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Auscultation of the Lungs
Auscultation
= listening for sounds produced in the body
ID normal vs. abnormal lung sounds
Aids in Dx & evaluation of RX
Use stethoscope, quiet room
Stethoscope
4 parts
bell low-pitched heart sounds diaphragm high-pitched lung sounds press firmly tubing not too long or too short earpieces point away
Technique
patient upright, relaxed
instruct patient to breathe a little deeper than normal with
mouth open
diaphragm placed against bare skin, if possible
tubing should not touch anything
systematic approach
listen for 1 full breath cycle
Diaphragm Positions
Examination
remember, physical exam of patient consists of 4 parts:
inspection palpation percussion auscultation
what are we listening for?
characteristics of breath sounds 7
Characteristics
1. pitch
vibration frequency
2. amplitude
intensity (loudness)
3. duration of inspiration vs. expiration
4. distinctive characteristics
normal vs abnormal Normal vesicular BS
Normal Breath Sounds
tracheal
heard over trachea tubular quality length: insp = exp
bronchovesicular
heard over upper half of sternum/between scapulae softer than tracheal, lower in pitch Normal tracheal BS Normal bronchovesicular BS
Crackles (Rales)
high pitched
heard during inspiration
due to
small airways & alveoli “popping” open atelectasis fibrosis pneumonia fluid in alveoli pulmonary edema CHF
do not clear with cough or suctioning
Fine inspiratory crackles Medium inspiratory crackles Chest hair crackles
Crackles (Rhonchi)
low pitched
heard during inspiration &/or expiration
due to
secretions in larger airways
may clear with cough or suctioning
coarse crackles or rhonchi 15
Stridor
produced by rapid airflow through narrowed upper
airway
infection inflammation/swelling tumors foreign body
place stethoscope on neck
may hear without stethoscope
life-threatening - ventilation may be compromised, esp. if
accompanied by cyanosis
Stridor
Pleural Friction Rub
creaking or grating
pleural surfaces are inflamed and rough edges rub
together
insp &/or exp
not very common
Pleural friction rub
Subcutaneous Emphysema
air leaks from lungs into subcutaneous tissues
fine beads of air produce a crackling sound and
sensation when palpated
Subcutaneous emphysema
