Stethography
Competency No – PY 6.7
DR.R.NIRUBA ,MD,
Professor,
Department Of Physiology,
Annapoorana Medical College and Hospitals,
Salem.
STETHOGRAPHIC RECORDING OF RESPIRATION
AIM :
To record movements of chest wall during respiration using stethograph
and to record effect of swallowing, sneezing, coughing, speech,
hyperventilation and breath holding.
APPARATUS:
Stethograph, Marey's tambour, Stop watch, Kymograph, Drum and time
marker.
STETHOGRAPH:
It is an instrument for recording the chest wall movements during
respiration.
The process of recording the respiratory movements is known as
Stethography.
It consists of:
1. A CORRUGATED RUBBER TUBE (60cm long, 2 cm
diameter), one end of which is blind and the other end is
connected through a pressure rubber tubing to Marey's tambour.
A hook and metallic chain arrangement enables the stethograph
to be tied around the chest wall.
2. MAREY’S TAMBOUR: It is provided with a metallic cup or
flat saucer shaped connection with its top covered with a latex or
rubber diaphragm. To the bottom is fixed a metal tube which is
connected with the stethograph through pressure rubber tubing. The
pressure variations occurring within the corrugated rubber tube are
thus transmitted faithfully on to the rubber diaphragm. A pointer sits
on the rubber diaphragm, to record its movements on the
kymograph.
PROCEDURE:
1. The subject sits quietly and comfortably on a stool with his back towards the recording
apparatus and the stethograph tied across the chest at the level of nipples that is fourth
intercostal space as maximum expansion of lungs seen there.
2. The corrugated tube is left partially stretched so that the respiratory movements can
produce pressure changes in it.
3. The connecting pressure tube is joined to the Marey's tambour, which is then
mounted along with a time marker on the same stand. The levers are brought in the same
vertical line and made to touch the kymograph drum.
OBSERVATION:
NORMAL RESPIRATION
The drum is set to move at a slow speed (2.5mm/sec), record the normal respiratory
movements and note:
a. The rate of respiration
B. The relative duration of inspiration and expiration and
C. Presence or absence of pause between inspiration and expiration, or between
expiration and inspiration.
Principle- Record of
stethograph: Downstroke is INSPIRATION
As the corrugated rubber tube expands
during inspiration
Volume inside the tube increases and
Expiration
pressure will drop …
which is recorded as downstroke
Inspiration
Upstroke is EXPIRATION
As the corrugated rubber tube compressed
during expiration
Volume inside the tube decreases and
pressure will raise …
which is recorded as upstroke
PRECAUTIONS
1. Do not let the subject see the recording.
2. Do not allow the subject to hyperventilate voluntarily beyond 2 minutes.
3. The stethograph tied across the chest should neither be too tight nor too
loose.
4. Do not forget to record 4-5 normal breaths before effect of any
parameter is observed; stop only when the recordings have come back to
resting level.
Record of stethograph:
Record of stethograph:
1- EFFECT OF BREATHE HOLDING (BHT)
Breath holding time is the maximum time a subject can hold his breath.
BHT is maximum after inspiration than expiration.
BHT can be prolonged by holding breath
• After deep inspiration
• Inhalation of 100% oxygen before breath holding
• Encouragement and motivation.
EFFECT OF BREATHE HOLDING(BHT)
EFFECT AFTER INSPIRATION AND EXPIRATION
Subjects sits quietly for few minutes breathing normally, instruct him to hold
his breath as long as possible in the following positions:
1. At the end of quiet expiration
2. At the end of maximum expiration
3. At the end of quiet inspiration
4. At the end of maximum inspiration
Record of stethograph:
Breaking point
Breaking point
Breaking point
Breaking point is the point at which subject no longer can hold his breath and
starts breathing in hyperventilation pattern for sometime followed by normal
breathing.
Cause of breaking point – Accumulation of carbon dioxide while breath holding
stimulates both central and peripheral chemoreceptors that stimulate respiration.
