To study about the structure

functioning of stethoscope
 Stethoscope
• Stethoscopes are often considered as a symbol of healthcare
professionals, as various healthcare providers are often seen or
depicted with stethoscopes hanging around their necks. A 2012
research paper claimed that the stethoscope, when compared to
other medical equipment, had the highest positive impact on
the perceived trustworthiness of the practitioner seen with it.
• The stethoscope is an acoustic medical device for auscultation,
or listening to the internal sounds of human body. It typically
has a small disc-shaped resonator that is placed against the body
part, and two tubes connected to earpieces. It is often used to
listen to lung and heart sounds. It is also used to listen
to intestines and blood flow in arteries and veins. In
combination with a sphygmomanometer, it is commonly used
for measurements of blood pressure.
 History
• The stethoscope was invented
in France in 1816 by René Laennec at
the Necker-Enfants Malades
Hospital in Paris. It consisted of a
wooden tube and was monaural.
Laennec called his device the
"stethoscope"[ (stetho- + -scope,
"chest scope"), and he called its use
"mediate auscultation", because it
was auscultation with a tool
intermediate between the patient's
body and the physician's ear.
• In 1851, Irish physician Arthur Leared
invented a binaural stethoscope
 Parts
• Eartips
• Eartube
• Tubing
• Headset
• Stem
• Chest-piece
• Diaphram
• Bell
 EARTIPS
• The eartips of a stethoscope is the part that
goes into the users ear where they receive the
sounds that come from the chest-piece.
• The eartips are generally made out of rubber
or silicone material and are designed to create
a form fitting seal inside of the ears so that
unwanted sounds stay out.
 EARTUBE
• The eartubes are the metal/steel parts of the
stethoscope that connect to the eartips and
the synthetic/PVC tubing, which connects to
the stem of the chest-piece.
• The eartubes are designed to isolate and
transfer sound to the users ears with
minimum quality loss.
 TUBING
• The soft flexible line of the
stethoscope is known as its tubing.
• The purpose of the tubing is to
maintain and transfer the sound
that is captured by the diaphram
or bell and send it to the eartubes
where it can make its way to the
users ears.
• Depending on the stethoscopes
make and model the tubing may
be made with a single tube or dual
lumen tube design that connects
to the steel eartubes.
 HEADSET
• The headset is the combined components of the upper half of
the stethoscope which include the eartubes, tension springs
and eartips.
• All of the components are designed together to form a
comfortable alignment in the users ears and are angled in a way
that provides maximum sound quality throughout the headset.
• When viewed from the side the eartips of the headset can be
seen pointed toward the users nose while the eartubes hang
back slightly.
• This allows sound to flow efficiently into the ear canal so that
their is minimal disturbance from the stethoscope.
 STEM
• The stem is basically the metal/steel part of
the stethoscope that connects the
stethoscopes tubing to the chest-piece.
• Aside from connecting the two components of
the stethoscope it also allows the user to
switch/click between the chest-pieces
diaphragm and bell by turning the chest-piece
and clicking it into place via the ball bearing.
 CHEST-PIECE
• The chest-piece of the stethoscope is composed of the
connected stem, diaphragm and/or bell.
• As far as function goes the chest-piece part of the
stethoscope is used to listen to patient sounds by placing
the diaphram or bell end of the chest-piece on the patients
chest, back or stomach.
• Most chest-pieces work best when applied against the
patients skin, however some stronger, high quality
stethoscopes may be able to pick up sounds through thin
layers of clothing.
 DIAPHRAGM
• The diaphragm is the large circular end of the
chest-piece.
• This side of device allows medical professionals to
listen to a wider area of the patients body and
picks up higher frequency sounds than the bell
half of the chest-piece.
• Some diaphragms feature a non-chill,
hypoallergenic diaphragm in order to ensure
maximum comfort for the patient being observed.
 BELL
• The bell is the smaller circular end of the chest-piece.
• This side of the device focuses on a narrower range
listens for lower-frequency sounds that may not easily
be detected by the diaphragm.
• As with the diaphragm the bell may also feature a
non-chill, hypoallergenic design to provide patients
with additional comfort while they are being listened
to.
 Working of stethoscope
• The sounds that are created from the patients body
parts are picked up through the diaphragm or bell
end of the stethoscope, which is pressed against the
patients chest, back or stomach of the patient.
• From the chest-piece, which houses the
diaphram/bell the sound then travels through the
tubing and into the eartubes before being passed to
the users ears where they can hear the patients
heartbeat, lungs and other internal sounds.
 Technique of usuage:
• Starting from the top of the stethoscope, the ear
pieces should be inserted so that they point towards
the bridge of your nose. A good stethoscope is
designed with binaurals (the two tubes that end with
the ear pieces) that point slightly forwards.
• This is because your ear canals are angled slightly
forwards. You’ll know that you have a good fit because
all the noise around you becomes very faint when the
ear pieces are inserted, allowing you to concentrate
on the sounds coming through the stethoscope.
• Another useful guide is to hold the stethoscope
headset in front of your face and see whether you
can see the holes in the earpieces. If you can, again
it’s the wrong way around. Because the earpieces
should face slightly away from you, the holes will
be out of sight.
• On some models these are on opposite sides,
requiring the chest piece to be rotated to switch
between the two. This is done by twisting the tube
just before the point where it enters the chest
piece.
• If one is not sure which side is currently active, or y
wants to be sure about switched modes, they
should tap the diaphragm lightly with your
fingertip. In diaphragm mode you’ll hear the
tapping very loudly through the earpieces.

