Lung Sounds and Auscultation Techniques
Chest auscultation
Dr Mohammed sami
Listening to lung sounds
•
How?
•
Where?
•
What are you listening for ?
•
Imagine what you
are hearing
Where do you
listen
•
There at least 4
separate areas on
both sides of the
body, top & bottom,
front & back, right &
left.
•
Each area should be
listened to in both
inspiration &
exhalation phases
Listening
•
Be sure to
listen
to each full cycle of inspiration and expiration before
moving your stethoscope
•
You should hear
breath sounds
over all
lung
tissue, and the quality of
the
breath sounds
should be similar as you
listen
from side to side.
Use of the Stethoscope
•
The diaphragm-
most suitable for listening to
high-pitched
sounds & murmurs.
•
The bell-
is best suited for
low-pitched sounds & murmurs
.
Breath sounds
•
Breath sounds result as air moves through the airways of the
respiratory tract. The diameter of the airway, pressure changes in the
airway, and vibrations of solid tissue all affect the sound produced.
Sound characteristics
•
Frequency
— measured in hertz — refers to the number of vibrations
occurring per unit of time. Different frequencies produce the different
sounds heard during auscultation. the term
pitch
is used to describe sound
frequency. High-pitched sounds have higher frequencies; low-pitched
sounds have lower frequencies
•
Intensity :
the loudness or softness of the vibrations that produce breath
sounds. Intensity can be measured electronically by recording amplitude.
Several factors affect intensity, including the type of structure that's
vibrating as well as the distance and type of substance through which the
vibrations must travel.
•
Duration
the vibrations that produce breath sounds can be measured in
milliseconds. However, during auscultation, you'll note sounds as being
long or short and as continuous or discontinuous.
When its not normal
•
Diminished or hard-to-hear lung sounds are most common with
thick chest walls (in either muscular or obese patients), or when the
patient is not taking deep breaths. However, diminished breath
sounds can also be associated with disease.
•
Absent sounds this can result from airway obstruction, with collapse
of lung tissue (such as pneumothorax)
W
h
e
e
z
e
s
•
Wheezes are continuous sounds caused by air moving through
constricted airways
. Airways can be narrowed by a number of causes: the
bronchial constriction that accompanies asthma, bronchial inflammation,
mucus accumulation or mucous plugs, or tumors.
•
Wheezes can be
:
high-pitched
,
which is common with asthma
low-pitched
with almost a
snoring
quality.
•
Low-pitched wheezes
are sometimes called
rhonchi
.
•
Mild wheezing is often limited to the expiratory phase of respiration, while
more severe wheezing can be heard throughout the respiratory cycle.
•
Both wheezing and crackles may clear with
coughing
, so ask the patient to
take a deep breath and cough a couple of times, then listen again
•
Stridor
is a high-pitched sound typically generated when a
larger airway is blocked by a foreign body, severe
inflammation, or a mass.
•
A
friction rub
may result when the pleural membranes
covering the lungs and lining the thoracic cavity are
inflamed. A friction rub is a
scratching or squeaking sound
that persists throughout the respiratory cycle and does not
clear with coughing.
•
The
c
haracteristics of a friction rub can be imitated by
pressing the palm of one hand over the ear and then lightly
and slowly rubbing the back of the hand with the fingers of
the other hand.
Vesicular
•
The vesicular breath sound is believed to be
the result of movement of air in the
bronchioles and alveoli.
•
Variously described as sighing or a gentle
rustling,vesicular breathing is a soft,
relatively low-pitched sound.
•
The normal vesicular respiration is longer in
the inspiratory than in the expiratory phase
by a ratio of approximately 5:2.
Vesicular
•
It should be emphasized that expiration as
heard in vesicular breathing is not actually
shorter than inspiration --
only that much of
expiration is not
audi
ble.
•
Inspiration is higher in pitch and louder than
expiration. In fact, expiration occasiona
lly
may be inaudible.
•
Vesicular breath sounds
heard from
normally over most of the lungs.
Bronchovesicular
•
In certain areas where
the
trachea and
major bronchi are in proximity to the chest
wall,there is heard a mixture of b
oth
tracheobronchial and vesicular elements
that
is
termed bronchovesicular breath
sound.
