| 1 | |
| 00:00:02,260 --> 00:00:05,920 | |
| السلام عليكم ورحمة الله وبركاته الجزء التاني من | |
| 2 | |
| 00:00:05,920 --> 00:00:09,260 | |
| محاضرة الـ Physical Examination للـ Pulmonary | |
| 3 | |
| 00:00:09,260 --> 00:00:15,120 | |
| System خلصنا .. كنا خلصنا الـ General Examination | |
| 4 | |
| 00:00:15,120 --> 00:00:20,620 | |
| وقلنا أنه الـ General Examination يـ examine the | |
| 5 | |
| 00:00:20,620 --> 00:00:24,560 | |
| patient environment then the patient general | |
| 6 | |
| 00:00:24,560 --> 00:00:29,860 | |
| appearance الـ face، الـ neck، الـ hand، الـ lower | |
| 7 | |
| 00:00:29,860 --> 00:00:36,860 | |
| limbطبعاً بتسأل عن الـ Vital Sign وممكن while | |
| 8 | |
| 00:00:36,860 --> 00:00:41,180 | |
| examining الـ Vital Sign مهم جداً الـ Respiratory | |
| 9 | |
| 00:00:41,180 --> 00:00:46,700 | |
| Rate والـ Respiratory Rate طبيعي من 12 إلى 20، 12 | |
| 10 | |
| 00:00:46,700 --> 00:00:50,680 | |
| إلى 18، هذا الـ Respiratory Rate ولما أنت بتفحص | |
| 11 | |
| 00:00:50,680 --> 00:00:55,340 | |
| الـ Respiratory Rate يعني ممكن أنت وانت بتفحص الـ | |
| 12 | |
| 00:00:55,340 --> 00:01:00,600 | |
| Pulse عينك على الشستتشوف إيش الـ Respiratory Rate | |
| 13 | |
| 00:01:00,600 --> 00:01:05,340 | |
| لأن sometimes ال patient ممكن يبطئ النفس أو يسهل | |
| 14 | |
| 00:01:05,340 --> 00:01:11,360 | |
| النفس إذا لاحظت أنك انت بتفحص اللي هو ال | |
| 15 | |
| 00:01:11,360 --> 00:01:13,940 | |
| respiratory rate فبالتالي وانت while you are | |
| 16 | |
| 00:01:13,940 --> 00:01:20,320 | |
| examining ال pulse هناك على الشست وexamining for | |
| 17 | |
| 00:01:20,320 --> 00:01:28,510 | |
| respiratory rate ال local exam of the chestطبعاً | |
| 18 | |
| 00:01:28,510 --> 00:01:34,110 | |
| first of all انت ماخد طبعاً من أول permission و | |
| 19 | |
| 00:01:34,110 --> 00:01:37,590 | |
| consent و introduce yourself و wash your hand و | |
| 20 | |
| 00:01:37,590 --> 00:01:40,890 | |
| make privacy و position the patient 45 degree هذا | |
| 21 | |
| 00:01:40,890 --> 00:01:45,110 | |
| كله من أول انت عملته في ال general exam في ال | |
| 22 | |
| 00:01:45,110 --> 00:01:49,410 | |
| local exam exposure is very important exposure | |
| 23 | |
| 00:01:49,410 --> 00:01:53,470 | |
| should be from the umbilicus and upward هذا | |
| 24 | |
| 00:01:53,470 --> 00:01:54,130 | |
| important | |
| 25 | |
| 00:01:57,290 --> 00:02:01,870 | |
| الشخص يستخدم استخبار الهواتف لتعرف إذا كان الشخص | |
| 26 | |
| 00:02:01,870 --> 00:02:09,550 | |
| في مضغوطات، في رتب، في مدخل الهواتف، إذا كان هناك | |
| 27 | |
| 00:02:09,550 --> 00:02:13,570 | |
| صوت مسموح أو لا | |
| 28 | |
| 00:02:19,570 --> 00:02:24,750 | |
| الـ Examination للـ local chest exam should be | |
| 29 | |
| 00:02:24,750 --> 00:02:30,130 | |
| from the end of the bell inspect the shape of the | |
| 30 | |
| 00:02:30,130 --> 00:02:36,790 | |
| chest anterior posterior diameter و ال ratio to | |
| 31 | |
| 00:02:36,790 --> 00:02:40,030 | |
| the transverse diameter usually تقريبا تلت إلى | |
| 32 | |
| 00:02:40,030 --> 00:02:45,070 | |
| تلتين inspect the symmetry of the patient's chest | |
| 33 | |
| 00:02:46,450 --> 00:02:48,670 | |
| الـ both movement ask the patient to take deep | |
| 34 | |
| 00:02:48,670 --> 00:02:52,290 | |
| breath يكون | |
| 35 | |
| 00:02:52,290 --> 00:02:58,710 | |
| both side ال comparison if | |
| 36 | |
| 00:02:58,710 --> 00:03:04,870 | |
| there is any obvious scar anteriorly طبعا بتعلق | |
| 37 | |
| 00:03:04,870 --> 00:03:08,850 | |
| لأن most of the thoracic scar او ال operation | |
| 38 | |
| 00:03:08,850 --> 00:03:14,850 | |
| بتكون from the backAny Deformity Pectus Carinatum | |
| 39 | |
| 00:03:14,850 --> 00:03:19,510 | |
| Pectus Excavator Any Chest Wall Deformity Any | |
| 40 | |
| 00:03:19,510 --> 00:03:23,850 | |
| Dilated Superficial Vein هذه كليتها في الـ Local | |
| 41 | |
| 00:03:23,850 --> 00:03:30,330 | |
| Chest Exam زي | |
| 42 | |
| 00:03:30,330 --> 00:03:33,550 | |
| ما حكينا برضه اللي لابي الـ Antirepidural Diameter | |
| 43 | |
| 00:03:33,550 --> 00:03:37,090 | |
| ال .. ال .. ال .. ال abnormal ال pattern of | |
| 44 | |
| 00:03:37,090 --> 00:03:40,270 | |
| breathing Cosmal breathing ال skin color sometimes | |
| 45 | |
| 00:03:40,740 --> 00:03:43,580 | |
| وإذا كان فيه obvious deformity زي الـ Pectus | |
| 46 | |
| 00:03:43,580 --> 00:03:55,060 | |
| Carinatum أو Excavatum أو Kyphoscoliosis زي | |
| 47 | |
| 00:03:55,060 --> 00:03:59,060 | |
| ما احنا شايفين هنا this is a increased | |
| 48 | |
| 00:03:59,060 --> 00:04:03,800 | |
| anteroposterior diameter barrel chest this is | |
| 49 | |
| 00:04:03,800 --> 00:04:07,800 | |
| severe kyphosis and sometimes | |
| 50 | |
| 00:04:10,990 --> 00:04:17,390 | |
| وهنا برضه بيجين شست وهنا بيجين شست وهنا funnel | |
| 51 | |
| 00:04:17,390 --> 00:04:24,050 | |
| chest بيكتس Excavated from cavity طبعا بالحالات | |
| 52 | |