• The stethoscope should be placed against different

points on the body. Ideally it should always be
against the skin because even a thin layer of
clothing will impede performance.
 The auscultation of chest

• To optimise the effectiveness of auscultation the

surroundings should be:
• Quiet - the ambient noise might interfere the heart
and lung sounds.
• Warm - so that the patient feels comfortable
while the upper part of the body is being exposed.
Also, it is to avoid shivering that may add the noise.
• Appropriate lighting - to allow good coordination
between visual and auscultatory findings.
To ausculate the lung for the breath sounds

• Ask the patient to disrobe, as this will allow the

stethoscope to be placed directly on the chest.
• Make sure the patient is sits upright in a relaxed
position, where this is possible.
• Instruct the patient to breathe a little deeper than
normal through the mouth.
• The bell/diaphragm of the stethoscope is then placed
against the chest wall.
• Auscultation of the lungs should be systematic, including
all lobes of the anterior, lateral and posterior chest.
• The examiner should begin at the top, compare
side with side and work towards the lung bases.
• The examiner should listen to at least one
ventilatory cycle at each position of the chest wall.
• The examiner should identify four characteristics of
breath sounds: pitch, amplitude, distinctive
characteristics and duration of the inspiratory
sound compared with the expiratory sound.
 Technique
• Auscultate from side to side and top to
bottom. Omit the areas covered by the
scapulae.
• Usually the APEX of the lungs
bilaterally (2cm superior to medial 1/3
of clavicle)
• Superior Lobes anterior (2nd
intercostal space mid clavicular line)
and posterior (Between C7 & T3)
• Inferior Lobes bilaterally anterior (6th
intercostal space, mid-axiallary line)
and posteriorly (between T3 & T10)
• Middle lobe right anterior only (4th
intercostal space mid-clavicular line)
• Compare one side to the other looking
for asymmetry and note the location
and quality of the sounds you hear.
 Normal breath sounds

