Lung Sounds Auscultation- Know where to place your stethoscope. PDF

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Summary

Handout to teach students where to place their stethoscope for learning auscultation of lung sounds. Also includes description of normal lung sounds and adventurous lung sounds....

Description

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Auscultation+of++Normal+Breath+Sounds+ Breath!sounds!are!created!when!air!moves!in!and!out!the!respiratory!tract.!When!you!assess!breath! sounds!you!are!assessing!the!pitch,!intensity,!quality!and!duration!of!the!inspiration!and!expiration.!The! classification!of!normal!breath!sounds!includes!vesicular,!bronchovesicular,!bronchial,!and!tracheal.! Vesicular+ Vesicular!breath!sounds!usually!are!a!low-pitched!sound!and!have!a!soft!quality.!You!will!hear!vesicular! breath!sounds!from!the!beginning!of!inspiration!to!almost!the!end!of!expiration.!Therefore,!there!is!not! usually!a!pause!in!this!breath!sound.!You!can!hear!vesicular!breath!sounds!throughout!the!periphery!of! the! lung ! fields.! Bronchovesicular+ Bronchovesicular!breath!sounds!are!the!inspiration!and!expiration!sounds!heard.!These!breath!sounds! will!have!a!pause!between!inspiration!and!expiration.!They!have!a!moderate!pitch.!You!can!usually!hear! this!breath!sound!over!the!upper!portion!of!the!lungs!around!the!1st!and!2nd!intercostal!spaces.! Bronchial+ Bronchial!breath!sounds!are!a!high-pitched!sound.!The!expiration!period!is!longer!than!the!inspiration! period.!You!will!hear!these!sounds!best!next!to!the!trachea.! Tracheal+ Breath!sounds!heard!over!the!trachea!are!tracheal!breath!sounds.!The!tracheal!breath!sounds!are!highpitched!and!are!loud.!The!sounds!are!heard!equally!during!inspiration!and!expiration.! Auscultation+of++Abnormal+(Adventitious+)+Breath+Sounds+ Abnormal!breath!sounds!are!called!“extra”!or!“adventitious”!breath!sounds.!Adventitious!breath!sounds! include!crackles!(formerly!known!as!rales),!wheezes,!rhonchi!and!friction!rubs.+ Air+flowing+by+liquid+cause+crackles+(rales).+ Crackles!can!be!fine,!medium!or!coarse.! Fine!crackles!are!high-pitched!crackling!or!popping!sound.! Coarse!crackles!are!a!low-pitched!gurgling!sound.! These!sounds!are!usually!heard!during!inspiration.! Crackles!create!a!dry!sound!when!heard!higher!in!the!bronchial!tree.! Crackles!create!a!wet!sound!when!heard!lower!in!the!bronchial!tree.! ! Air+flowing+through+constricted+airways+cause+wheezes.+ • • • • • • •

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Wheezes!have!a!high-pitched!musical!sound.! High-pitched!wheezes!are!sibilant.! Low-pitched!wheezes!are!sonorous.! Heard!on!inspiration!and!expiration.! Wheezes!are!continuous.!

They!are!unusually!bilateral.!Wheezes!that!are!unilateral!are!usually!due!to!an!obstruction!by!a! foreign!object.! • ! Air+flowing+over+thick+secretions+cause+rhonchi.+ •

Rhonchi!create!a!low-pitched!sound.! They!are!usually!continuous!and!prolonged.! Sibilant!or!high!pitched!rhonchi!are!heard!over!the!smaller!bronchi.! And,!sonorous!or!low!pitched!rhonchi!are!heard!over!the!larger!bronchi.! It!is!sometimes!hard!to!distinguish!between!crackles!and!rhonchi.!Therefore,!have!the!patient! cough.!If!it!disappears,!it!is!usually!rhonchi.! ! Inflammation+of+the+pleural+space+cause+friction+rubs.+ • • • • •

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A!friction!rub!is!not!produced!inside!the!airways.! Also,!friction!rubs!are!a!dry,!rubbing,!crackling!sound.! Usually!caused!by!inflammation!or!loss!of!pleural!fluid.! You!will!hear!friction!rubs!during!inspiration!and!expiration!

Locations for Auscultation of Lung Sounds (1-14)...