Auscultation: Listening to breath sounds with a stethoscope

Normal Breath Sounds and Their Locations

Abnormal Breath Sounds: Diminished or Absent Increased distance between aerated lung and chest wall: Pneumothorax, Pleural effusion, Atelectasis, Obesity around thorax Decreased or absent airflow Airflow obstruction (eg asthma), Hyperinflation (COPD), Malpositioned ET Tube

Abnormal Breath Sounds: Bronchial or Bronchovesicular in abnormal part of the lung Lung has become more solid and less aerated in these areas Consolidation, eg, pneumonia, or Atelectasis

Abnormal Breath Sounds: Adventitious Sounds Wheeze – continuous musical sounds heard mostly during expiration May be also heard on inspiration Caused by a sudden change in airway caliber Edema, spasm, secretions, foreign body

Abnormal Breath Sounds: Adventitious Sounds Crackles – discontinuous sound heard mostly on inspiration Caused by small airways and alveoli popping open or from secretions in very large airways

Lets all listen in

Chest Excursion Fremitus Percussion Breath Sounds Condition Atelectasis Pneumothorax Pleural Effusion COPD Pulmonary Consolidation Fibrosis Pulmonary Edema

Chest Physical Exam: Case Study A patient is admitted with fever and cough. Auscultation reveals bronchial breath sounds in the lower chest posteriorly and normal vesicular breath sounds in the rest of the lower thorax.

Chest Physical Exam: Case Study A patient is scheduled for inguinal hernia surgery. Observation reveals increased AP diameter and use of accessory muscles for breathing. Auscultation yields diminished breath sounds in the upper and middle chest and absent breath sounds in the lower chest.

Chest Physical Exam: Case Study A 12 year patient in the ER with respiratory distress has bilateral wheezes throughout both lung fields and prolonged expiration. A-P diameter of the chest is increased.

Chest Physical Exam: Case Study A ventilator patient suddenly becomes diaphoretic and tachycardic. The pressure limit alarm on the ventilator is sounding on every breath. Auscultation shows absent breath sounds on the left and percussion yields hyperresonance on the left.