558 - Unintentional ASMR - Assessment / Exam / Head to Toe

追加: 2026-05-23

[00:00:01]Hi, I'm Ella. I'm going to be your student physical therapist. Can you um just verify your name and date of birth?

[00:00:06]Jasmine Alford, January 10th, 2001. All right. So, is it okay if I treat you today?

[00:00:12]All right. Well, today what I'm going to be doing is we're going to be going through a series of different skills, um but we're first going to get started with something called postural drainage.

[00:00:21]So, postural drainage is really important uh when you have kind of like some fluid that's not wanted in your lungs or any secretions that we're going to try to get out in different lobes of our lungs. Okay? So, to start we have um our upper lobes, and I'm going to be draining first. I'm going to just grab a stool real quick.

[00:00:43]Turn this way over here.

[00:00:47]All righty.

[00:00:48]So, for our upper lobes, it is important for apical lobes to have your patient in like a long seated position like so, and you're going to have them in about a 30° angle leaning forward. So, I'm just going to measure here.

[00:01:09]Like so.

[00:01:19]Good. And Jasmine's actually right already right about there.

[00:01:23]And then, after we get our patient in this position, you're going to make two um C cup shapes with your hands, and you're going to do something called percussion, which is just this motion here, and you're going to do it for 3 to 5 minutes.

[00:01:40]And for the sake of the video, I won't be doing it that long, but you percuss for 3 to 5 minutes.

[00:01:46]And then, after this, I'm going to do something called vibration. So, vibration is when you have your patient inhale, and then on the exhale is when you perform the vibration, and then they do a cough at the end to try and get the secretions out.

[00:01:59]All right, you ready? So, take an inhale for me.

[00:02:02]And exhale.

[00:02:04]And cough.

[00:02:06]Good. And we'll do it two more times.

[00:02:08]Inhale.

[00:02:10]And exhale.

[00:02:15]Good. And then one more time for me.

[00:02:16]Inhale.

[00:02:18]And exhale.

[00:02:22]Good. So, you can do um those three to four times to help them get the secretions out. And then you can also go on to the other side as well and do that.

[00:02:32]Um next we're going to be moving into the posterior lobe of the the posterior portion of your upper lobes. So, for that one I'll have my patient just off into a or sitting off the edge of this table here.

[00:02:50]Okay.

[00:02:51]So, same thing how we had her in a 30° lean.

[00:02:55]We're going to do the same thing, but she's going to be leaning forward and you can have them hold onto the edge just so they don't fall.

[00:03:02]Oops.

[00:03:08]Go a little bit uh further forward.

[00:03:10]There you go. Right there's good. Okay.

[00:03:12]So, now that I have my patient there, I would do the same exact thing. I already showed you that position the first time, but you'd make your C um shaped hands and then you would percuss for 3 to 5 minutes and then do your vibrations three to four times and then cough after each one to get the unwanted secretions out.

[00:03:32]Then moving on into our anterior lobe.

[00:03:34]So, for this one you can have your patient laying down.

[00:03:40]And you can also put a um pillow underneath their legs if they're comfortable.

[00:03:45]Patient preference.

[00:03:47]And then for this one here, it's the same exact steps. Um this time I'm going to be percussing right up here for them.

[00:03:55]And again, 3 to 5 minutes.

[00:03:58]We won't do the full thing for 3 to 5 minutes, and then you perform the vibration, they then inhale, on the exhale you vibrate, and then they cough at the end. And we do that three to four times.

[00:04:09]Okay, so that is it for our upper lobes.

[00:04:13]Now, we're going to be moving into our middle lobes. So, for our middle lobes, we have two that we're going to want to get. We're going to do our right upper middle lobe first. [snorts] Or we have right middle lobe. So, for this one, your patient is going to be laying on their left side. So, we'll go ahead and get to a left side lying position.

[00:04:32]Okay.

[00:04:36]All right.

[00:04:38]Should be this spot.

[00:04:40]Good.

[00:04:42]Perfect.

[00:04:44]Um, for this one here, since she's in a left side lying position, we need them to raise their left hand above their head, because when we're going to be percussing, it's going to be right here in this area.

[00:04:55]Um, but before we can do that, we have to actually measure.

[00:04:59]So, [snorts] let's see where I put I think I put it right here.

[00:05:03]All right. So, you're going to get your measuring tape like so. And what we're going to do here is you have to measure in inches from the table to the ground.

[00:05:17]And we get 24. So, then for our middle lobes, we have to add 16. So, 16 to that is going to be 40.

[00:05:29]And once we have that, I'm going to go ahead and elevate the table.

