Lung Markings & Auscultation Flashcards
What part of the stethoscope do you use for auscultation?
Diaphragm (large side)
To hear the high frequency of breath sounds
How is the stethoscope positioned on the skin?
Diaphragm placed firmly onto the skin to reduce extraneous sounds including the rustle of chest hair
How do you ask the patient to breathe?
Clear any oral secretions first if able
Breathe a little deeper than normal, but steadily in and out through the mouth (reduces turbulence through the nose)
Ensure they are not hyperventilating
Best position for patient?
Sitting up right in a relaxed position on edge of bed or chair, arms facing forward to protract scapulae
If patients can’t sit up, side lying may be used but sounds from underneath lung are usually quieter
Position/technique of physiotherapist?
Standing behind/to side of patient
In a quiet room
Ask for consent, and if pt comfortable removing clothing
Compare right to left sides systematically and work from apex to bases
Always listen to a full cycle insp/exp in each area
Listen for pitch, amplitude, distinctive characteristics, duration of insp/exp ratio
Description of normal breath sounds (vesicular)
Low pitched, rustling quality
Muffled because air in alveoli is a poor conductor of sound
Quieter in base than apex because greater volume in the lung base filters the sound further
Inspiration louder than expiration because of turbulence created by airway bifurcations
Insp 3: 1 exp, distinctive pause in between
https://www.easyauscultation.com/cases?coursecaseorder=1&courseid=201
Where to listen for superior lobes?
Anteriorly - 2nd intercostal space mid clavicular line
Posteriorly - between C7 and T3 (not area covered by scapulae)
Where to listen for inferior lobes?
Anteriorly - 6th intercostal space, mid clavicular line
Posteriorly - between T3 and T10
Where to listen in the mid zones?
Ask patient to raise arm
Listen a few centimetres below armpit
6th/7th intercostal space in midaxillary line
Listening for: middle lobe on right side, lower lobe on left
Surface marking of oblique fissure
divides into superior and inferior lobes
T3 spinous process
Along medial border of scapula
Along 6th rib and costal cartilage (below nipple)
Surface marking of horizontal fissure (right lung)
4th costal cartilage (above nipple)
Surface marking of diaphragm on left side
Anteriorly at 6th rib
Mid-axilla 8th rib
Posteriorly at T10
Surface marking of diaphragm on right side
5th rib
Mid-axilla 8th rib
Posteriorly T9
higher due to presence of liver
Surface marking of trachea
Bifurcation into bronchi at sternal angle (where manubrium meets body of sternum)
Surface marking of apical segments
Anteriorly, upper aspect extends 2.5cm above medial 1/3rd of clavicles
Posteriorly extends to T1
