auscultation Flashcards
what is auscultation?
-listening to and interpreting the sounds produced within the thorax
-divided into breath sounds (BS) and added sounds (AS)
What are the steps of doing auscultation with a stethoscope?
-use the diaphragm of the stethoscope
-ear pierces should point forwards
-chest should be exposed, dont listen through fabric
-ask pt to breathe in and out through mouth
-always compare left w/ right
what are the different areas of auscultation in the front and the back of the lungs?
what do normal or vesicular breath sounds sound like?
-faint, muffled and low pitched
-note inspiration is longer than expiration
-heard at the bases of the lungs
what are examples of abnormal breath sounds?
-bronchial
-decreased
-absent
-adventitious/added
what is the inspiratory time: expiratory time ratio for breath sounds?
3:1
where are bronchial breath sounds heard?
heard normally over the trachea / large airway
-abnormal if heard in the peripheral airways
describe bronchial breath sounds
- expiration is as loud as inspiration
-sounds like Darth Vader breathing
-loud and harsh sounding heard equally on inspiration and expiration
where is it normal vs abnormal to hear bronchial breath sounds ?
-normal -over trachea / large airway
-abnormal - in peripheral airways
how are breath sounds created?
by flow related turbulence
what can reduced flow cause to BS?
less sound
what are the causes of decreased or absent breath sounds?
-bi basal post-op atelectasis or lobar atelectasis
-poor inspiratory effort due to pain or fatigue
-emphysema
-asthma
-pneumothorax
-obesity
pleural effusion
what are adventitious / added breath sounds?
-extra noises that shouldn’t be there
list examples of added breath sounds
-crackles (creps)
-rhonchi (gurgling / bubbling sounds heard during breathing)
-wheezes (whoosh eeeee)
-stridor (inspiratory wheeze due to large airway narrowing)
-pleural rub
describe crackles (added sound)
-popping sound (like fireworks)
-created when air is forced through airways that have been narrowed by inflammation, secretions or oedema
-mainly heard on inspiration
-can be early or late
-velcro sound
how would you distinguish between early and late crackles?
-ask pt to cough if crackles heard at the mouth
-early inspiratory crackles indicate diffuse airflow limitation eg COPD
-coarse early inspiratory crackles occur when bronchioles open due to secretions eg bronchiectasis
-late inspiratory crackles involve alveoli eg bronchiectasis or IPF
describe wheezes
-a whistling sound produced by airflow vibrating a narrowed or compressed airway
-can be high or low pitch
-mainly heard during expiration
-low pitched - known as rhonchi
what’s the difference between a monophonic vs polyphonic wheeze?
-monophonic- large airway obstruction - single sound
-polyphonic wheeze - small airway obstruction, multiple sounds
what can cause wheezes?
-bronchospasm
-mucosal oedema
-sputum
-foreign body / tumour
-pulmonary oedema
what is stridor and what does it indicate?
-a loud inspiratory wheeze heard at the mouth
-indicates significant upper airway obstruction (larynx, trachea, main bronchi)
when is stridor heard?
inspiration - if severe airway obstruction it is heard on both inspiration and expiration
what are the possible causes of stridor?
-foreign body
-obstruction
-large airway tumour
why is stridor common in paediatrics?
as they have small narrow airways - can get blocked easier
what is pleural rub?
-creaking or rubbing sound eg creaking door
-inspiratory and expiratory sound
-reoccurs at same time in each resp cycle
