Breath sound

Human physiology-II
 Auscultation
STETHOSCOPE

• Chest piece

• Diaphragm- High frequency - Lungs

• Bell- Low frequency – Heart

• Tubing– 11-16 inches.

• Ear pieces– Angled.

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 Listening Techniques

• Sit Patient Up.

• Deep Breath Through Mouth.

• Stethoscope on Skin.

• TV, Radio, Visitors OFF!

• Systematic Comparison of L and R, and All Lobes.

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 Normal Breath Sounds

• Bronchial or Tracheal

• Bronchovesicular.

• Vesicular.

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 Tracheal / Bronchial

Heard over and

around trachea
• Loud, high
pitched, harsh,
“tubular”
• E is louder and
longer then I
• Short pause
between I and E

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 Bronchovesicular
Combination of the other 2
• Heard around sternum,
between
scapula, anterior RUL.
• I and E are equal duration
and
loudness, no pause.
• More muffled than
Bronchial.

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 vesicular

Heard over the Majority lung

periphery.
• Medium pitch and loudness.
• Inspiration is louder and
longer than expiration.

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 Adventitious (Abnormal)
Breath Sounds
Bronchial or Bronchovesicular where you should hear
vesicular.
• Indicates fluid filled or consolidated areas.

• Fluid transmits vibrations better than air.

• Breath sounds are “telegraphed" from large airways to

periphery.

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• Lung auscultation is listening to the lungs bilaterally at
the anterior chest and posterior chest.
• Wheezing is described as a musical sound on expiration
or inspiration. It is the result of narrowed airways.
• Crackles or rales are similar to rhonchi except they are
only heard during inspiration. It is the result of alveoli
popping open from increased air pressure.

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Rhonchi/Wheezes
• Continuous “musical” notes

• Primarily heard on E

• Large airways=low pitch=sonorous

rhonchi (“Snoring” type of sound)

• Small airways=high pitch=wheeze=sibilant rhonchi.

• Caused by narrowed airways from secretions, edema,

bronchospasm.

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Rales/Crackles
• Discontinuous notes, “bubbling”,

“pops”, “fizz”, moist or dry

• Mainly heard on I, often clears with coughing.

• Lg airways=low pitch=bubbling coarse rales/crackles

• Sm airways=highpitch=fine/velcro/dry rales/crackles.

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Rubs
• Heard at lung apices.

• End of I and beginning of E.

• Like creaking leather or balloon.

• From pleural/visceral membranes rubbing.

• Pleurisy, some neoplasms.

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Stridor (A harsh, shrill, grating, or creaking sound)
• Continuous sounds heard during inspiration.

• High pitched. Suggests about upper airway obstruction.

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Diminished/Absent BreathSounds

• Fluid, blood, or air between lung and chest wall.

• Complete airway blockage (mucus, tumor, foreign body)

• Pneumothorax, severe emphysema, resection, obesity,

effusion.

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THANK YOU

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