[00:05:33]Um, we'll elevate the table with 16° of an additional 16°, or sorry, 16 in of the table, and then I'll perform the percussion and vibration.

[00:05:44]So, I'm going to go ahead and do that, if that's all right.

[00:05:47]If I have this set.

[00:06:08]Perfect.

[00:06:10]Put it there.

[00:06:12]And then same thing.

[00:06:15]I'm going to come right here. She'll have her arm over her head. And then we can percuss just like so. 3 to 5 minutes. Have her inhale. Big inhale and then on exhale you vibrate.

[00:06:27]Big cough.

[00:06:28]3 to 4 times. Okay? I'll go ahead and bring her back down.

[00:06:37]And now we have our lingula or yeah, lingula. That's what it's our left side.

[00:06:43]And we have to have our patient flip the other way.

[00:06:48]Go ahead and give her this pillow.

[00:06:52]Okay.

[00:06:53]Now for this one instead of having her arm up, you can just have your patient if I take her arm here and then just rest it behind her if that's comfortable for them.

[00:07:03]>> [snorts] >> Um same exact thing. I already have her measuring tape um out to where I need it to be so now I'm going to redo that. But I measured it to 24 cuz it's the height from the table to the floor. Add 16 and that's 40 in. So So same thing I'll go ahead and elevate so you all can see what that looks like.

[00:07:39]Okay.

[00:07:40]All right.

[00:07:41]We got our patient there. And then same thing, C-cup hands, we percuss for 3 to 5 minutes, vibration three to four times, after each one they'll do a good cough to get the secretions out.

[00:07:55]All right. Then I'll bring my patient right back down.

[00:07:59]So those that concludes our middle lobes. Now lastly we have um our lower ones that we got to work on.

[00:08:06]So for this one you go ahead [snorts] and lay supine.

[00:08:10]Just follow as I explain it first. Um for our lower lobes, instead of adding 16°, we're going to actually add 20. So since I've already measured it to save us some time here, I am going to go and go exactly to where I need here.

[00:08:27]So I'm adding 20 the 20 in to um 24 in, okay?

[00:08:35]Um and yeah, I already have that measured. So for our lower lobes, we have our anterior. So for your anterior lower lobes, you have to have them in pure side in a pure side lying position.

[00:08:52]Doesn't matter which side, but for the sake of the video, we'll just do one, but you can always perform both.

[00:09:01]Okay?

[00:09:05]I'll go ahead and put my patient and elevate them. You doing all right? Mhm.

[00:09:09]Okay.

[00:09:23]All right, perfect. Have them right there.

[00:09:29]Same thing, C-cup hands, we percuss at the lower portion of her lungs, and then we perform those three to four vibrations after each one. They would >> [cough and clears throat] >> perform the cough, just like I showed you all in the beginning.

[00:09:44]Moving on. So, that was our interior interior portion. Now, we're going to move into the lateral portion. So, for the lateral portion, you're going to want to have your patient in a 1/4 prone position.

[00:09:58]Okay? So, what that means is they're not going to be fully laying on their stomach, but like all of this.

[00:10:06]So, so this Yeah, that'll help. Be just like that, okay? And we'll do the exact same thing.

[00:10:14]I'll go ahead. I already have this measured.

[00:10:17]And I elevate him to that position.

[00:10:22]>> [snorts] >> Okay.

[00:10:38]Perfect.

[00:10:39]All right.

[00:10:40]So, same thing. We're going to be percussing over that same area, the lower portion here. C-shaped hand, we percuss for 3 to 5 minutes, and then three to four vibrations with a cough at the end of each one.

[00:10:56]All right. Moving on.

[00:10:59]We're almost done with our drainage.

[00:11:02]So, we just did our lateral one. Now, we're going to move into our posterior one.

[00:11:06]And this time, you get to have your patient in a fully prone position, so you can take this away.

[00:11:13]And you can ask him if they're comfortable. They might want some more pillows. You good?

[00:11:18]Okay.

[00:11:20]The same thing. Go ahead and elevate it again.

[00:11:24]This is our last one to elevate.

[00:11:27]>> [snorts] >> So, I measure him from the edge the table at the feet.

[00:11:36]And this is in inches.

[00:11:43]Perfect. Okay.

[00:11:45]All right, so we have that there.

[00:11:48]And you're just going to come right behind here. Percuss over the lower portion just like so, 3 to 5 minutes, and then do these three to four vibrations.

[00:11:59]And then they would cough at the end of each one.

[00:12:02]All right.

[00:12:03]Now we got one more.

[00:12:05]So, we just did [music] our posterior.

[00:12:06]Now we're going to do our um superior one.