| 00:04:24,050 --> 00:04:28,110 | |
| اللي زيها ال respiratory systemالـ Pectus | |
| 53 | |
| 00:04:28,110 --> 00:04:32,810 | |
| excavatum ما بتخوف كتير لإذا كانت كبيرة كفاية | |
| 54 | |
| 00:04:32,810 --> 00:04:36,890 | |
| لتسبب مرض اللغة المضالة لأكيد اللي بيخوف اللي هو | |
| 55 | |
| 00:04:36,890 --> 00:04:40,370 | |
| الـ Pectus carinatum أو الـ Pigeon chest أو | |
| 56 | |
| 00:04:40,370 --> 00:04:46,170 | |
| البرلشست اللي يعني أن هناك مرض اللغة المضالة إذا | |
| 57 | |
| 00:04:46,170 --> 00:04:49,230 | |
| كانت أزمة أو مرض بلمونية مضالة كرونية مضالة كرونية | |
| 58 | |
| 00:04:49,230 --> 00:04:50,690 | |
| مضالة كرونية مضالة كرونية مضالة كرونية مضالة | |
| 59 | |
| 00:04:50,690 --> 00:04:54,230 | |
| كرونية مضالة كرونية مضالة كرونية مضالة كرونية | |
| 60 | |
| 00:04:54,230 --> 00:04:54,270 | |
| مضالة كرونية مضالة كرونية مضالة كرونية مضالة | |
| 61 | |
| 00:04:54,270 --> 00:04:57,580 | |
| كرونية مضالة كرونية مضالة كهذه بيجين شست وهذه بيرل | |
| 62 | |
| 00:04:57,580 --> 00:05:03,020 | |
| شست انكريز | |
| 63 | |
| 00:05:03,020 --> 00:05:07,520 | |
| انتيوبستيرو ديامتر في حالات الـ COPD secondary | |
| 64 | |
| 00:05:07,520 --> 00:05:11,140 | |
| emphyseme hyperinflation obstructive lung disease | |
| 65 | |
| 00:05:11,140 --> 00:05:16,440 | |
| which is part of COPD | |
| 66 | |
| 00:05:16,440 --> 00:05:21,740 | |
| emphysematous type وهنا دي شست دفوع الـ deformity | |
| 67 | |
| 00:05:24,440 --> 00:05:33,560 | |
| Pectus Excavatum جببص جببص جببص | |
| 68 | |
| 00:05:33,560 --> 00:05:33,900 | |
| جببص جببص جببص جببص جببص جببص جببص جببص جببص جببص | |
| 69 | |
| 00:05:33,900 --> 00:05:33,980 | |
| جببص جببص جببص جببص جببص جببص جببص جببص جببص جببص | |
| 70 | |
| 00:05:33,980 --> 00:05:35,940 | |
| جببص جببص جببص جببص جببص جببص جببص جببص جببص جببص | |
| 71 | |
| 00:05:35,940 --> 00:05:40,020 | |
| جببص جببص جببص جببص جببص جببص جببص جببص جببص جببص | |
| 72 | |
| 00:05:40,020 --> 00:05:46,280 | |
| جببص جببص جببص جببص جببص جببص جببص جببص جببص جببص | |
| 73 | |
| 00:05:46,280 --> 00:05:50,560 | |
| جببص | |
| 74 | |
| 00:05:50,560 --> 00:05:54,640 | |
| جبعدها ال palpation في ال palpation لل chest wall | |
| 75 | |
| 00:05:54,640 --> 00:06:01,960 | |
| خمس حاجات مهمة يجب أن نركز عليها palpation for | |
| 76 | |
| 00:06:01,960 --> 00:06:07,200 | |
| superficial mass or tenderness all over the chest | |
| 77 | |
| 00:06:07,200 --> 00:06:12,020 | |
| by your hand for superficial mass or tendernessللـ | |
| 78 | |
| 00:06:12,020 --> 00:06:17,600 | |
| Eclipse إذا كان فيه surgical emphysema في الناس | |
| 79 | |
| 00:06:17,600 --> 00:06:21,900 | |
| اللي عندهم نيمو ميدياستينام في بعض الوقت يكون في | |
| 80 | |
| 00:06:21,900 --> 00:06:25,860 | |
| عيننا surgical emphysema association فبالتالي can | |
| 81 | |
| 00:06:25,860 --> 00:06:28,700 | |
| be detected by superficial palpation superficial | |
| 82 | |
| 00:06:28,700 --> 00:06:36,500 | |
| mass or tenderness palpation of the apexطبعاً في | |
| 83 | |
| 00:06:36,500 --> 00:06:42,400 | |
| الـ cardiovascular exam لازم تحدد الـ time والـ | |
| 84 | |
| 00:06:42,400 --> 00:06:48,040 | |
| sight، exactly sight والـ time of apex والـ apex | |
| 85 | |
| 00:06:48,040 --> 00:06:54,110 | |
| speedوإذا كان فيها Healing، Trusting لكن في الـ | |
| 86 | |
| 00:06:54,110 --> 00:06:58,530 | |
| Respiratory Case I just want to know if it's in | |
| 87 | |
| 00:06:58,530 --> 00:07:01,390 | |
| the left or in the right لأن في حالات الـ | |
| 88 | |
| 00:07:01,390 --> 00:07:06,050 | |
| Dextrocardia اللي بيكون عندهم الـ heart على اليمين | |
| 89 | |
| 00:07:06,050 --> 00:07:10,810 | |
| و associated with bronchiectasis and chronic | |
| 90 | |
| 00:07:10,810 --> 00:07:15,090 | |
| rhinocerositis في حالات اللي هي مرض Carthagin | |
| 91 | |
| 00:07:15,090 --> 00:07:15,750 | |
| Syndrome | |
| 92 | |
| 00:07:18,780 --> 00:07:21,760 | |
| وبالتالي ال apex and palpation of apex هاي اتنين | |
| 93 | |
| 00:07:21,760 --> 00:07:24,940 | |
| يعني يقولنا superficial path او tenderness او | |
| 94 | |
| 00:07:24,940 --> 00:07:30,180 | |
| clicks ال apex بعدين ممكن ال palpation اللي هو ال | |
| 95 | |
| 00:07:30,180 --> 00:07:31,200 | |
| lung expansion | |
| 96 | |
| 00:07:34,360 --> 00:07:40,680 | |
| Symmetrical movement or not و الـ «TVF» أو | |
| 97 | |
| 00:07:40,680 --> 00:07:45,520 | |
| «Tactile Vocal Fremitas» وهي تقريبا استبدلت بـ | |
| 98 | |
| 00:07:45,520 --> 00:07:52,560 | |
| «Vocal Resonance» وهي عن طريق السماعة و اللي هم في | |
| 99 | |
| 00:07:52,560 --> 00:07:58,980 | |
| الـ «Palpation» also لـ «Trachea» «Trachea» فيها | |
| 100 | |
| 00:07:58,980 --> 00:08:01,820 | |
| تلت حاجات برضه في الـ Examination، هنحكي عنها | |
| 101 | |
| 00:08:05,410 --> 00:08:10,950 | |
| طبعا ال TBF بنحكي للمريض يحكي 99 او 44 ونشوف ال | |
| 102 | |
| 00:08:10,950 --> 00:08:14,590 | |
| vibratory movement by the ulnar surface of the | |
| 103 | |
