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
what is pleural rub caused by?
-caused by inflammation eg lobar pneumonia
what area will an increased liver size have an effect on?
the right lower lobe breath sounds
what effect will an increase in stomach size have on the BS?
decrease in left lower lobe breath sounds
do you listen posteriorly or anteriorly to assess LL?
posteriorly
what is the ideal position of a patient to auscultate them?
-forward lean sitting
which area of the lung are fine crackles heard well?
-the base of the lung
course crackles are louder and longer in duration in comparison to fine crackles … true or false
true
how can you test vocal resonance ?
-place stethoscope on the chest wall as the patient whispers 99 or 1,2,3 over and over
-whispered speech cannot usually be heard over normal healthy lung
what are some things you need to document about auscultating?
-air entry AE - eg good throughout or poor AE right base
-comment on additional sounds eg expiratory crackles right base