Bronchovesicular
•
This type of breath sound is
hea
rd
no
r
mall
y
on each side of the sternum in the first and
second interspaces,between the scapulae,
and over the apices anteriorly and
posteriorly,but are more prominent on the
right than on the left.
•
When
heard in other lo
cations,
brocho
vesi
cular breathing is
abno
r
m
al
and
is indicati
ve
of some disease pro
ce
ss
.
Vesicular and bronchovesicular
are the
tw
o types of
breath
sounds heard no
r
mally over the
lungs.
Bronchial breathing
•
Bronchial breath sounds are in general
higher in pitch than vesicular or
bronchovesicular sounds.
•
Expiration usually longer than
inspiration in length.
Bronchial breathing
•
Bronchial breathing is not normally
heard over the lungs. Therefore,its
presence over the lungs always
indicates disease.
•
It occurs only with pulmonary
consolidation,an increased conducting
mechanism.
Bronchovesicular breathing
•
Bronchovesicular breathing is abnormal
when heard in any area of the lungs that
normally have vesicular breath sounds.
•
An admixture of
consolidated and
aerated
lung produces a mixture of bronchial and
vesicular breathing--bronchovesicular
breath sounds.
Elongated expiratory breath sound
Occurs because of partial obstruction,spasm
or stricture of the lower respiratory tract,
happening in bronchitis,bronchial asthma etc.
Because of lowering elasticity of pulmonary
tissue,happening in COPD etc.
Decreased or absent breath sounds
l
.
fluid in the pleural space.
2.air in the pleural space(pneumothorax)causes a
diminution in the breath sounds.
3.
If there is thickened pleura caused by
fibrosis
-which may
follow eff
us
ion,hemothor
ax,
and empyema-or by actual tumor
in
volvement of the pleura,decrease in breath sounds is noted
Decreased or absent breath sounds
4. Breath sounds are commonly decreased in
emphysema because of the decreased air velocity
and sound conduction.
5. Breath sounds are markedly diminished or absent
in complete bronchial obstruction.
6.If there is definite decrease in expansion, such as
that commonly noted in painful pleurisy with its
attendant shallow breathing, the breath sounds are
diminished because of the decreased ventilation.
Rales
حشرجة
•
They result from the passage of air
through secretions in the respiratory
tract and from reinflation of the
alveoli and bronchioles, the walls of
which have become adherent as the
result of moisture.
Rales,therefore,are
produced by air flow plus abnormal
moisture.
Rhonchi
•
Rhonchi are continuous sounds
p
roduced
by the passage of air through the trachea,
bronchi,
and bronchioles that have been
narrowed,
irrespective of the cause. As long
as air passes the obstruction,
the sound will
be produced.
Normal Lung Sounds
A
u
s
c
u
l
t
a
t
i
o
n
f
i
n
d
i
n
g
i
n
p
n
e
u
m
o
n
i
a
•
In the early stages of lobar pneumonia, the
breath sounds may be diminished or
suppressed. Fine crepitant rales may be heard.
•
With the development of frank consolidation,
the crepitant rales disappears, the breath
sounds become bronchial .
A
u
s
c
u
l
t
a
t
i
o
n
P
u
l
m
o
n
a
r
y
e
m
p
h
y
s
e
m
a
•
On auscultation the breath sounds are vesicular and
generally diminished in intensity or almost inaudible.
•
Expiration is commonly prolonged.
•
Rhonchi are normally widespread, but may be most
marked at the bases of the lung.
•
occurs when an area of lung tissue is not ventilated.
The signs and symptoms that follow depend upon the
amount of lung tissue involved and vary from an
asymptomatic shadow on an X-ray to acute
respiratory distress.
•
When a sufficient amount of lung is involved, there
are signs of respiratory distress
•
The breath sounds are usually absent over the
affected area.
Pulmonary atelectasis
Exploring the world of chest auscultation with Dr. Mohammed Sami, this guide provides insights into how to listen to lung sounds, where to listen, what to listen for, and the use of a stethoscope. Learn about different lung areas, sound characteristics, airflow patterns, and the mechanics behind breath sounds. Enhance your auscultation skills by understanding laminar airflow, sound characteristics, and frequency measurements.
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Presentation Transcript
Chest auscultation Dr Mohammed sami
Listening to lung sounds How? Where? What are you listening for ?
