Lung Auscultation
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Purpose: Detect different forms of pathology by listening to the chest for abnormal and normal lung sounds.
Procedure: Anterior Aspect: 1. To auscultate the apical and apical posterior segments of the upper lobes place the diaphragm proximal to the clavicle or just beneath the clavicle. 2. To auscultate the anterior segments of the upper lobes place the diaphragm approximately between Ribs 1 and Rib 4. Rib 4 is superior to the nipples. 3. To auscultate the lateral aspect of the right middle lobe place the diaphragm approximately between ribs 4-6 using the middle third of the clavicle as a landmark. You may use the ziphoid process as a landmark for rib 6 (lateral to the nipple) 4. To auscultate the superior lingual of the left upper lobe, place the diaphragm between ribs 4 and 5; medial or lateral to the left nipple. 5. To auscultate the medial aspect of the right middle lobe place the diaphragm between the sternal border and mid-clavicular line of ribs 4-6 using the ziphoid as a landmark of ribs 6 6. To auscultate the inferior lingula of the left upper lobe, place the diaphragm between ribs 5-6 just below the left nipple and using the middle third of the clavicle. 7. To auscultate anterior basal segments of the lower lobes place the diaphragm along the lateral aspect between ribs 6-7. Posterior Aspect: 1. To auscultate apical posterior on the left and posterior on the right of the upper lobe palpate the superior angle of the scapula, this is at the 2nd rib and auscultate just superior or just inferior to this. 2. To auscultate the superior basal of the lower lobes go to the spine of scapula, which corresponds to T3; superior basal is approximately from T3 to T6; approximately mid scapula 3. To auscultate posterior basal segments of the lower lobe, auscultate from T6-T9, which is about rib 10 and where the lungs end. 4. To auscultate lateral basal of the lower lobes auscultate lateral aspect of the inferior angle of the scapula (lateral basal goes from T6-T9) Normal Findings: Bronchial: Loud, high pitched “like air moving through a pipe” Heard over the trachea. Pause between Inspiration & Expiration (I:E ratio= 2:3) Bronchovesicular: Softer, lower pitched. Heard anteriorly over the mainstem bronchi and posteriorly between the scapula (I:E ratio= 1:1) Vesicular: Soft, breezy sound "rustling leaves." Normal over peripheral lung fields (I:E ratio= 3:1) Abnormal Findings: Crackles or rales: non-musical sounds. Sounds like someone crumpling paper. Caused by snapping open of airways or alveoli. Inspiratory crackles: commonly heard in lower lobes. If heard early in deep inspiration, it indicates large airways are opening suddenly (emphysema, bronchitis, and bronchiectasis). If heard late in inspiration it indicates smaller airways are opening (CHF, pulmonary fibrosis) Expiratory crackles: may indicate reopening of previously closed airways or fluid in the large airways Wheezes or rhonchi: continuous musical sound (slide whistle) produced by air flow through airways. Local wheeze:
Gurgles: sounds like air flowing through a straw in water, suggests fluid in airways. Rubs: coarse, grating leather sounds. Heard during ventilation and indicate pleural inflammation. |
References
Hillegass, E. (2016). Essentials of cardiopulmonary physical therapy. Elsevier Health Sciences.
Frownfelter, D., & Dean, E. (2014). Cardiovascular and Pulmonary Physical Therapy: Evidence to Practice. Elsevier Health Sciences.
Watchie, J. (2009). Cardiovascular and pulmonary physical therapy: a clinical manual. Elsevier Health Sciences.
Hillegass, E. (2016). Essentials of cardiopulmonary physical therapy. Elsevier Health Sciences.
Frownfelter, D., & Dean, E. (2014). Cardiovascular and Pulmonary Physical Therapy: Evidence to Practice. Elsevier Health Sciences.
Watchie, J. (2009). Cardiovascular and pulmonary physical therapy: a clinical manual. Elsevier Health Sciences.
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