A few additional things worth noting.
1. Don't get in the habit of performing auscultation through clothing.
2. Ask the patient to take slow, deep breaths through their mouths while you are performing your exam. This forces the patient to move greater volumes of air with each breath, increasing the duration, intensity, and thus detectability of any abnormal breath sounds that might be present.
3. Sometimes it's helpful to have the patient cough a few times prior to beginning auscultation. This clears airway secretions and opens small atelectatic (i.e. collapsed) areas at the lung bases.
4. If the patient cannot sit up (e.g. in cases of neurologic disease, post-operative states, etc.), auscultation can be performed while the patient is lying on their side. Get help if the patient is unable to move on their own. In cases where even this cannot be accomplished, a minimal examination can be performed by listening laterally/posteriorly as the patient remains supine.
5. Requesting that the patient exhale forcibly will occasionally help to accentuate abnormal breath sounds (in particular, wheezing) that might not be heard when they are breathing at normal flow rates.
In thin bony chests, the bell may give a more airtight fit and is less likely to trap hairs underneath, which produce a crackling sound. The breath sounds are produced in the large airways, transmitted through the airways and then attenuated by the distal lung structure through which they pass. The sounds you hear at the lung surface are therefore different from the sounds heard over the trachea and are modified further if there is anything obstructing the airways, lung tissue, pleura or chest wall. When reporting on auscultatorychanges, you must distinguish between the breath sounds and the added sounds. Breath sounds are termed either vesicular or bronchial and the added sounds are divided into crackles, wheezes and rubs.
Date: 2015-02-03; view: 614