| 00:08:14,590 --> 00:08:21,330 | |
| hand هنا palpation of the apex نتأكد إذا ما كان | |
| 104 | |
| 00:08:21,330 --> 00:08:25,690 | |
| محسوس بنخلي ال patient just to slightly turn to | |
| 105 | |
| 00:08:25,690 --> 00:08:31,390 | |
| the left side in order to palpate the apexماهمنا | |
| 106 | |
| 00:08:31,390 --> 00:08:34,670 | |
| زي ما حكينا في الصدرية إنه it is in the right or | |
| 107 | |
| 00:08:34,670 --> 00:08:40,090 | |
| in the left هنا الـ chest expansion في عيننا upper | |
| 108 | |
| 00:08:40,090 --> 00:08:45,850 | |
| zone و middle zone و lower zone supermemory، | |
| 109 | |
| 00:08:45,850 --> 00:08:50,430 | |
| memory، inframemory في ال chest expansion to check | |
| 110 | |
| 00:08:50,430 --> 00:08:53,750 | |
| for symmetry لازم يكون ال movement between both | |
| 111 | |
| 00:08:53,750 --> 00:08:57,910 | |
| some من تلاتة إلى خمسة صنطي | |
| 112 | |
| 00:09:01,300 --> 00:09:05,580 | |
| زي ما احنا هنا شايفين هنا اللي هي Supramemory و | |
| 113 | |
| 00:09:05,580 --> 00:09:11,120 | |
| Memory و Inframemory سايت و from posteriorly also | |
| 114 | |
| 00:09:11,120 --> 00:09:15,120 | |
| Suprascapular | |
| 115 | |
| 00:09:15,120 --> 00:09:21,960 | |
| و Infrascapular for estimation of just movement | |
| 116 | |
| 00:09:21,960 --> 00:09:24,360 | |
| لكن from posterior site | |
| 117 | |
| 00:09:27,620 --> 00:09:32,980 | |
| وهنا برضه ال TVF طبعا ما قلنا في ال TVF ما بنعملها | |
| 118 | |
| 00:09:32,980 --> 00:09:36,440 | |
| في ال palpation لكن نذكرها بعض الأحيان و هي | |
| 119 | |
| 00:09:36,440 --> 00:09:42,420 | |
| replaced by vocal resonance التريكيا ال | |
| 120 | |
| 00:09:42,420 --> 00:09:46,560 | |
| examination مهم جدا تلت حاجات في التريكيا ان نشوف | |
| 121 | |
| 00:09:46,560 --> 00:09:50,200 | |
| التريكيا central ولا not centralDeviated to the | |
| 122 | |
| 00:09:50,200 --> 00:09:52,960 | |
| right side، Deviated to the left side، Normally | |
| 123 | |
| 00:09:52,960 --> 00:09:55,040 | |
| sometimes التريكة بتكون Deviated to the right | |
| 124 | |
| 00:09:55,040 --> 00:10:00,040 | |
| side، ومنجيز برضه لـ cricosteral distance، و لازم | |
| 125 | |
| 00:10:00,040 --> 00:10:07,230 | |
| يكون أقل من three finger width،و لازم برضه في | |
| 126 | |
| 00:10:07,230 --> 00:10:11,570 | |
| حالات اللي هو نشوف الـtracheal tug و pulpate | |
| 127 | |
| 00:10:11,570 --> 00:10:14,410 | |
| للتراكيا وهو the scent of the trachea during | |
| 128 | |
| 00:10:14,410 --> 00:10:20,070 | |
| inspiration وهذا pathognomonic side للـCOPD | |
| 129 | |
| 00:10:24,660 --> 00:10:28,100 | |
| فيه برضه inspect for the tracheal position فيه | |
| 130 | |
| 00:10:28,100 --> 00:10:35,180 | |
| trail sign اللي هي بتكون prominent of the head of | |
| 131 | |
| 00:10:35,180 --> 00:10:38,080 | |
| the sternocleidomastoid in case of the trachea | |
| 132 | |
| 00:10:38,080 --> 00:10:44,340 | |
| deviated to the same side وهنا الحالة ما هو | |
| 133 | |
| 00:10:44,340 --> 00:10:48,100 | |
| examining for the tracheal tunnel asks the patient | |
| 134 | |
| 00:10:48,100 --> 00:10:51,500 | |
| to take deep breath لتركيا بتكون descended during | |
| 135 | |
| 00:10:51,500 --> 00:10:58,600 | |
| inspirationوهنا trail sign كما احنا شايفين هنا | |
| 136 | |
| 00:10:58,600 --> 00:11:03,220 | |
| prominent of the sternal head of the | |
| 137 | |
| 00:11:03,220 --> 00:11:06,560 | |
| sternocleidomastoid التالي ان الـ trachea slightly | |
| 138 | |
| 00:11:06,560 --> 00:11:11,820 | |
| deviated to the right side و this is a TVF طبعا ال | |
| 139 | |
| 00:11:11,820 --> 00:11:16,520 | |
| tactile vocal ephermitus او ال vocal resonance | |
| 140 | |
| 00:11:16,520 --> 00:11:20,360 | |
| اللي هي بتنسمع عن طريق السماعة فيها يعني | |
| 141 | |
| 00:11:20,360 --> 00:11:25,510 | |
| indication وبتعطينا برضه ideaفي حالات بتعمل | |
| 142 | |
| 00:11:25,510 --> 00:11:29,430 | |
| increase للـVocal Resonance أو الـ Tactile Vocal | |
| 143 | |
| 00:11:29,430 --> 00:11:33,030 | |
| Affirmatives بحيث الـ Consolidation، نمونيا، حيث | |
| 144 | |
| 00:11:33,030 --> 00:11:36,530 | |
| الـ Cavitation، Collapse لكن patent من الـ | |
| 145 | |
| 00:11:36,530 --> 00:11:39,590 | |
| Pronchus بيزود اللي هي الـ TVF أو الـ Vocal | |
| 146 | |
| 00:11:39,590 --> 00:11:43,770 | |
| Resonance إذا كان Collapse لكن abstracted من الـ | |
| 147 | |
| 00:11:43,770 --> 00:11:47,990 | |
| Pronchus، بيكون decrease للـ TVF Also الـ TVF أو | |
| 148 | |
| 00:11:47,990 --> 00:11:50,410 | |
| الـ Vocal Resonance decrease in the sexiest wall | |
| 149 | |
| 00:11:50,410 --> 00:11:53,530 | |
| في الـ Plural Thickness، Plural Fusion، Fibrosis، | |
| 150 | |
| 00:11:53,530 --> 00:12:01,930 | |
| Nemothorax، هذه كليتهابتعمل decrease للـ TVF ال | |
| 151 | |
| 00:12:01,930 --> 00:12:04,870 | |
| percussion خلصنا من ال palpation خمس حاجات ال | |
| 152 | |
| 00:12:04,870 --> 00:12:09,370 | |
| second step percussion technique أهم حاجة في ال | |