• The vesicular breath sound:

is heard over the thorax,
lower pitched and softer
than bronchial breathing.
Expiration is shorter and
there is no pause between
inspiration and expiration.
• Bronchial breath sound:
heard over the trachea has a
higher pitch, louder,
inspiration and expiration are
equal and there is a pause
between inspiration and
expiration.
• https://
www.easyauscultation.com/vesicular-breath-s
ounds
• https://
www.easyauscultation.com/bronchial-breath-
sounds
• https://
www.easyauscultation.com/crackles-lung-sou
nds
• https://www.easyauscultation.com/wheezing
• Abnormal breath sounds:
Intensity of breath sounds, in general, is a good index of ventilation of
the underlying lung. If the intensity increases there is more ventilation
and vice versa. Breath sounds are markedly decreased in emphysema.
• Symmetry: If there is asymmetry in intensity, the side where there is
decreased intensity is abnormal.
• Any form of pleural of pulmonary disease can give rise to decreased
intensity.
• Bronchial breathing anywhere other than over the trachea, right clavicle
or right inter-scapular space is abnormal. Presence of bronchial breathing
would suggest:
• Consolidation
• Cavitation
• Complete atelectasis
• Foreign body airways
• Tension Pneumothorax
• Pleural effusion
 Observations and results:
Name, age/ Type of Site pitch character Pause
sex breath
sound
VBS
Xyz, 21y/M BBS
VBS
Pqrs, 35y/F BBS
VBS
ABC , 28Y/M BBS
 Results:
• The breath sounds of the selected subjects are
found to be normal in character, hence the
respiratory functions of those subjects are
found to be normal.
 To ausculate the chest for heart sounds

• It should be noted that auscultation comes after palpation, the

patient is normally lying comfortably at 45 degrees angle with
their chest region fully exposed.
• There are four main regions of interest for auscultation:
• The 4 pericardial areas are examined with diaphragm,
including:
• Aortic region (between the 2nd and 3rd intercostal spaces at
the right sternal border) (RUSB – right upper sternal border).
• Pulmonic region (between the 2nd and 3rd intercostal spaces
at the left sternal border) (LUSB – left upper sternal border).
• Tricuspid region (between the 3rd,
4th, 5th, and 6th intercostal spaces at
the left sternal border) (LLSB – left
lower sternal border).
• Mitral region (near the apex of the
heard between the 5th and 6th
intercostal spaces in the mid-
clavicular line) (apex of the heart).
• The four pericardial areas relate to
the heart sounds and can detect
various abnormalities in the heart
such as the valve stenosis or
incompetence which are diagnostic
for many diseases in the
cardiovascular system.
Characteristics of normal heart sounds:
• First heart sound S1: longer dull sound produced due to the
closure of AV valves that resembles the slang L-U-B-B.
• Second Heart sound S2: sharp shorter sound produced due
to the closure of SL valves that resembles the slang D-U-P.
• Third heart sound S3: audible in 60% of the normal
subjects only.
• Fourth heart sound S4: sound heard just before S1 not
audible by stethoscope but by cardio-phonogram.
• Murmur : abnormal sounds heart due to turbulence of
blood flow
 Observations:
Heart sound Audibility Splitting Nature
First heart sound
Second heart sound
Third heart sound
Fourth heart sound
Murmur
 Results:
• The first and second heart sounds are audible
by stethoscope with normal nature and no
splitting. The third and fourth heart sounds
are inaudible by stethoscope. No murmur was
heard during the examination. The cardiac
functions are supposed to be normal.
 To observe bowel sounds by stethoscope
• As peristalsis moves the chyme along the bowel tract,
grumbling noises are heard indicating that the bowels are
active. For ausculation of bowel sounds, the abdomen is
divided into four quadrant. And one needs to listen over each
quadrant for at least five minutes. Finding no bowel sounds
can mean an ileus, or an obstruction above that area of the
intestine. Hypoactive bowel sounds are considered as one
every three to five minutes, and this can indicate constipation,
anxiety, or gastroenteritis. Hyperactive bowel sounds are
often found before a blockage. It is quite common to find one
quadrant with hyperactive bowel sounds and one with none or
hypoactive ones. This is because the intestine is attempting to
clear the blockage with increased peristalsis.
Ruq=right Upper Quadrant, RLQ=right Lower Quadrant,
LUQ=Left Upper Quadrant, LLQ=left Lower Quadrant
 Observations and result:
• The bowel sound in audible by stethoscope in
……..Quadrant with the frequency
of………../Min.
• The bowel sounds of the selected subject are
found to be normal.