I'm going to demonstrate the advanced
pulmonary techniques. If I listen to
Steve's lungs and I heard something different on one side compared to another, I'm going to do some
further testing to determine what is the
reason for this change. The first one is
tactile fremitus. Tactile fremitus means
to feel the sound. So I'm going to ask
Steve to speak, and I'm going to
check to see whether the vibration seems
to be the same as I'm palpating throughout
the chest wall. Steve, can you say 99? Ninety-nine. And that's what I'll have him repeat as I move my hands. I'm using the balls of my hands here to be able to palpate whether there's
any difference. I can feel a vibration here, and it's equal on both sides. So continue to say 99. Ninety-nine. Okay. Ninety-nine.
Ninety-nine. Ninety-nine. All right, everything
seems equal in terms of vibration
on both sides, what I'm hearing him say, and that helps me to show that
there's no consolidation, and there's no areas of
decreased air movement. If I found that there
was an area where it was much more vibratory
than anywhere else, that could indicate a pneumonia. If I felt there's
an area where I can barely tell that
there's any sound, then that could be
either fluid or could be emphysema or enlargement of the lungs in that
particular area. Now the next test I'll check
is called the Egophony. Egophony means that the sound is changing from what it normally sounds like and being distorted. I'll listen in those areas, and I'll ask Steve to
say E. As he's saying E, I'll listen to hear
whether it sounds like E or has it changed to
sounding more like an A sound? I'll demonstrate
that. Can you say E? E. Again. E. Again. E. Again. E. Again. E. Okay. All right. So what I hear as I listen is
everything sounds the same. E's all the way through. If there was an area
where it sounded like A, and that would indicate
a probable pneumonia and area of consolidation. Then the last test I'll do
is whispered pectoriloquy. Again, being able to hear a sound and whether
there's any distortion. So as I listen with
my stethoscope, I'll say, can you whisper 99? Ninety-nine. Again. Ninety-nine. Again. Ninety-nine. Again. Ninety-nine. I would move again throughout the lungs to hear whether
there was any difference. Whispered pectoriloquy. is changed or the sound is different again in an
area of consolidation. Now the last part of this
is a test that you can use to determine whether
your patient likely has COPD or emphysema. And this is to indicate
whether or not the diaphragm moves up and
down as the patient breathes. I'm going to use the reflex
hammer for percussion, so that you may be able to hear the difference here
between the sounds. I want to know where
the diaphragm is, and then whether
the diaphragm moves as Steve takes in a deep breath. First, I'll find the diaphragm. Right there. There's
a change in the sound from here to here. I'm going to find right
where the edge is, which is right there. Now, Steve, can you take a
deep breath and hold it? Now I have to move down that far in order to hear the diaphragm. You can let out the air.
Steve's diaphragm was here. He took a deep breath, and it moved down
to about there. I know that this
diaphragm moves. I would also check
on the other side to confirm that that is also
true on the other side. Right there is where
the diaphragm is. The sound is like this
compared to like this. Now, Steve, can you take in
a deep breath and hold it? And the diaphragm
moved down to here. You can let the
breath out again. What I'll do this
time so you can hear that difference is
to tap over here, and then I'll continue
tapping as Steve's taking in a deep breath. And let it out. If you can hear that,
the sound changes, showing that the diaphragm
is moving on either side. Those are the specialized
pulmonary tests that you would use in a patient in whom you're concerned about either COPD, pleural effusion
for consolidation, such as from pneumonia.