| 153 | |
| 00:12:09,370 --> 00:12:14,330 | |
| percussion يكونالبركاشن، الـ movement كله يتهم من | |
| 154 | |
| 00:12:14,330 --> 00:12:18,090 | |
| عند الـ wrist الـ full range of movement ال middle | |
| 155 | |
| 00:12:18,090 --> 00:12:21,630 | |
| finger، you percuss the middle finger here place | |
| 156 | |
| 00:12:21,630 --> 00:12:24,890 | |
| it intercostally | |
| 157 | |
| 00:12:24,890 --> 00:12:28,370 | |
| or between the ribs و ال full movement لازم تكون | |
| 158 | |
| 00:12:28,370 --> 00:12:37,840 | |
| from the wrist like a hammer effectو ال percussion | |
| 159 | |
| 00:12:37,840 --> 00:12:47,620 | |
| notes لإما dullness لإما resonance طبعا | |
| 160 | |
| 00:12:47,620 --> 00:12:52,700 | |
| ال percussion لازم anteriorly نعمل percussion اللى | |
| 161 | |
| 00:12:52,700 --> 00:12:57,580 | |
| هو subra clavicular space و ال percussion كمان | |
| 162 | |
| 00:12:57,580 --> 00:13:01,520 | |
| this is angle of Lewis ال angle of Lewisبتكون | |
| 163 | |
| 00:13:01,520 --> 00:13:07,680 | |
| beside it اللي هي second inter coastal space أو | |
| 164 | |
| 00:13:07,680 --> 00:13:11,520 | |
| بنعمل percussion و دايما يكون زيك زاك movement زيك | |
| 165 | |
| 00:13:11,520 --> 00:13:16,520 | |
| زاك movement always to compare تمام؟ while you are | |
| 166 | |
| 00:13:16,520 --> 00:13:22,860 | |
| descending down you will go more laterally more | |
| 167 | |
| 00:13:22,860 --> 00:13:25,700 | |
| laterally هنا ال percussion note و هنا ال | |
| 168 | |
| 00:13:25,700 --> 00:13:29,900 | |
| percussion اللي بتكون في ال في ال posterior area | |
| 169 | |
| 00:13:33,250 --> 00:13:38,290 | |
| متى بنعمل الـ tidal percussion؟ لما بنعمل الـ | |
| 170 | |
| 00:13:38,290 --> 00:13:40,610 | |
| percussion بيكون resonance، resonance، resonance، | |
| 171 | |
| 00:13:40,610 --> 00:13:46,270 | |
| صار في عنا، في dullness هنا فبنعمل، نتأكد إن هذا | |
| 172 | |
| 00:13:46,270 --> 00:13:50,470 | |
| الـ dullness because of a plural effusion ولا ال | |
| 173 | |
| 00:13:50,470 --> 00:13:54,950 | |
| diaphragm is high ولا there is consolidation | |
| 174 | |
| 00:13:54,950 --> 00:13:59,710 | |
| فبنعمل الـ tidal percussion، بنسأل العيان، بنقول | |
| 175 | |
| 00:13:59,710 --> 00:14:06,030 | |
| له خد deep breathوhold the breath for a while | |
| 176 | |
| 00:14:06,030 --> 00:14:10,570 | |
| وبعدين المنطقة اللي صارت كانت فيها dullness صارت | |
| 177 | |
| 00:14:10,570 --> 00:14:16,550 | |
| resonance هذا بيكون denoting that this is there is | |
| 178 | |
| 00:14:16,550 --> 00:14:24,450 | |
| no blue fusion and there is just diaphragm is | |
| 179 | |
| 00:14:24,450 --> 00:14:27,330 | |
| abnormally higher than that | |
| 180 | |
| 00:14:33,670 --> 00:14:39,130 | |
| This is the tidal percussion طبعاً | |
| 181 | |
| 00:14:39,130 --> 00:14:42,290 | |
| الـ tidal percussion test نحن بنعمله to | |
| 182 | |
| 00:14:42,290 --> 00:14:45,930 | |
| differentiate an elevated hemidiaphragm from other | |
| 183 | |
| 00:14:45,930 --> 00:14:49,890 | |
| causes of dullness زي ما قلنا اللي هو مثلا يكون | |
| 184 | |
| 00:14:49,890 --> 00:14:52,610 | |
| secondary to the blue refusal consolidation five | |
| 185 | |
| 00:14:52,610 --> 00:14:55,830 | |
| process or there is just only elevated | |
| 186 | |
| 00:14:55,830 --> 00:14:57,150 | |
| hemidiaphragm | |
| 187 | |
| 00:15:03,130 --> 00:15:07,790 | |
| بعد الـ percussion بيجي عندنا الـ auscultation في | |
| 188 | |
| 00:15:07,790 --> 00:15:12,790 | |
| الـ auscultation عندنا أربع حاجات مهمة لازم نركز | |
| 189 | |
| 00:15:12,790 --> 00:15:18,590 | |
| عليها اللي هي أول حاجة ال breath sound إيش نوعه و | |
| 190 | |
| 00:15:18,590 --> 00:15:25,030 | |
| ال intensity و ال added sound و الرقم أربع ال | |
| 191 | |
| 00:15:25,030 --> 00:15:32,330 | |
| vocal resonance هنعلق عليهاوالمناطق اللي بنعمل | |
| 192 | |
| 00:15:32,330 --> 00:15:37,130 | |
| فيها اسكلتشن نفس اللي عملنا فيها percussion لكن في | |
| 193 | |
| 00:15:37,130 --> 00:15:41,330 | |
| الـ superclavicular area احنا بنفحص اللي هو | |
| 194 | |
| 00:15:41,330 --> 00:15:47,610 | |
| بالسماعة بالـ pill of the stethoscope مش في | |
| 195 | |
| 00:15:47,610 --> 00:15:53,250 | |
| الديافرام ال superclavicular area اللي هي بنفحصها | |
| 196 | |
| 00:15:53,250 --> 00:15:56,670 | |
| في ال pill of the stethoscope وباق المناطق | |
| 197 | |
| 00:15:56,670 --> 00:15:57,590 | |
| بالديافرام | |
| 198 | |
| 00:16:01,840 --> 00:16:03,740 | |
| طبعا I understand the patient, the right of the | |
| 199 | |
| 00:16:03,740 --> 00:16:07,040 | |
| patient, ask the patient sculpted in the middle of | |
| 200 | |
| 00:16:07,040 --> 00:16:10,500 | |
| the clavicular line, right or left, always compare | |
| 201 | |
| 00:16:11,630 --> 00:16:15,790 | |
| always compare طبعا البرتسان فيه normally اللي هو | |
| 202 | |
| 00:16:15,790 --> 00:16:20,150 | |
| vesicular breathing هو عبارة عن اللي هو | |
