Stigmata of Chronic Obstructive Pulmonary Disease (Stanford Medicine 25)
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- เผยแพร่เมื่อ 4 ส.ค. 2024
- This Stanford Medicine 25 video was created in conjunction with Stanford's AIM lab teaching the examination of the spleen.
The Stanford Medicine 25 is a Stanford School of Medicine initiative to teach and promote the bedside physical exam. Here you will find videos teaching bedside physical exam techniques.
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1. Tripod position
........... Allows the scalene muscle (an accessory muscle of the neck) to yank the rib cage & aid in its expansion. Also, sitting forwards pushes the abdominal contents upwards, increasing the curvature of the diaphragm and improving its effectiveness. The tripod position optimizes the mechanics of respiration by taking advantage of the accessory muscles of the neck and upper chest to get more air into the lungs. With the position of the arms secure, contraction of the pectoralis results in elevation of the anterior wall of the chest.
The tripod position may be seen in cases of pericarditis as well since leaning forward tends to alleviate the chest pain of pericarditis.
2. Dahl’s sign (or thinker’s sign)
........... Dermatitis (hyperpigmentation & hyperkeratosis or thickening) on the thighs from prolonged resting of the palms on the thighs while in the tripod position.
COPD patients tend to sit forwards with their arms resting on their thighs (tripod position), leading to chronic erythema of the skin at the points of contact. Over time, hemosiderin released from RBCs trapped in the skin causes a brown discoloration of said skin.
3. Flaring of the ala nasi
4. Pursed-lip breathing - Lips pursed during exhalation in order to prolong the expiratory phase and reduce air trapping.
5. Hollowing (cupping) of the supraclavicular fossa
6. Hollowing of the subclavicular fossa
7. Sternocleidomastoid muscle (SCM) hypertrophy
8. Inspiratory descent of the trachea
9. Descent of the laryngeal prominence (Adam’s Apple) during inspiration caused by the flattened diaphragm pulling on the taut pericardial sac &, thus, the trachea during contraction.
10. Prominent sternal angle of Louis
11. Exaggerated thoracic kyphosis
12. Increased anteroposterior diameter of the chest (barrel chest)
13. Harrison's sulcus
........... Hourglass appearance of the lower thoracic cage (subcostal grooves forming on the patient’s sides) as the diaphragm pulls the rib cage in as it contracts during inspiration.
14. Obtuse subcostal angle
- a normal subcostal angle is acute (< 90°).
15. Hoover’s sign
........... Narrowing of the subcostal angle (which should normally widen) upon inhalation due to the inward pull on the rib cage by the flattened diaphragm as it contracts in a horizontal fashion.
the signs that he talked about in the video are
stooped posture or tripod position
dahl's sign which is dermatitis of thighs because of resting your hands on the thighs too long for maintaining stooped posture
alar flaring
pursed lips while exhaling
hypertrophy of the sternocleidomastoid muscle
tracheal decent with inspiration
cupping of supra clavicular fossae
very prominent angle of louis
barrel chest
thoracic kyphosis
subcoastal angle widening
hour glass apperance of lower throacic cage (harrisons sulcus)
hoovers sign (narrowing of sub coastal angle with each diapragmatic contraction)
Than u
I've got all these. 😕
Wow probably the most informative video on COPD
You keep us maintain our hope on getting proper clinical education. Many thanks to your efforts.
You have fantastic clinical education videos, and the physician in these videos explains things well. My suggestion is to either illustrate these signs with a real patient, or pause the video and show these signs when mentioned
these videos are great hope more are made
That was a good video doc! thanks.
I love this Doc.
Excellent video. Thanks!
Excellent video thank you so much!
Best explanation till date ❤️
Wonderful . I like it .
priceless teaching
Thanks for clearing up the reasoning behind the tracheal tug maneuvre could not find it anywhere
+sai2k70 Thanks! More videos coming!
I love you DOCTOR!!!!
Thank you for helping us
thank you for this video!
greattt video thank you
U guys are amazing!
Thank you! :)
Thank you
Superb
Awesomely informative. Thanks for posting these valuable videos for all to learn.
+rumit99 Thanks! More videos coming!
@@StanfordMedicine25 sir i want to know that this disease name, because i also have this type of sign in my chest
suggestion ; when doctor tels example sing harrison sulcus its important to put image at the sides of the video
Thank you🤍🤍🤍
Tracheal tug and inspiratory tracheal descent is so confusing can u plz explain it more ...
i would like to learn more that it is a obstructive disease
Why is there supraclavicular and infraclavicular hollowing in emphysema??
thx good video is good to learn this i have been a send hand smoker sense i was born , i have trade smokering but it did not like the feeling that the nikitin gave so i said that not for me. thx
Can these elevations on the patient be classified as keloids?
Which books can we find these in? Or is just many years of experience and reading.
Bedside clinics in medicine by Arup Kumar Kundu
Nice video, but why not demonstrate with an actual COPD patient?
Too bad I can't understand I'm from Romania with this severe mixed chronic bronchitis disease
Can any one please summarize all the signs of obstructive pulmonary disease
I have all these. Quite obviously too. I'm a 5'5" woman and will be 58 next month. I can slowly walk about 10 yds without oxygen, and maybe 50 yds slowly with oxygen. I'm on 2lts oxygen for min 16 hours a day. I weigh about 98lb (never weighed more than about 115lb). I found out I had COPD about 10 years ago. I'd love to know how long I've got left?
I’m almost 35 and I might have very mild COPD.. when I breathe and it’s quiet like when I’m in my car at night I can hear slight rails/whistling when breathing out.. I smoked cigs and weed a lot at a young age (13) and did drugs in my mid 20s.. I’m scared for what’s to come but I feel like I deserve it for being stupid.. I knew the consequences.. I hope you’re doing ok though
I smoked/vaped from 13 to earlier this year 34.. I quit for a year a few times throughout the years and for months here and there.. cut back a lot of times.. I quit cigs at 31 and vaped for a solid 2 years and went back to smoking cigs earlier this year.. I noticed when I smoked more than 4 cigs I’d get a burning feeling in my chest It took a few weeks to a month to notice this.. I quit the cigs and vape and don’t smoke anymore I just chew nicotine gum I still want a cigarette though but I can’t because I don’t want anything to progress further than how I feel now but it might be inevitable... I haven’t tried any medication at all yet so I do have options hopefully
@@Kris-ez2qp
God bless you. You're doing better than I ever did. I'm also an ex druggy. Tho I still smoke weed. My breathing is horrendous. I can now walk about 10 yds with oxygen. I daren't go without it at all. I even sleep with it on low. If the catheter comes off in my sleep, I wake up for lack of oxygen.
It does sound as though you may have mild copd. Mine would have started years before I ever got diagnosed. I'd strongly urge you to stick with the gum or whatever you can to not smoke. I wouldn't wish stage 4 copd on anyone. I can barely do anything for myself now. It's boring being stuck in a chair all day. I have the same mind (tho my memory is shot to pieces) and enthusiasm. I just no longer have the energy to do anything. I'm an artist, or rather, used to be. I'm too tired to even hold a paint brush for any length of time.
My grandson hugged me last week and I had to gently push him away cos I couldn't breathe. That is terrible to me.
What happened to his chest?
lol fuck up on my typeing sorry
I'm just here for the hot guy lol
Nakamay log kuch ata ni ha