[00:12:11]So, for this one, we don't have to elevate the head the table at all. They can stay right there, and you're going to go over in that same portion where we were doing before, percuss for 3 to 5 minutes, and then do three to four vibrations where you're just shaking just like so on the exhale for the patient, and then they would cough at the end.

[00:12:32]All right. So, that concludes all of our drainage drainage positions.

[00:12:38]Now we can go ahead and come up into a um seated position.

[00:12:44]And I'm just going to talk to you a little bit about um some of our breathing techniques, okay?

[00:12:50]So, there's a few different ones that we're going to go over today. The first one is called pursed-lip breathing. So, pursed-lip breathing is really good for patients that may have like an obstructive disease since they have a hard time getting air out.

[00:13:06]Um for pursed-lip breathing, what we want to instruct them to do is you breathe in for 2 seconds. So, I can show you. So, you breathe in, and then you exhale for four.

[00:13:18]Okay. And you want to make like a fishy face, like a kissy face, and you want to hear the air come out.

[00:13:23]>> Okay. Okay, you want to try it? All All Inhale two, exhale two, three, four. Good. Do it one more time. Inhale two, and then exhale one, two, three, four.

[00:13:38]Good. All right. So, that was called our pursed-lip breathing. Next, we have something called diaphragmatic breathing. So, with our diaphragmatic breathing, this is also called um box breathing, and it's good for just opening up airways and getting secretions out as well. Um I can show you, but we're going to take place our hands on our stomach, and you're going to inhale for four, then you hold for four counts, exhale for four, and then you hold for four counts again.

[00:14:09]So, I can walk you through it. You feel comfortable?

[00:14:11]>> Mhm.

[00:14:12]You ready? So, inhale two, three, four, hold two, three, four, exhale two, three, four, hold two, three, four.

[00:14:25]And it's also known as known as belly breathing because you'll feel like your stomach going to your hands if you're doing it properly. So, it's a good way to kind of cue your patient. Okay?

[00:14:35]Now, we have one more that we're going to go over, and this is called active cycle breathing. So, with active cycle breathing, we're going to do the diaphragmatic breathing that I just walked you through, which is like the four four four four that we just talked about, okay? Then, after that, you're going to take four deep breaths at your own time.

[00:14:54]Then, you're going to do something called controlled breathing, which is just at rest, your normal breathing for like 5 to 10 seconds. Um then, after that, you have four more deep breaths.

[00:15:05]Controlled breathing again for 5 to 10, and then you you're going to perform something called two huffs. So, huffs, a good way to think about that is like if you think about fogging up a mirror, so it's like just like that. You do two of those, okay?

[00:15:20]You ready to try it? Yes. All right. I can walk you through it.

[00:15:23]Okay, so let's do the diaphragmatic breathing. Ready? Hands on our stomach and here we go. Inhale 2 3 4 hold 2 3 4 exhale 2 3 4 hold 2 3 4. Good. Four big deep breaths. Here we go. At your own time.

[00:15:54]Good. And then we'll just rest here for about 5 to 10 seconds. Doing good.

[00:15:58]And then let's go ahead and do four more deep breaths.

[00:16:11]All right. Then we have that controlled breathing, so we'll rest here for 5 to 10 seconds.

[00:16:19]And then let's go ahead and try this hacks. So let's do them two. Ready?

[00:16:23]>> [sighs] >> Good. And then one more.

[00:16:26]Very nice. Okay. So those are our breathing techniques. That concludes those. Now we're going to go into a cough. So pretty much a cough I can kind of explain real quick and then we'll practice it. But what happens when you're doing a cough is you're going to inhale and you um close your epiglottis. It's going to build up the intrathoracic pressure within here. And then when you exhale it opens your epiglottis.

[00:16:54]Like a cough. That's essentially what happens. Um or you can go ahead and try that. So go ahead and just take a big deep breath in >> [snorts] >> and cough.

[00:17:03]>> [cough] >> Good. Okay. So there's two things that we can do for our patient that I'm going to be showing you today. One is going to be a manual assisted cough. Um so I don't have a a good chair with me in here, but we're going to kind of improvise here. I'm going to just put my patient up here so it's supported surface for her leaning on.

[00:17:26]Yep.

[00:17:27]Then I'm going to come right here by the side.

[00:17:31]And it's really important to get information from your patient cuz you're going to be placing your hands just like this right below the sternum. Is that okay?

[00:17:39]Okay, so what I'm going to be doing is you're going to perform your cough. As you cough, I'm going to give you a push or a fine like an upwards um pressure just to help kind of get a better cough for you. You want to try it? All right, ready? Inhale.

[00:17:57]And go ahead.