| 203 | |
| 00:16:20,150 --> 00:16:24,850 | |
| inspiration و total expiration ويكون soft ويكون | |
| 204 | |
| 00:16:24,850 --> 00:16:29,650 | |
| normal breathing وفيه bronchovascular وفيه | |
| 205 | |
| 00:16:29,650 --> 00:16:33,970 | |
| bronchial breathing وال transmitted طبعا اللي هو | |
| 206 | |
| 00:16:33,970 --> 00:16:38,920 | |
| sound وفيه ال advantageous اللي هولا إما fine | |
| 207 | |
| 00:16:38,920 --> 00:16:43,040 | |
| crackles لا إما coarse crackles اللي هي بيكون الـ | |
| 208 | |
| 00:16:43,040 --> 00:16:46,320 | |
| added sound و إذا كان discontinuous و إذا كانت | |
| 209 | |
| 00:16:46,320 --> 00:16:51,460 | |
| continuous advantageous sound اللي هو بيكون في | |
| 210 | |
| 00:16:51,460 --> 00:16:56,780 | |
| الويز والرنكاي هنا زي ما احنا شايفين this is the | |
| 211 | |
| 00:16:56,780 --> 00:17:00,180 | |
| tracheal sound وهو ال inspiratory و الexpiratory | |
| 212 | |
| 00:17:00,180 --> 00:17:05,340 | |
| بيكونوا equal بيكون very loudو high pitch و ممكن | |
| 213 | |
| 00:17:05,340 --> 00:17:09,040 | |
| لما تسمع تحط ال diaphragm بتاع ال stethoscope over | |
| 214 | |
| 00:17:09,040 --> 00:17:14,080 | |
| the trachea in the neck في ال bronchiole بيكون ال | |
| 215 | |
| 00:17:14,080 --> 00:17:20,280 | |
| expiratory أعلى و أطول من ال inspiratoryوهذا الـ | |
| 216 | |
| 00:17:20,280 --> 00:17:24,080 | |
| Pronchial Breathing ممكن نسمعه إذا حطينا دفرام | |
| 217 | |
| 00:17:24,080 --> 00:17:29,180 | |
| over the Maniprium لكن إذا كان حطيناه في مكان تاني | |
| 218 | |
| 00:17:29,180 --> 00:17:32,660 | |
| في الرؤى وكان فيه Pronchial Breathing this is a | |
| 219 | |
| 00:17:32,660 --> 00:17:38,360 | |
| pronchial denoting there is consolidation or mass | |
| 220 | |
| 00:17:38,360 --> 00:17:43,960 | |
| pneumonia هذه كلها بتعطينا Pronchial Breathing | |
| 221 | |
| 00:17:43,960 --> 00:17:46,760 | |
| normally ممكن نسمع ال Pronchial Breathing إذا | |
| 222 | |
| 00:17:46,760 --> 00:17:51,320 | |
| حطينا سماع over the Manipriumوهذا الطبيعي اللي هو | |
| 223 | |
| 00:17:51,320 --> 00:17:54,220 | |
| الـ vesicular أو اللي بتسميه alveolar a breathing | |
| 224 | |
| 00:17:54,220 --> 00:17:59,960 | |
| sound بيكون soft و low pitch و بيكون heard over | |
| 225 | |
| 00:17:59,960 --> 00:18:03,600 | |
| the most of the lungs و ال inspiratory are longer | |
| 226 | |
| 00:18:03,600 --> 00:18:08,300 | |
| than expiratory تقريبا true expiratory phase | |
| 227 | |
| 00:18:08,300 --> 00:18:13,860 | |
| تقريبا the true expiratory phase is two to three | |
| 228 | |
| 00:18:13,860 --> 00:18:16,760 | |
| longer than inspiratory phase لكن احنا ما بنسمعه | |
| 229 | |
| 00:18:17,040 --> 00:18:22,080 | |
| بالسماعة بنسمع حوالي تقريبا الـ full inspiratory | |
| 230 | |
| 00:18:22,080 --> 00:18:31,360 | |
| لكن الـ expiration تلتة بنسمع زي ما هو موضح وهنا | |
| 231 | |
| 00:18:31,360 --> 00:18:36,500 | |
| البرونكوفيزيكولار this is a diagram how to | |
| 232 | |
| 00:18:36,500 --> 00:18:38,100 | |
| differentiate inspiratory | |
| 233 | |
| 00:18:40,870 --> 00:18:44,790 | |
| Stridor بيكون في ال obstruction أو narrowing في ال | |
| 234 | |
| 00:18:44,790 --> 00:18:50,010 | |
| upper airway وبيكون في ال trachea وفي ال upper | |
| 235 | |
| 00:18:50,010 --> 00:18:52,450 | |
| airway obstruction في الناس اللي عندهم مكروب، في | |
| 236 | |
| 00:18:52,450 --> 00:18:56,210 | |
| الأطفال اللي عندهم مكروب أو foreign body بيجي بعد | |
| 237 | |
| 00:18:56,210 --> 00:19:00,470 | |
| حيان في acute stridor و اللي هو بيكون continuous | |
| 238 | |
| 00:19:00,470 --> 00:19:04,090 | |
| high pitch sound from obstruction of the upper | |
| 239 | |
| 00:19:04,090 --> 00:19:09,470 | |
| airwayالويز قولنا continuous، musical، high pitch، | |
| 240 | |
| 00:19:09,470 --> 00:19:14,610 | |
| هو بيكون advantageous | |
| 241 | |
| 00:19:14,610 --> 00:19:19,190 | |
| sound بيكون في ال bronchial asthma و ال COPD و ال | |
| 242 | |
| 00:19:19,190 --> 00:19:24,390 | |
| bronchi بيكون low pitch و most likely fluid or | |
| 243 | |
| 00:19:24,390 --> 00:19:26,370 | |
| secretion في ال larger airway | |
| 244 | |
| 00:19:30,410 --> 00:19:33,830 | |
| الـ crackles أو الـ crepitation short popping | |
| 245 | |
| 00:19:33,830 --> 00:19:38,550 | |
| sudden inflation of the alveoli تعطينا non | |
| 246 | |
| 00:19:38,550 --> 00:19:42,530 | |
| -continuous أو discontinuous crackles انترقت non | |
| 247 | |
| 00:19:42,530 --> 00:19:45,970 | |
| -musical sound رزقته from collapse of the | |
| 248 | |
| 00:19:45,970 --> 00:19:50,070 | |
| peripheral airway on expirationon inspiration | |
| 249 | |
| 00:19:50,070 --> 00:19:53,930 | |
| rapidly entered the distal airway and the alveoli | |
| 250 | |
| 00:19:53,930 --> 00:19:57,650 | |
| and small bronchi opened abruptly producing sound | |
| 251 | |
| 00:19:57,650 --> 00:20:04,850 | |
| اسمه اللي هو crackling noise وفي ال crackles فيه | |
