Auscultation Flashcards
what is auscultation
the process of listening to and interpreting the sounds produced within the thorax-breathing, it is used to verify observed and palpated findings before, during and after treatment.
what do you have to do before auscultation
prior to auscultation it is worth listening at the mouth, crackles heard at the mouth should be cleared by coughing in order to prevent them for masking other sounds during auscultation
stethoscope labelled
earpieces-should be facing forward, conducting tube-12 inches long, bell- used for cardiac sounds and paediatrics or people smaller, diaphragm- area that physios use all of the time- listen to peoples breathing and respiratory sounds, check stethoscope is tuned to diaphragm
what are the 2 elements of lung auscultation
breath sounds and added sounds
what is breath sounds
the terminology breath sound is more accurate than air entry as air may be entering the lungs, but the transmission is blocked. breath sounds can be: normal, increased (AKA bronchial), decreased/ absent
how are breath sounds generated
turbulent air in airways, only generated in small portions of the airway (first 4-5 generations- primary bronchi to bronchioles), transmitted through lung to chest wall
how are breath sounds generated- conductors
lung tissue is a good sound conductor, air is a poor sounds conductor. want to consider intensity- expect there to be a change- closer to big aways= more intense (e.g. trachea), further away less intense
how are breath sounds generated- breath sounds
consider quality of breath sounds, duration and pitch of inspiration to expiration
breath sounds- normal
sounds heard over the entire lung field, muffled in quality, gets quitter the further from the trachea, inspiration is louder than expiration- active process- turbulence, inspiration is longer due to more turbulence, no pause between inspiration and expiration
breath sounds- increased (bronchial)
it is a louder, more coarse sound compared to normal, inspiration and expiration are- equal pitch, intensity, duration, pause between inspiration and expiration, AKA- darth vader breathing
where is increased breathing sound heard
normally over a trachea, occurs when the lung tissue is more dense due to pathology- increase breathing sound- good conductor
breathing sound- decreased/ absent
decreased sound much quieter breath sound caused by pathology of the underlying causing a disproportionate reduction in normal breath sound
breathing sound- decreased/ absent- cause
decreased ventilation to generate sound- e.g. collapse/ consolidation, decreased mechanics of breathing or chest wall movement (scoliosis or fractured rib), decreased transmission of the sound- e.g. obesity or pleural effusion- extra fluid in lungs, anything that creates extra barrier between lung tissue and breathing, can affect love or complete lung
increased breathing sound- possible cause
consolidation, collapse, at the fluid line of pleural effusion, large mass
decreased/absent breathing sound- possible cause
shallow breathing, poor positioning, atelectasis/collapse with complete obstruction of airway, hyperinflation (empheymma), obesity/ very muscular patients, pleural effusion, pneumothorax, spondylitis
what is added sound
they are superimposed on top of breath sounds, they are sometimes more obvious and can mask the breath sound, in order for them to be an added sound they must be respiratory in origin and must be confused with non-respiratory sound such as vocal and abdomen noises or water in oxygen tubing
3 types of added sounds
crackles/ creoutatubilis/ rales, wheezes, pleural rub
added sounds- crackles
it is suggested that the primary source of crackling during to the explosive equalisation of gas pressure between 2 components of lung, when a closed section of airway separating them suddenly open (can only occur in inspiration- cant hear lungs collapsing down), other suggestions are that crackles are due to seperation in the airways being audible as air passes through them
2 groups of cracking
coarse- Coarse crackles are louder, more low pitched and longer lasting. They indicate excessive fluid on the lungs which could be caused by aspiration, pulmonary oedema from chronic heart disease, chronic bronchitis, pneumonia[7].
and fine- Fine crackles could suggest an interstitial process; e.g pulmonary fibrosis, congestive heart failure
crackles- what does it indicate
can happen anywhere in the respiratory cycle (inspiration, expiration or both), mostly indicative of sputum although absence of crackles does not necessarily indicate the absence of sputum, if you hear crackles that are sputum in origin- where is important- target treatment to a specific area
crackles and the respiratory cycle
the timing of when crackles are heard in the cycle can indicate their position in the bronchial tree
early inspiratory crackles- proximal airways, late inspiratory crackles- peripheral airways, early expiratory crackles- proximal airways, late expiratory crackles- peripheral airways
added sounds- wheeze
wheezing sound caused by air passing through narrowed airways. pitch varies depending on the amount of narrowing- the greater the narrowing the higher the pitch, can occur on inspiration and expiration
2 types of wheeze
monophonic is generated by one airway, single note, same position in respiratory cycle
polyphonic is generated by several airways giving different notes- sounds musical,
added sounds- rub
clearly leathery sound, pleural surfaces rubbing together, usually heard in late inspiration and early expiration, often identical on inspiration and expiration, crickey sound- opposite sound between 2
examples of crackles
reopening of collapsed. atelatic airways, sputum, pulmonary oedmea, fibrosis
examples of wheezes
bronchospasm, airway oedema, sputum, tumor, foreign body
auscultation technique
should be conducted in a systemic manner, comparing one side to the other whilst visualising the underlying lung structure, should not be placed on clothing, sheet, should be cleaned in between patient use, the patients should be asked to sit upright where they can breathe through the mouth to reduce the nose turbulence- hear more, warn the patient to inform you if they feel dizzy, document what you heard,
auscultation technique
the stethoscope should be placed in a methodical order comparing the lobes on one side to that of the other lung, even though there is no middle lobe in the left lung, the corresponding area should still be compared to that of the right middle lobe
auscultation- different lobes
upper lobes- assessed anteriorly, middle lobes- assessed anteriorly or laterally, lower lobes- posteriorly
lung markins
2.5cm above medial clavicle, 4th CC, 6th CC (midclavicular line on left), 8th rib on axillary line, T2 and T10
things that can interfere with assessment
movement of stethoscope on skin, oral cavity sounds, clothing/ sheets, hair skin (use bell part), water in tubing, shivering, external sound
