Introduction to auscultation

it is very precise topic and it can help many medical student.

1. GROUP:5 Point :AUSCULTAION

2. INTRODUCTION TO AUSCULTATION

3. Auscultation is listening to the internal sounds of the body usually using a stethoscope. Auscultation is performed for the purpose of examining the circulatory and respiratory system as well as gastrointestinal system (bowel sounds)

4. The auscultation of the respiratory system is an inexpensive, save, easy to perform, and one of the oldest diagnostic techniques used by the physicians to diagnose various pulmonary diseases. There are three forms of auscultaion classic(immediate auscultaion ) , mediate auscultaion and doppler auscultaion .

5. immediate auscultaion immediate auscultaion is an antiquated medical term for listening to the internal sounds of the body. Directly placing the ear on the body. Mediate auscultation mediate auscultation is an antiquated medical term for listening to the internal sound of the body using an instrument (mediate) usualy stethoscope

6. Doppler auscultion it defined as auscultation of valvular movements and blood flow sounds that are undetected during cardiac examination with a stethoscope in adults it has sensitivity of 84% for the detection of aortic regurgitaion while classic stethoscope auscultation presented a sensitivity of 58%.

7. Stethoscope four parts *bell low-pitched heart sounds * diaphragm high-pitched lung sounds press firmly * tubing not too long or too short * earpieces point away

8. Ways to auscultate lung Anterior lung auscultaion 1. start at the apex of the lung which is right above the clavicle. 2. then move to the 2 nd intercostal space to assess the right and left upper lobes. 3. at the 4 th intercostal space you will be assessing the right middle lobe and the left upper lobe. 4. then midaxillary at the 6 th intercostal space you will be assessing the right and left lower lobes

9. Posterior lung auscultaion points. 1. start right above the scapulae to listen to the apex of the lungs 2.then find c7 and go to T3 this will assess the right and left upper lobes 3. then T3 to T10 you will be able to assess right and left lower lobes

10. Normal breath sounds * tracheal : heard over trachea tubular quality lenght : inspiration is equal to expiration

11. Bronchial auscultated over anterior chest and heard over tracheal area Bronchial breath sounds are hollow, tubular souns that are lower pitched. They can be auscultated over the trachea where they are considered normal. There is dintinct pause in the sound between inspiration and expiration. I:E ratio is 1:3.

12. Bronchovesicular auscultated anteriorly ( 1 st and 2 nd intercostal space ) and posteriorly ( between the scapulae ) and heard over the bronchi. inspiration to expiration periods are equal. These are normal sounds in the mild chest area or In the posterior chest between the scapulae. They reflect a mixture of the pitch of the bronchial breath sounds heard near the trachea and the alveoli with the vesicular sound. They have an I:E ratio of 1:1.

13. vesicular-normal vesicular breath sounds are soft and low pitched with a rustling quality during inspiration an are ever softer during expiration. This are most commonly auscultated breath sounds normaly head over the most lung surface .

14. Abnormal lung sounds

15. 1. Crackles -fine ( Rales ) fine crackles are brief, discontinous , popping lung sounds that are high-pitched .fine crackles are also similar to the sound of wood burning in an fireplace. Crackles previosly termed rale , can be heard in both phases of respiratory. * Early ins.and exp. Crackles are hallmark of chronic bronchitis . May be heard in patient with edema in the lungs or ARDS.

16. *While late inspiratory crackles may mean pneumonia, CHF, or atelectasis and pulmonary fibrosis

17. 2.Crackles – course ( rales ) course crackles are discontinuous, brief, popping lung sounds. Compared to fine crackles they are loader, lower in pitch and last longer. They have also been described as a bubbling sound. You can stimulate this sound by roling strands of hair between your fingers near your ear. May be heard in patient whith fluid overload , pneumonia

18. 3.Wheeze wheezes are adventitious lung sounds that are continuous( more than 0.2 second during full inspiration) with a musical quality. Wheezes can be high or low pitched. High pitched wheezes may have an auscultation sound similar to squeaking. Lower pitched wheezes have a snoring or moaning quality.

19. the proportion of the respiratory cycle occupied by the wheeze roughly corresponds to the degree of airway obstruction. Wheezes are caused by narrowing of the airways. The most common cause of recurrent wheezing are Asthma, emphysema and COPD low pitched may be heard in patient with( COPD) high pithced may be heard in patient with ashtma

20. 4.Rhonchi –low pitched wheezes . Low pitched wheezes( rhonchi ) are continuous, both inspiratory and expiratory, low pitched adventitious lung sounds that are similar to wheezes. They often have a snoring, gurgling or rattle-like quility . Rhonchi occur in the bronchi. Sounds defined as rhonchi are heard in the chest wall were bronchi occur not over any alveoli. Rhonchi usualy clear after coughing.

21. 5. Pleural Rubs pleural rubs are discontinuous or continuous , creaking or grating sounds. The sound has been described as similar to walking on fresh snow or a leather –on –leather type of sound. Coughing will not alter the sound. They are produced because two inflamed surfaces are sliding by one another such as in pleurisy. During auscultaion pleural rubs can usually be localized to aparticular place on the chest wall. They also come and go because these sounds occur whenever the patient’s chest wall moves.

22. They appear on inspiration and expiration. Pleural rubs stop when the patient holds her or his breath. If the rubbing sound continues while the patient holds a breath it may be pericardial friction rub. Patients may have pain when breathing in and out due to inflamation of pleural layer s may heard in patients with pleuritis .

23. 6.Stridor stridor is a load, high pitched, harsh, vibratory sound produced by upper respiratory tract obstruction( narrowing of the trachea ), it different fom wheezing by the following reasons, * it is louder over the neck than chest wall , secondly stridor is mainly inspiratory . If occurs in expiration it is usualy biphasic . On the other hand wheeze is mainly expiratory and occurs during both phases.

24. Continue…… it indicates extrathoracic upper airway obstruction ( supraglottic lesions like larnygomalacia , vocal cord lesion)

25. Thank you