| 252 | |
| 00:20:04,850 --> 00:20:07,070 | |
| two types فيه fine و فيه coarse crepitation | |
| 253 | |
| 00:20:10,850 --> 00:20:15,050 | |
| بنحدد هذه الـ «causes of crackles» ممكن نشوف، | |
| 254 | |
| 00:20:15,050 --> 00:20:20,010 | |
| بنعتمد على اللي هو زي ما حكينا، إذا كان curse | |
| 255 | |
| 00:20:20,010 --> 00:20:23,790 | |
| crackles، ask the patient to cough، يعني بتساعد، | |
| 256 | |
| 00:20:23,790 --> 00:20:32,210 | |
| you ask the patient يكحّ، ifالـ Crepitation تتغير | |
| 257 | |
| 00:20:32,210 --> 00:20:36,570 | |
| في شخصيته أو تفادى، هذا كورس الـ Crepitation دايما | |
| 258 | |
| 00:20:36,570 --> 00:20:39,890 | |
| ال كورس ال Crepitation بتكون في صغير شخص مع | |
| 259 | |
| 00:20:39,890 --> 00:20:45,290 | |
| Bronchectasis وبتكون ال Crepitation دايما ايرلي | |
| 260 | |
| 00:20:45,290 --> 00:20:49,450 | |
| لكن في حالات ال lung fibrosis في الالدرلي، بيكون | |
| 261 | |
| 00:20:49,450 --> 00:20:53,290 | |
| fine Crepitation وإذا كحل عيال، برضه ال | |
| 262 | |
| 00:20:53,290 --> 00:20:57,470 | |
| Crepitation لن تفادىالـ crepitation will not | |
| 263 | |
| 00:20:57,470 --> 00:21:00,610 | |
| disappear و ال crepitation في الـ fine بتكون soft | |
| 264 | |
| 00:21:00,610 --> 00:21:06,970 | |
| و high pitch و very brief و بتكون في ال end | |
| 265 | |
| 00:21:06,970 --> 00:21:10,530 | |
| inspiratory crepitation بيسموها و بيسئلها اسم | |
| 266 | |
| 00:21:10,530 --> 00:21:15,210 | |
| بتاعي اللي بيطلق عليه Velcro sound Velcro sound أو | |
| 267 | |
| 00:21:15,210 --> 00:21:20,130 | |
| الشريط اللاصق نقرا | |
| 268 | |
| 00:21:20,130 --> 00:21:25,100 | |
| ال friction rap whispering بيجتلكوااللي هو لما | |
| 269 | |
| 00:21:25,100 --> 00:21:30,620 | |
| تحكي للعيان اهمس يعني كلام اللي هدا بتكون مسموع هو | |
| 270 | |
| 00:21:30,620 --> 00:21:34,780 | |
| some sort of اللي هو الـ vocal resonance أو الـ | |
| 271 | |
| 00:21:34,780 --> 00:21:41,760 | |
| TVF بيكون عالي ومسموع بالسماعة Lego | |
| 272 | |
| 00:21:41,760 --> 00:21:46,990 | |
| فيني؟ Okayطبعًا «putting all together» دائمًا إحنا | |
| 273 | |
| 00:21:46,990 --> 00:21:50,090 | |
| في الـ «final» بعد ما نخلص بالـ «general» بعد إن | |
| 274 | |
| 00:21:50,090 --> 00:21:54,630 | |
| الـ «local exam» لازم نعطي اللي هو الـ «summary» | |
| 275 | |
| 00:21:54,630 --> 00:22:00,890 | |
| الـ «summary» للـ «finding» قلنا في الحالات الأول | |
| 276 | |
| 00:22:00,890 --> 00:22:05,410 | |
| حاجة بالـ «essential checklist» أو «general | |
| 277 | |
| 00:22:05,410 --> 00:22:10,270 | |
| inspection»Patient في الـ «General inspection»، | |
| 278 | |
| 00:22:10,270 --> 00:22:13,150 | |
| «Well» أو «unwell»؟ «Gashectic»؟ «Cianosis»؟ | |
| 279 | |
| 00:22:13,150 --> 00:22:15,850 | |
| «Pallor»؟ «Accessory muscle»؟ «General | |
| 280 | |
| 00:22:15,850 --> 00:22:18,610 | |
| appearance»؟ «Distance»؟ «Sign of specific»؟ | |
| 281 | |
| 00:22:18,610 --> 00:22:22,490 | |
| طبعاً، before الـ «essential checklist» لازم | |
| 282 | |
| 00:22:22,490 --> 00:22:24,990 | |
| يقولنا احنا اللي هو «washing hands»، «introduce | |
| 283 | |
| 00:22:24,990 --> 00:22:29,890 | |
| yourself»، «position»، «consent»، تمام، بعدين تفحص | |
| 284 | |
| 00:22:29,890 --> 00:22:32,170 | |
| الـ «hand»، الـ «hand» بيفحص فيه «clapping»، فيه | |
| 285 | |
| 00:22:32,170 --> 00:22:35,030 | |
| «muscle wasting»، «unilaterally»، فيه تعريف تاني، | |
| 286 | |
| 00:22:35,030 --> 00:22:38,470 | |
| «preference cianosis»،Pulpate the wrist for | |
| 287 | |
| 00:22:38,470 --> 00:22:41,890 | |
| tenderness، check for flamming tremor، radial | |
| 288 | |
| 00:22:41,890 --> 00:22:47,150 | |
| pulse، ونسمع الـ vital sign، ناخد الـ vital sign | |
| 289 | |
| 00:22:47,150 --> 00:22:51,130 | |
| ونشوف الـ respiratory rate، و الـ face، كنا في | |
| 290 | |
| 00:22:51,130 --> 00:22:54,330 | |
| الأليميا، في الـ jaundice، Horner، سندروم المouth، | |
| 291 | |
| 00:22:54,330 --> 00:22:57,940 | |
| في الـ central cyanosisفي الـ Bad Oral Hygiene في | |
| 292 | |
| 00:22:57,940 --> 00:23:01,480 | |
| الناس اللي عندهم Infective Endogarditis أو الـ | |
| 293 | |
| 00:23:01,480 --> 00:23:04,980 | |
| Lung Abscess Pairslip Breathing في الناس الـ COPD | |
| 294 | |
| 00:23:04,980 --> 00:23:07,620 | |
| الـ Voice, Hoarseness of Voice في الناس اللي عندهم | |
| 295 | |
| 00:23:07,620 --> 00:23:13,820 | |
| Lung Cancer إنك تشيك for GVB for lymph node Local | |
| 296 | |
| 00:23:13,820 --> 00:23:16,960 | |
| interest exam, inspection also, palpation, | |
| 297 | |
| 00:23:17,100 --> 00:23:20,620 | |
| percussion, auscultation, inspectiongeneral | |
| 298 | |
| 00:23:20,620 --> 00:23:25,300 | |
| inspection و ال palpation خمسة و ال percussion | |
| 299 | |
| 00:23:25,300 --> 00:23:27,920 | |
| then auscultation بنركز على the auscultative | |
| 300 | |
| 00:23:27,920 --> 00:23:31,020 | |
| finding ال type of breath sound، vesicular ولا | |
| 301 | |
| 00:23:31,020 --> 00:23:36,660 | |
