Auscultation: Listening to breath sounds with a stethoscope

Normal Breath Sounds and Their Locations

Abnormal Breath Sounds: Diminished or Absent

Increased distance between aerated lung and chest wall:

Pneumothorax, Pleural effusion, Atelectasis, Obesity around thorax

Decreased or absent airflowAirflow obstruction (eg asthma), Hyperinflation (COPD), Malpositioned ET Tube

Abnormal Breath Sounds: Bronchial or Bronchovesicular in abnormal part of the lung

Lung has become more solid and less aerated in these areasConsolidation, eg, pneumonia, or Atelectasis

Abnormal Breath Sounds: Adventitious Sounds

Wheeze – continuous musical sounds heard mostly during expiration

May be also heard on inspiration

Caused by a sudden change in airway caliber

Edema, spasm, secretions, foreign body

Abnormal Breath Sounds: Adventitious Sounds

Crackles – discontinuous sound heard mostly on inspirationCaused by small airways and alveoli popping open or from secretions in very large airways

Lets all listen in

Condition Chest Excursion

Fremitus Percussion

BreathSounds

Atelectasis

Pneumothorax

Pleural Effusion

COPD

Pulmonary Consolidation

Fibrosis

Pulmonary Edema

Chest Physical Exam: Case Study

A patient is admitted with fever and cough. Auscultation reveals bronchial breath sounds in the lower chest posteriorly and normal vesicular breath sounds in the restof the lower thorax.

Chest Physical Exam: Case Study

A patient is scheduled for inguinal herniasurgery. Observation reveals increased APdiameter and use of accessory muscles forbreathing. Auscultation yields diminishedbreath sounds in the upper and middle chest and absent breath sounds in the lower chest.

Chest Physical Exam: Case Study

A 12 year patient in the ER with respiratory distress has bilateral wheezes throughout bothlung fields and prolonged expiration. A-P diameter of the chest is increased.

Chest Physical Exam: Case Study

A ventilator patient suddenly becomes diaphoreticand tachycardic. The pressure limit alarm on theventilator is sounding on every breath. Auscultationshows absent breath sounds on the left and percussion yields hyperresonance on the left.