pulmonary
disease — such as
emphysema
• anterior-posterior
diameter 1:1
 Respiratory rate
• Respiratory rate should be measured with the patient seated
comfortably.
• The normal adult respiratory rate is approximately 12-16 breaths/min.
• Tachypnoea =Respiratory rate greater than 20 breaths /min,
• Rapid, shallow breathing….sign of respiratory distress
• It may also occur with metabolic acidosis and
anxiety.
• Bradypnoea = Respiratory rate of less than 10 breaths/min.
• Neurological and metabolic causes
 Breathing patterns

• The approximate ratio of inspiratory to expiratory

time (I: E ratio) is 1:1.5 to 1:2.
 Inspection: Breathing patterns

Depth
• Hyperpnea
• h depth
• Hyperventilation
• h depth & rate
• Hypoventilation
• i depth & rate
 Inspection: Breathing patterns
Depth
• Kussmaul's
• h rate & depth + labored
• Associated with sever acidosis
• Apneustic Respiration
• Prolonged inspiration…insufficient
release
• localizes damage to the midpons and
is most commonly a result of a
basilar artery infarct.
 Inspection: Breathing patterns

Rhythm:
• Apnea
• absence of breathing for more than 15 seconds.
Cheyne-stokes
• Varying depth apnea
• Most common cause = severe congestive heart failure (CHF)
• Others = renal failure, meningitis, drug overdose, and increased intracranial
pressure. It may be a normal breathing pattern in infants and older persons during
sleep.
 Ataxic breathing

• Biot’s:
• Irregular pattern of deep and shallow breaths with
abrupt pauses
• caused by disruption of the respiratory
rhythm generator in the medulla.
• Prolonged expiration
• Obstructive lung disease
I: E ratio may increase to 1:3 or 1:4.
• Pursed-lip breathing
PALPATION
 Trachea deviation/ shift
It is a clinical sign that results from unequal intrathoracic pressure within the chest
cavity
• When tracheal deviation is present, the trachea will be displaced in the
direction of less pressure
• Deviated towards diseased/same side: (pull)
• Atelectasis
• Pneumonectomy
• Pleural fibrosis
• Deviated away from diseased/opposite side: (push )
• Pneumothorax
• Pleural effusion
• Large mass
 Position of Trachea

• Firstly, the trachea is palpated to

assess its position in relation to the sternal notch /
SCM.
 Chest expansion
• Symmetry and amount of chest wall excursion can be assessed
by having the therapist lightly place their hands on the patient's
chest anteriorly or posteriorly
• Asking the patient to inspire deeply to total lung capacity and
expire slowly
• Movement of both thumbs is observed.
• Both sides should move equally, with 3-5 cm being the normal
displacement.
• An alternative technique is to measure chest expansion using a
tape measure at the level of the axilla and xiphoid / nipple level.
 Vocal fremitus
• Measure of speech vibrations transmitted through the chest
wall to the examiner's hands.
• Patient to repeatedly say '99', whilst the examiner's hands are
placed flat on both sides of the chest.
• The hands are moved from apices to bases, anteriorly and
posteriorly, comparing the vibration felt.
• Increased when the lung underneath is relatively solid
(consolidated), as this transmits sound better.
• As sound transmission is decreased through any interface
between lung and air or fluid, vocal fremitus is decreased in
patients with a pneumothorax or a pleural effusion.