T h e Th or a x a n d lu n g s
◦ 2 n d in t e r c o st a l s p a ce f o r n ee d l e
in s e r t i o n f o r t e n s i on p n eu m o t h ora x .
• 4 th in t e r c o s t a l s p a ce f o r c h e s t t u b e
in s e r t i o n
• 1 4 f or t h e lo w e r m a r g i n o f
a n en d o t r a c h e a l t u b e o n a c h est x -r a y .
N e u r ov a s cu la r s t r u ct u r e s ru n a lo n g t h e in fe r io r m a r gi n o f
ea ch ri b , s o n e e d le s a n d t u b e s s h o u ld b e p la ced j u st a t
t h e S u p e r io r ri b m a r g i n s
7 7 - 7 8 in t e r c o s t a l s p a c e a s a la n d m a r k f or t h o r a cen t e sis w it h n ee d le
in sert i on im m e d i a t ely s u per i or t o t h e 8 t h r ib .
A n a t om ic D e sc rip t or s o f t h e c h e st
S u p ra c ta r ic u l a r - a b o v e t h e c l a v i c le s
In f r a c l a v i c u l a r - b e l o w t h e c la v i c le s
In t e r s c a p u l a r - b e t w e e n t h e s ca p u l a e
In f r a s c a p u l a r - b e l ow t h e s c a p u l a e
B a se s o f t h e l u n g s- t h e lo w e r m o s t p o r t i o n s
u p p er , m i d d l e a n d l o w er l u n g f ie l d s .
, Asp ira t i on p n eu m o n i a is m o r e co m m o n i n t h e ri gh t
m i d d l e a n d lo w e r l o b e b e ca u se t h e r ig h t m a i n b r o n c h u s
is m o r e v e r t i c a l .
A c c u m u la t ion s o f p le u r a l f lu i d , m a y b e tr a n s u d a t e s
see n in h ea r t f a ilu r e , c ir r h o s is a n d n e p h r otic s y n d r om e
o r ex u d a t e s s ee n in n u m er ou s con di ti on s in c l u d in g
p n e u m o n i a , m a li g n a n c y , p u lm on a r y e m b o lis m ,
IB a n d pa n c r e a t it i s .
Ir r it a t i on o f t h e p a r ie t a l p le u r a p r o d u c e s p le u r it i c
p a in w i t h d e e p i n sp ir a t i o n in v i r a l p le u r i s y
p n e u m o n i a , p u lm o n a r y e m b o l i s m , p e r i ca r d i t is
a n d c o ll ag en v a s c u l a r d i s e a s e s
, The Health history
common or concerning symptoms
◦ chest pain
◦ shortness of breath (dyspnea)
• wheezing
◦ cough
◦ Blood -streaked sputum (hemoptysis)
• Daytime sleepiness or snoring and disordered sheep.
Sources of chest pain and related causes
The myocardium Angina pectoris, MI, myocarditis
The pericardium Pericarditis
The aorta Aortic dissection
The trachea and large bronchi Bronchitis
The parietal pleura pericarditis, pneumonia, pneumothorax,
pleural effusion, pulmonary embolus
the chest wall, including the costochondritis,herpes zoster
musculoskeletal and neurologic
systems Gastroesophageal reflux disease,
The esophagus esophageal spasm,esophageal tear
Extra thoracic structures such as cervical arthritis, biliary colic,
the neck,gallbladder and gastritis
stomach
chest pain is reported in one in four patients with panic
and anxiety disorders.
◦ 2 n d in t e r c o st a l s p a ce f o r n ee d l e
in s e r t i o n f o r t e n s i on p n eu m o t h ora x .
• 4 th in t e r c o s t a l s p a ce f o r c h e s t t u b e
in s e r t i o n
• 1 4 f or t h e lo w e r m a r g i n o f
a n en d o t r a c h e a l t u b e o n a c h est x -r a y .
N e u r ov a s cu la r s t r u ct u r e s ru n a lo n g t h e in fe r io r m a r gi n o f
ea ch ri b , s o n e e d le s a n d t u b e s s h o u ld b e p la ced j u st a t
t h e S u p e r io r ri b m a r g i n s
7 7 - 7 8 in t e r c o s t a l s p a c e a s a la n d m a r k f or t h o r a cen t e sis w it h n ee d le
in sert i on im m e d i a t ely s u per i or t o t h e 8 t h r ib .
A n a t om ic D e sc rip t or s o f t h e c h e st
S u p ra c ta r ic u l a r - a b o v e t h e c l a v i c le s
In f r a c l a v i c u l a r - b e l o w t h e c la v i c le s
In t e r s c a p u l a r - b e t w e e n t h e s ca p u l a e
In f r a s c a p u l a r - b e l ow t h e s c a p u l a e
B a se s o f t h e l u n g s- t h e lo w e r m o s t p o r t i o n s
u p p er , m i d d l e a n d l o w er l u n g f ie l d s .
, Asp ira t i on p n eu m o n i a is m o r e co m m o n i n t h e ri gh t
m i d d l e a n d lo w e r l o b e b e ca u se t h e r ig h t m a i n b r o n c h u s
is m o r e v e r t i c a l .
A c c u m u la t ion s o f p le u r a l f lu i d , m a y b e tr a n s u d a t e s
see n in h ea r t f a ilu r e , c ir r h o s is a n d n e p h r otic s y n d r om e
o r ex u d a t e s s ee n in n u m er ou s con di ti on s in c l u d in g
p n e u m o n i a , m a li g n a n c y , p u lm on a r y e m b o lis m ,
IB a n d pa n c r e a t it i s .
Ir r it a t i on o f t h e p a r ie t a l p le u r a p r o d u c e s p le u r it i c
p a in w i t h d e e p i n sp ir a t i o n in v i r a l p le u r i s y
p n e u m o n i a , p u lm o n a r y e m b o l i s m , p e r i ca r d i t is
a n d c o ll ag en v a s c u l a r d i s e a s e s
, The Health history
common or concerning symptoms
◦ chest pain
◦ shortness of breath (dyspnea)
• wheezing
◦ cough
◦ Blood -streaked sputum (hemoptysis)
• Daytime sleepiness or snoring and disordered sheep.
Sources of chest pain and related causes
The myocardium Angina pectoris, MI, myocarditis
The pericardium Pericarditis
The aorta Aortic dissection
The trachea and large bronchi Bronchitis
The parietal pleura pericarditis, pneumonia, pneumothorax,
pleural effusion, pulmonary embolus
the chest wall, including the costochondritis,herpes zoster
musculoskeletal and neurologic
systems Gastroesophageal reflux disease,
The esophagus esophageal spasm,esophageal tear
Extra thoracic structures such as cervical arthritis, biliary colic,
the neck,gallbladder and gastritis
stomach
chest pain is reported in one in four patients with panic
and anxiety disorders.