Generally breaking point is reached at alveolar pO2 of 56mmHg and alveolar CO2
of 49mm Hg to restart breathing in hyperventilating pattern so that accumulated
carbon dioxide gets washed out .
2- EFFECT OF VOLUNTARY HYPERVENTILATION
Record normal respiration. Stop the drum, instruct the subjects to breathe
in and out as deeply and as rapidly as possible for 45-60seconds. Switch on
the drum and stop hyperventilation, and pay further attention to
breathing. Record the respiratory movements till it comes back to normal.
Apnea after hyperventilation is due to washing out of carbon dioxide
during hyperventilation and no stimulus for respiratory center present.
If the subject do hyperventilation for prolonged period they end up
having alkalosis as carbon dioxide is responsible for maintain pH.
3-EFFECT OF SWALLOWING
a. Ask the subject to take a mouthful of water and hold it in his mouth without
swallowing. Make a record of the normal respiration and then direct him to
Swallow the water once during expiration and a second time during inspiration;
mark on the drum simultaneously. Note the inhibitory effect of deglutition on
respiration.
b. Ask the subject to drink water (about 250 ml) from a glass in a continuous
swallowing movement, and note its effect on the respiratory movements.
Deglutition apnea:
Cause of apnea during deglutition is due to closure of glottis which helps in passage of
food or water into esophagus preventing entry of food into respiratory passage.
Record of stethograph:
4- EFFECT OF SNEEZING, COUGHING, LAUGHING, TALKING
Subject sits quietly for few minutes breathing normally, and then the effect of
following manoeuvre is recorded on respiratory movements:
1. Sneezing
2. Coughing
3. Laughing, and
4. Talking.
Record of stethograph:
Abnormal Breathing Patterns
Abnormal breathing patterns may be regular or irregular
Regular abnormal breathing patterns
a. Cheyne-Stokes breathing: It is characterised by hyperpnoea
followed by apnoea.
It occurs in cardiac failure, renal failure, narcotic drug
poisoning and raised intracranial pressure
b. Kussmaul’s breathing: It is characterised by increase in rate and
depth of breathing.
It occurs in metabolic acidosis and pontine lesions.
Irregular abnormal breathing patterns
a.Biots breathing: It is characterised by apnoea between several
shallow or few deep inspirations. It occurs in meningitis
b.Ataxic breathing: It is characterised by irregular pattern of
breathing where both deep and shallow breaths occur randomly. It
occurs in brainstem lesions
c. Apneustic breathing: It is characterised by pause at
full inspiration, alternating with a pause in expiration,
lasting for 2 to 3 seconds. It occurs in pontine
lesions
Record of stethography:
Case sheet
Name:
Age:
Sex:
Occupation :
NOTE:
DOWNSTROKE IS INSPIRATION
UPSTROKE IS EXPIRATION
Important points you have to keep in mind while drawing is
Where the breath holding starts at the end of inspiration or expiration
Duration of apnea – after normal inspiration it is more than normal expiration
After taking a deep inspiration is the maximum time of breath holding than all
and after deep expiration you are washing out the reserve volume in lungs so it is
the minimum time of breath holding.
Keep the above points in mind and draw.
After every maneuver there is change in depth and frequency of inspiration and
expiration
QUESTIONS
1. What is the normal respiratory rate?
2. How is normal inspiration and expiration recorded in stethography?
3. Describe the record obtained during coughing, sneezing and speech. What is the
mechanism?
How these reflexes are helpful for the body?
4. What is deglutition apnea? What are the neural pathways involved in this mechanism?
5. What is the normal duration of breath holding?
6. How does the duration of breath holding differ when performed at the end of
inspiration
and expiration?
7. What is breaking point? Why is it caused? What are the levels of pCO2 and pO2 at
which
breaking point may occur normally?
8. What is the effect of hyperventilation?
9. Why the person may feel dizzy after 15-30 seconds of hyperventilation?
10. Enumerate important differences between exercise and voluntary hyperventilation.