Imagine what you are hearing
Where do you listen There at least 4 separate areas on both sides of the body, top & bottom, front & back, right & left. Each area should be listened to in both inspiration & exhalation phases
Listening Be sure to listen to each full cycle of inspiration and expiration before moving your stethoscope You should hear breath sounds over all lung tissue, and the quality of the breath sounds should be similar as you listen from side to side.
Use of the Stethoscope The diaphragm- most suitable for listening to high-pitched sounds & murmurs. The bell- is best suited for low-pitched sounds & murmurs.
Laminar airflow In the small airways and respiratory bronchioles, airflow is slow and linear. This is called laminar airflow. No abrupt changes in pressure or airway wall movements occur to generate sound. Consequently, air movement in these areas produces no sound. Breath sounds P Comparing airflow patterns The following illustrations show the three primary airflow patterns affecting airway dynamics. Breath sounds result as air moves through the airways of the respiratory tract. The diameter of the airway, pressure changes in the airway, and vibrations of solid tissue all affect the sound produced. Turbulent airflow Circular airflow (vortices) Laminar airflow Understanding sound Mechanical vibrations, sound damping, and impedance matching also affect the sounds heard during auscultation. Mechanical vibrations The mechanical vibrations of solid tissue also produce breath sounds. The speed at which these vibrations travel depends on whether they're traveling through air, fluid, or tissue. The frequency, intensity, and duration of these sounds can be measured. Frequency
Sound characteristics Frequency measured in hertz refers to the number of vibrations occurring per unit of time. Different frequencies produce the different sounds heard during auscultation. the term pitch is used to describe sound frequency. High-pitched sounds have higher frequencies; low-pitched sounds have lower frequencies Intensity : the loudness or softness of the vibrations that produce breath sounds. Intensity can be measured electronically by recording amplitude. Several factors affect intensity, including the type of structure that's vibrating as well as the distance and type of substance through which the vibrations must travel. Duration the vibrations that produce breath sounds can be measured in milliseconds. However, during auscultation, you'll note sounds as being long or short and as continuous or discontinuous.
When its not normal Diminished or hard-to-hear lung sounds are most common with thick chest walls (in either muscular or obese patients), or when the patient is not taking deep breaths. However, diminished breath sounds can also be associated with disease. Absent sounds this can result from airway obstruction, with collapse of lung tissue (such as pneumothorax)
Wheezes Wheezes Wheezes are continuous sounds caused by air moving through constricted airways. Airways can be narrowed by a number of causes: the bronchial constriction that accompanies asthma, bronchial inflammation, mucus accumulation or mucous plugs, or tumors. Wheezes can be: high-pitched, which is common with asthma low-pitched with almost a snoring quality. Low-pitched wheezes are sometimes called rhonchi. Mild wheezing is often limited to the expiratory phase of respiration, while more severe wheezing can be heard throughout the respiratory cycle. Both wheezing and crackles may clear with coughing, so ask the patient to take a deep breath and cough a couple of times, then listen again
Stridor is a high-pitched sound typically generated when a larger airway is blocked by a foreign body, severe inflammation, or a mass. A friction rub may result when the pleural membranes covering the lungs and lining the thoracic cavity are inflamed. A friction rub is a scratching or squeaking sound that persists throughout the respiratory cycle and does not clear with coughing. The characteristics of a friction rub can be imitated by pressing the palm of one hand over the ear and then lightly and slowly rubbing the back of the hand with the fingers of the other hand.
Vesicular The vesicular breath sound is believed to be the result of movement of air in the bronchioles and alveoli. Variously described as sighing or a gentle rustling,vesicular breathing is a soft, relatively low-pitched sound. The normal vesicular respiration is longer in the inspiratory than in the expiratory phase by a ratio of approximately 5:2.
Vesicular It should be emphasized that expiration as heard in vesicular breathing is not actually shorter than inspiration --only that much of expiration is not audible. Inspiration is higher in pitch and louder than expiration. In fact, expiration occasionally may be inaudible. Vesicular breath sounds heard from normally over most of the lungs.
Bronchovesicular In certain areas where the trachea and major bronchi are in proximity to the chest wall,there is heard a mixture of both tracheobronchial and vesicular elements that is termed bronchovesicular breath sound.
