Understanding Lung Auscultation Techniques

Oct 6, 2024

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Lung Auscultation Lecture Notes

Presenter: Sarah, Registered Nurse

Objectives

  • Understand lung anatomy for effective auscultation.
  • Identify specific auscultation sites with landmarks.
  • Recognize normal breath sounds and their locations.
  • Distinguish between normal and abnormal breath sounds with audio examples.

Lung Anatomy Overview

Auscultation Sites:

  • Anterior Chest: Predominantly upper lobes.
  • Posterior Chest: Predominantly lower lobes.

Right Lung Anatomy:

  • Lobes: Right Upper Lobe, Right Middle Lobe, Right Lower Lobe.
  • Fissures: Horizontal Fissure, Oblique Fissure.

Left Lung Anatomy:

  • Lobes: Left Upper Lobe, Left Lower Lobe.

Important Structures:

  • Trachea: Branches into bronchi and bronchioles.
  • Gas Exchange: Occurs in alveolar sacs.

Auscultation Tips

  • Use the diaphragm of the stethoscope directly on the patientā€™s skin for best sound quality.
  • Positioning for women: Raise their breast to access lung sounds.
  • Listen to both front and back sides of the chest.
  • Note the full cycle of inspiration and expiration.
  • Characteristics to evaluate:
    • Pitch (high, medium, low)
    • Sound quality
    • Duration (inspiration vs. expiration)
    • Adventitious sounds
  • Start at the lung apex and compare sides systematically.
  • Patient Positioning: Have them sit up and move arms forward to separate shoulder blades.
  • Breathing: Encourage slow breathing through the mouth.

Auscultation Sites

Anterior Chest:

  1. Apex: Above the clavicle.
  2. Upper Lobes: Second intercostal space, midclavicular line.
  3. Right Middle Lobe: Fourth intercostal space.
  4. Lower Lobes: Sixth intercostal space, midaxillary line.

Posterior Chest:

  • Upper Lobes: C7 to T3.
  • Lower Lobes: T3 to T10.
  • Compare sides systematically down the back.

Normal Breath Sounds

Types:

  1. Bronchial:

    • Location: Anteriorly over the trachea.
    • Pitch: High and loud.
    • Inspiration < Expiration.

  2. Bronchovesicular:

    • Location: Anteriorly (1st & 2nd intercostal spaces) and posteriorly (between scapulae).
    • Pitch: Medium.
    • Inspiration = Expiration.

  3. Vesicular:

    • Location: Throughout peripheral lung fields.
    • Pitch: Low and soft.
    • Inspiration > Expiration.

Abnormal Breath Sounds

Continuous:

  1. High-Pitched Polyphonic Wheeze:
    • Mainly heard in expiration, high-pitched musical sound.
  2. Low-Pitched Monophonic Wheeze:
    • Low-pitch whistle, one sound quality.
  3. Stridor:
    • High-pitched whistling on inspiration, indicates obstruction.

Discontinuous:

  1. Coarse Crackles:
    • Low-pitched, wet bubbling sound, mainly in inspiration.
  2. Fine Crackles:
    • High-pitched crackling, does not clear with cough.
  3. Pleural Friction Rub:
    • Low-pitched harsh grading sound, heard in both inspiration and expiration.
    • Differentiate from pericardial friction rub by holding breath.

Additional Resources

  • Take a free quiz available on the website.
  • Check out related videos for practical demonstrations.

End of Lecture Notes