[00:17:59]Good.

[00:18:00]All right, nice.

[00:18:03]So that was our assisted cough. Then we can also have our patient sit on the edge and this is one that we can um they can do at home. So for this one, this is just like self-assisted.

[00:18:19]Um what you're going to instruct them to do is as they cough, they would throw themselves forward and it'd be a forceful cough. Okay? Would you like to try it?

[00:18:29]All right, ready?

[00:18:32]Good. Yep. Very nice. Okay. So those are our two techniques uh for cough. Now we have two more things left. So first we're going to go over some lung sounds.

[00:18:44]So I'm going to go over some auscultation.

[00:18:48]And we have three different lobes.

[00:18:50]Um we have your upper lobes, your middle lobes, and your lower.

[00:18:54]And if the patient is comfortable, it's always a little bit easier to hear um without like any clothing on. So if they are comfortable removing your shirt, you'd ask them to do that.

[00:19:06]Okay?

[00:19:07]Now to start, I'm just going to have Jasmine swing her legs this way so y'all can see what I'm doing.

[00:19:17]Okay, so we have our upper lobes, all right? Now, with your upper lobes, what you're going to do is when listening, these are typically going to be more high-pitched sounds. Um so maybe easier to listen with the diaphragm side. Then we have our middle and we have our lower. With those, the middle ones is going to be moderate and then your lower lobes is going to be um low.

[00:19:43]I forgot to mention this, but your upper lobes are called your bronchial lobes and then it's bronchio-vesicular and then it turns into your vesicular vesicular lobes, which is your low-pitched sounds. Okay, so I'm just going to go ahead and also tape that with my stethoscope here.

[00:19:59]If that's all right.

[00:20:03]And just breathe normally for me.

[00:20:13]This is the bronchial side or bronchial here.

[00:20:23]Then it turns into our bronchio-vesicular here and is it okay if I lift your sports bra up a little bit?

[00:20:41]Same thing.

[00:20:48]And I'll switch my side here.

[00:21:05]Okay, so that's done. That's how you do it from the back, and then you can also do it from the front, as well. So, I'll have her swing her legs around.

[00:21:13]An additional component that you want to watch out for that would maybe be abnormal, um you can have something called crackles or rails, and that's going to be in the like the vesicular area, so your lower lobes. And that'll kind of hear I like to think of it like a fire, like cracking, popping. You'll hear something like that. Um and then um your wheezing, that is going to be found like maybe in your upper or more middle areas, and um that's more like a dry You'll You'll know when you hear it.

[00:21:44]It's It's It's a wheeze instead of like something wet like a crackle. Um so, it's going to be the same exact thing from the front. It's pretty similar. And I'll go ahead and show y'all how to auscultate the bronchial, bronchovesicular, and then vesicular areas.

[00:22:34]And then do you have hands on your upper chest a little bit?

[00:22:36]There you go.

[00:22:49]Okay.

[00:22:50]So, those are our lung sounds. Now, the last thing we have um are heart sounds. So, when listening to the heart, um same thing. We're going to use the diaphragm side, and then because we can hear our normal sound our normal sounds, which are your S1 and your S2. S1 and S2 are just your love dub, so it's opening and closing of the heart valves.

[00:23:13]After you go in with this side, you can also go in with the bell, and that'll help you hear those abnormal sounds, so S3 and S4. S3 can be normal for athletes. Um But yeah, S4 is definitely not not normally a normal sound. Um okay, so to start off, we have our aortic, pulmonic, tested or tricuspid, and then our mitral valves.

[00:23:38]So, to start, we have our aortic, which is going to be about in the second the second intercostal space, so you can palpate with permission of your patient.

[00:23:46]You'll feel their clavicle, however you like to palpate, but that's kind of where I'm going to go from.

[00:23:52]And then that's your aortic, is your second intercostal space on the right side. Then moving over to our left, we have our pulmonic, and then if you go below, we have our tricuspid, which is in your fourth and fifth intercostal space. And then with your mitral, you go a little bit laterally, and then you'll find you'll find that one. So, I'm going to go ahead and show y'all how to do that.

[00:24:17]Flipping it around.

[00:24:38]So, that's the aortic [snorts] and pulmonic, everything sounds good. I'm going to go on to the mitral, and then tricuspid.

[00:24:56]Okay.

[00:24:57]But everything sounds good on Jasmine.

[00:25:00]Um, but you can also flip it around and listen for those S3 and S4 and you go in the same exact spots. Okay, so aortic, pulmonic, tricuspid, and then mitral.

[00:25:10]All right, and that's it for today.

[00:25:13]That's our heart sounds. So, yeah, thank you.