Bronchovesicular This type of breath sound is heard normally on each side of the sternum in the first and second interspaces,between the scapulae, and over the apices anteriorly and posteriorly,but are more prominent on the right than on the left. When heard in other locations, brochovesicular breathing is abnormal and is indicative of some disease process.
Vesicular and bronchovesicular are the two types of breath sounds heard normally over the lungs.
Bronchial breathing Bronchial breath sounds are in general higher in pitch than vesicular or bronchovesicular sounds. Expiration usually inspiration in length. longer than
Bronchial breathing Bronchial breathing is not normally heard over the lungs. Therefore,its presence over the indicates disease. It occurs only consolidation,an increased conducting mechanism. lungs always with pulmonary
Bronchovesicular breathing Bronchovesicular breathing is abnormal when heard in any area of the lungs that normally have vesicular breath sounds. An admixture of consolidated and aerated lung produces a mixture of bronchial and vesicular breathing--bronchovesicular breath sounds.
Elongated expiratory breath sound Occurs because of partial obstruction,spasm or stricture of the lower respiratory tract, happening in bronchitis,bronchial asthma etc. Because of lowering elasticity of pulmonary tissue,happening in COPD etc.
Decreased or absent breath sounds l. fluid in the pleural space. 2.air in the pleural space(pneumothorax)causes a diminution in the breath sounds. 3. If there is thickened pleura caused by fibrosis -which may follow effusion,hemothorax, and empyema-or by actual tumor involvement of the pleura,decrease in breath sounds is noted
Decreased or absent breath sounds 4. Breath sounds are commonly decreased in emphysema because of the decreased air velocity and sound conduction. 5. Breath sounds are markedly diminished or absent in complete bronchial obstruction. 6.If there is definite decrease in expansion, such as that commonly noted in painful pleurisy with its attendant shallow breathing, the breath sounds are diminished because of the decreased ventilation.
Rales They result from the passage of air through secretions in the respiratory tract and from reinflation of the alveoli and bronchioles, the walls of which have become adherent as the result of moisture. Rales,therefore,are produced by air flow plus abnormal moisture.
Rhonchi Rhonchi are continuous sounds produced by the passage of air through the trachea, bronchi, and bronchioles that have been narrowed, irrespective of the cause. As long as air passes the obstruction, the sound will be produced.
If you hear diminished but normal breath sounds in both lungs, the patient may have emphysema, atelectasis, severe broncho-spasm, or shallow breathing. If you hear breath sounds in one lung only, the patient may have pleural effusion, pneumothorax, a tumor, or mucus plugs in the airways. In such cases, the doctor may order pulmonary function tests to further assess the patient's condition. P (See Interpreting pulmonary function test results, page 40.) Characteristics of breath sounds Use this chart to help you recognize patterns of breath sounds by their intensity, pitch, and duration of inspiratory and expiratory phases. Note that the thickness of the bars indicates intensity; the steeper an incline, the higher the pitch. Intensity of expiratory sound Pitch of expiratory sound Duration of sounds Location where normally heard Breath sound Inspiratory sounds last longer than expiratory ones. Soft Relatively low Over most of the lungs Inspiratory and expiratory sounds are about equal. Intermediate Intermediate Commonly in the first and second interspaces anteriorly and between the scapulae Expiratory sounds last longer than inspiratory ones. Loud Relatively high Over the manubrium, if heard at all Inspiratory and expiratory sounds are about equal. Very loud Relatively high Over the trachea in the neck Sounding board
Auscultation Auscultation finding in pneumonia finding in pneumonia In the early stages of lobar pneumonia, the breath sounds may be diminished or suppressed. Fine crepitant rales may be heard. With the development of frank consolidation, the crepitant rales disappears, the breath sounds become bronchial .
Auscultation Auscultation Pulmonary emphysema Pulmonary emphysema On auscultation the breath sounds are vesicular and generally diminished in intensity or almost inaudible. Expiration is commonly prolonged. Rhonchi are normally widespread, but may be most marked at the bases of the lung.
Pulmonary atelectasis occurs when an area of lung tissue is not ventilated. The signs and symptoms that follow depend upon the amount of lung tissue involved and vary from an asymptomatic shadow on an X-ray to acute respiratory distress. When a sufficient amount of lung is involved, there are signs of respiratory distress The breath sounds are usually absent over the affected area.