| bronchial و اللي هو ال intensity و ال added sound | |
| 302 | |
| 00:23:36,660 --> 00:23:41,820 | |
| و then ال vocal resonanceفبنفحث الليك طبعا ممكن | |
| 303 | |
| 00:23:41,820 --> 00:23:44,740 | |
| نفحث الليك بارتوف جينيرال exam for إريمة for | |
| 304 | |
| 00:23:44,740 --> 00:23:48,560 | |
| temperature for color for skin lesion و for | |
| 305 | |
| 00:23:48,560 --> 00:23:53,380 | |
| complete exam for you ask for exam for spew time | |
| 306 | |
| 00:23:53,380 --> 00:23:56,440 | |
| or temperature chart و ال peak flow rate و ال | |
| 307 | |
| 00:23:56,440 --> 00:23:57,980 | |
| oxygen status | |
| 308 | |
| 00:24:04,130 --> 00:24:06,750 | |
| طبعاً هذه scattered cases أشياء اللي نركز فيها | |
| 309 | |
| 00:24:06,750 --> 00:24:11,110 | |
| البرونكال أزمة بنسمع فيها بيكون عيال ممكن الـ | |
| 310 | |
| 00:24:11,110 --> 00:24:13,970 | |
| central cyanosis in severe أزمة ممكن نسمع wheeze | |
| 311 | |
| 00:24:13,970 --> 00:24:18,690 | |
| bilateral because of hyperinflation و rabid pulse | |
| 312 | |
| 00:24:18,690 --> 00:24:22,410 | |
| النمونيا بيكون في عندنا sign of consolidation | |
| 313 | |
| 00:24:22,410 --> 00:24:25,190 | |
| reduced chest expansion dullness to percussion, | |
| 314 | |
| 00:24:25,630 --> 00:24:29,990 | |
| bronchial breathing plus minus coarse crackles or | |
| 315 | |
| 00:24:29,990 --> 00:24:35,120 | |
| increased vocal resonanceالبرونكيكتسيس بيكون دايما | |
| 316 | |
| 00:24:35,120 --> 00:24:38,040 | |
| في الـ young بيكون course، crackles، adventitious | |
| 317 | |
| 00:24:38,040 --> 00:24:42,480 | |
| sound، bilaterally، ممكن يكون finger clubbing، | |
| 318 | |
| 00:24:42,480 --> 00:24:45,140 | |
| ممكن يكون عيان عنده أنيميا because of a chronic | |
| 319 | |
| 00:24:45,140 --> 00:24:48,400 | |
| disease، cyanosis، race GVB، إذا صار عنده core | |
| 320 | |
| 00:24:48,400 --> 00:24:52,840 | |
| بلمونال، patient plethoric، قلنا course crackles | |
| 321 | |
| 00:24:52,840 --> 00:24:56,860 | |
| over the area، sometimes ممكن plus minus، بيكون | |
| 322 | |
| 00:24:56,860 --> 00:25:02,350 | |
| فيويز، adventitious،قلنا ممكن يكون برضه اللي هو | |
| 323 | |
| 00:25:02,350 --> 00:25:09,150 | |
| right-sided heave اللي هو كرب المنال ممكن يكون | |
| 324 | |
| 00:25:09,150 --> 00:25:16,850 | |
| lower limb قديمة ويكون عندنا حواليه ال environment | |
| 325 | |
| 00:25:16,850 --> 00:25:21,310 | |
| sputum because of producing a large amount of | |
| 326 | |
| 00:25:21,310 --> 00:25:28,690 | |
| sputumالـ Blural effusion بيكون في ال exam degrees | |
| 327 | |
| 00:25:28,690 --> 00:25:31,910 | |
| and chest expansion بيكون stony dullness to | |
| 328 | |
| 00:25:31,910 --> 00:25:36,130 | |
| percussion note، decrease in breath sound ومافيش | |
| 329 | |
| 00:25:36,130 --> 00:25:39,730 | |
| added sound، و ال vocal resonance بيكون decrease، | |
| 330 | |
| 00:25:39,730 --> 00:25:42,910 | |
| و بعض الأحيان إذا كان mediastinal shift إذا كان | |
| 331 | |
| 00:25:42,910 --> 00:25:48,630 | |
| large، بلورال effusion طبعا هي ال differential | |
| 332 | |
| 00:25:48,630 --> 00:25:52,070 | |
| diagnosis للdullness in the lung baseالـ lung | |
| 333 | |
| 00:25:52,070 --> 00:25:56,830 | |
| fibrosis بيكون زي ما حكينا «fine late inspiratory | |
| 334 | |
| 00:25:56,830 --> 00:25:59,750 | |
| creepitation» أو «fine end inspiratory | |
| 335 | |
| 00:25:59,750 --> 00:26:06,170 | |
| creepitation» «finger clapping» | |
| 336 | |
| 00:26:06,170 --> 00:26:11,110 | |
| هنا هي هذه الـ «bipasal» «fine end inspiratory | |
| 337 | |
| 00:26:11,110 --> 00:26:13,930 | |
| crackles» أو الـ «Velcro» هذا شريط اللاسق الـ | |
| 338 | |
| 00:26:13,930 --> 00:26:16,650 | |
| «Velcro» الصوت اللي ممكن يطلع في حالات اللي هو | |
| 339 | |
| 00:26:16,650 --> 00:26:21,880 | |
| lung fibrosisوزي ما عرفنا بيكون bilateral fine end | |
| 340 | |
| 00:26:21,880 --> 00:26:25,340 | |
| في نهاية ال inspiratory phase بيكون في fine | |
| 341 | |
| 00:26:25,340 --> 00:26:29,400 | |
| crackles low pitch وما بتتغير بالكف و تقريبا بيكون | |
| 342 | |
| 00:26:29,400 --> 00:26:37,340 | |
| صوتها زي كده على | |
| 343 | |
| 00:26:37,340 --> 00:26:39,500 | |
| نهاية ال inspiration | |
| 344 | |
| 00:26:44,440 --> 00:26:48,780 | |
| و COPD كما قلنا برضه بيكون فيه ممكن بالاترالويز و | |
| 345 | |
| 00:26:48,780 --> 00:26:51,840 | |
| finger clapping إذا كان associated with lung | |
| 346 | |
| 00:26:51,840 --> 00:26:56,820 | |
| cancer COPD alone will not cause finger clapping | |
| 347 | |
| 00:26:56,820 --> 00:26:59,920 | |
| Pairs lip breathing | |
| 348 | |
| 00:27:03,890 --> 00:27:06,810 | |
| How to differentiate between Blue Refusion and | |
| 349 | |
| 00:27:06,810 --> 00:27:09,770 | |
| Consolidation؟ في الـ Blue Refusion بيكون Reduced | |
| 350 | |
| 00:27:09,770 --> 00:27:12,350 | |
| tactile vocal fremitus أو Decreased vocal | |
| 351 | |
| 00:27:12,350 --> 00:27:15,890 | |
