CHEST AUSCULTATION

Auscultation is the evaluation of breath sounds with a stethoscope.

➢ Auscultation over the thorax (chest) is performed to identify normal or abnormal lung sounds.
➢ Assessment of the patient’s lung sounds is useful in making initial diagnosis and the effects of treatment.
➢ A stethoscope is used during auscultation for better transmission of sounds to the examiner.
➢ Whenever auscultation is performed, the room must be as quiet as possible.

Stethoscope is the instrument used in detecting sounds produced in our body (lung and heart sounds).

➢ Basic parts: earpieces, binaural, tubing, bell and diaphragm.

➢ The bell is of particular value when listening to low-pitched heart sounds but may be also used to listen to
lung sounds in emaciated patients.
➢ The bell should be pressed lightly against the chest when attempting to auscultate low-frequency sounds. If
its pressed too firmly against the chest, the skin will be stretched under the bell and may act as diaphragm,
filtering out certain low-frequency sounds.
➢ The diaphragm piece is used most often in auscultation of the lungs, since most lung sounds are high
frequency.
➢ The diaphragm should be pressed firmly against the chest so that external sounds are not heard.
➢ The ideal tubing should be thick enough to exclude external noises and should be approximately 25-35 (11-
16 in.) in length. Longer tubing may compromise transmission of lung sounds, and shorter tubing is often
inconvenient in reaching the patient’s chest.
➢ The stethoscope should be examined regularly for cracks in the diaphragm, wax or dirt in the earpieces, and
other defects that may interfere the transmission of sounds. It should be wiped off with alcohol on regular
basis to prevent buildup of microorganisms.

Earpieces

Binaural

Tubing

Bell

Diaphragm

Technique

➢ When possible, the patient should be sitting upright in a relaxed position.

➢ The patient should be instructed to breathe in a little deeper.
➢ The bell or diaphragm must be placed directly against the chest wall, since clothing may alter lung sounds
or produced distorted sounds.
➢ The tubing should not be rubbing against any objects, since they produce extraneous sounds.

Errors Correct technique

Listening to breath sounds through the patient’s gown Place bell or diaphragm directly against the chest wall

Allowing tubing to rub against bed rails or patient’s gown Keep tubing free from contact with any objects during
auscultation

Attempting to auscultate in a noisy room Turn television or radio off

Interpreting chest hair sounds as adventitious lung sounds Wet chest hair, if thick, before auscultation

Auscultating only the convenient areas Ask alert patient to sit; roll comatose patient onto side to
auscultate posterior lobes
 1. Normal breath sounds

a. Bronchial or tracheal breath sounds – heard over the trachea, the sound is loud with tubular quality.

b. Vesicular breath sounds – heard over the bases of the lungs. It reveals a soft muffled sound and are
usually heard during inspiration but minimally during exhalation.

c. Bronchovesicular breath sound – heard over the airways specifically over the sternum on the front
chest and between the scapulae at the back chest. It is softer than bronchial breath sounds and lower in
pitch, being heard both during inspiration and expiration.

2. Adventitious or abnormal breath sounds

a. Crackles (rales). A discontinuous sound (less than 20 msec) that is perceived as wet,
crackling, bubbling sound associated with gas moving through liquid. Normally they are heard
during:

a. Pulmonary edema
b. Congestive Heart Failure (CHF)
c. The opening and collapse of airways during inspiration
d. In the presence of excessive secretions

b. Rhonchi: A continuous sound (longer than 25 msec) that is low in pitch and normally
indicative of secretions in large airways. In patients who can successfully mobilize their own
secretions, rhonchi clear with coughing.

c. Wheeze: A continuous sound (longer than 25 msec) that is high pitched and normally
indicative of bronchospasm or mucosal edema in medium to larger airways. Wheezes do not
clear with coughing.

d. Pleural friction rub: A creaking or grating sound as a result of inflamed pleural surfaces
rubbing together during breathing.

Proper sequence in chest auscultation

Sites for Auscultation of the Lungs