| resonance فالـ Consolidation بيكون Increased vocal | |
| 352 | |
| 00:27:15,890 --> 00:27:19,230 | |
| resonance Reduced cyst expansion Reduced cyst | |
| 353 | |
| 00:27:19,230 --> 00:27:23,290 | |
| expansion together، Bilaterally إذا كان في عندك | |
| 354 | |
| 00:27:23,290 --> 00:27:25,370 | |
| Bilateral Blue Refusion أو إذا كان في | |
| 355 | |
| 00:27:25,370 --> 00:27:30,340 | |
| ConsolidationStony dullness في حالات اللي هو Blue | |
| 356 | |
| 00:27:30,340 --> 00:27:33,480 | |
| Refusion ويكون برضه dullness في ال consolidation | |
| 357 | |
| 00:27:33,480 --> 00:27:39,440 | |
| Decrease in breath sound Blue Refusion وممكن | |
| 358 | |
| 00:27:39,440 --> 00:27:43,420 | |
| sometimes consolidation in bronchial breathing وNo | |
| 359 | |
| 00:27:43,420 --> 00:27:47,540 | |
| added sound لكن في ال added sound يكون curse | |
| 360 | |
| 00:27:47,540 --> 00:27:52,060 | |
| crackles or weeds وهنا برضه how to differentiate | |
| 361 | |
| 00:27:52,060 --> 00:27:59,550 | |
| between thiswasn't as easy as it looked no sir no | |
| 362 | |
| 00:27:59,550 --> 00:28:06,110 | |
| it was wasn't تقريبا احنا يعني الحين في some يعني | |
| 363 | |
| 00:28:06,110 --> 00:28:14,350 | |
| example بنشوف من الحالات اللي هو ال sound خلينا | |
| 364 | |
| 00:28:14,350 --> 00:28:17,550 | |
| نشوف breath sounds are classified by their | |
| 365 | |
| 00:28:17,550 --> 00:28:20,910 | |
| intensity pitch and duration during inspiration | |
| 366 | |
| 00:28:20,910 --> 00:28:26,160 | |
| and expirationالعادية لصوص الهواتف هي صوت صوت صوت | |
| 367 | |
| 00:28:26,160 --> 00:28:30,280 | |
| صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت | |
| 368 | |
| 00:28:30,280 --> 00:28:32,900 | |
| صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت | |
| 369 | |
| 00:28:32,900 --> 00:28:34,540 | |
| صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت | |
| 370 | |
| 00:28:34,540 --> 00:28:34,740 | |
| صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت | |
| 371 | |
| 00:28:34,740 --> 00:28:34,780 | |
| صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت | |
| 372 | |
| 00:28:34,780 --> 00:28:35,640 | |
| صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت | |
| 373 | |
| 00:28:35,640 --> 00:28:36,320 | |
| صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت | |
| 374 | |
| 00:28:36,320 --> 00:28:40,780 | |
| صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت صوت | |
| 375 | |
| 00:28:40,780 --> 00:28:44,280 | |
| صوت صوت صوت صوت صوت | |
| 376 | |
| 00:28:44,280 --> 00:28:44,340 | |
| صوت | |
| 377 | |
| 00:28:53,660 --> 00:28:57,620 | |
| الصوت البرانكي يكون أكثر و أكثر و أكثر و أكثر و | |
| 378 | |
| 00:28:57,620 --> 00:28:58,500 | |
| أكثر و أكثر و أكثر و أكثر و أكثر و أكثر و أكثر و | |
| 379 | |
| 00:28:58,500 --> 00:28:59,700 | |
| أكثر و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و | |
| 380 | |
| 00:28:59,700 --> 00:29:03,360 | |
| أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و | |
| 381 | |
| 00:29:03,360 --> 00:29:04,520 | |
| أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و | |
| 382 | |
| 00:29:04,520 --> 00:29:06,660 | |
| أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و | |
| 383 | |
| 00:29:06,660 --> 00:29:22,640 | |
| أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و | |
| 384 | |
| 00:29:26,900 --> 00:29:30,280 | |
| الصوتات الانسباراتية والاستباراتية تقريبًا تقريبًا | |
| 385 | |
| 00:29:30,280 --> 00:29:34,620 | |
| تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا | |
| 386 | |
| 00:29:34,620 --> 00:29:35,380 | |
| تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا | |
| 387 | |
| 00:29:35,380 --> 00:29:36,640 | |
| تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا | |
| 388 | |
| 00:29:36,640 --> 00:29:40,900 | |
| تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا | |
| 389 | |
| 00:29:40,900 --> 00:29:46,640 | |
| تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا | |
| 390 | |
| 00:29:46,640 --> 00:29:50,500 | |
| تقريبًا | |
| 391 | |
| 00:29:50,500 --> 00:29:52,140 | |
| تقريبًا ت | |
| 392 | |
| 00:30:04,260 --> 00:30:12,180 | |
| and bronchovascular Adventitious | |
| 393 | |
| 00:30:12,180 --> 00:30:15,880 | |
| or added breath sounds consist of two basic types | |
| 394 | |
| 00:30:15,880 --> 00:30:27,260 | |
| the discontinuous sounds or crackles and | |
| 395 | |
| 00:30:27,260 --> 00:30:30,060 | |
| the continuous sounds wheezes and ronca | |
| 396 | |
| 00:30:37,880 --> 00:30:47,040 | |
| بالتالي، هذا مثال للتحقيق | |
| 397 | |
| 00:30:47,040 --> 00:30:49,260 | |
| الإسقاطي | |
| 398 | |
| 00:30:50,660 --> 00:30:57,480 | |
| pronchial sound and adventitious sound وبهذا نختتم | |
| 399 | |
| 00:30:57,480 --> 00:31:05,220 | |
| هذه المحاضرة عن ال approach for physical exam in | |
| 400 | |
| 00:31:05,220 --> 00:31:09,460 | |
| respiratory patient thank you | |