Auscultation meaning, breath sounds? Added sounds?

 The action of listening to sounds from heart, lungs or other part with stethoscope,Auscultation should be conducted in a systematic manner, comparing the same area on the left and right side while visualizing the underlying lung structures. Ideally patients should be sitting up right and be asked to breathe through the mouth to reduce nose turbulence. 

Breath sounds

Normal-->more prominent at the top of the lungs and centrally, with the volume decreasing towards the bases and periphery. Expiration is shorter and quieter than inspiration and follows inspiration without a pause. 

Abnormal (bronchial breathing) -->Similar to the breath sounds heard when listening over the trachea. They are typically loud and harsh and can be heard throughout inspiration and expiration. Expiration is longer than inspiration and there is a pause between the two. They occur if air is replaced by solid tissue, which transmits sound more clearly. Caused by consolidation, areas of collapse with adjacent open bronchus, pleural effusion, tumour. 

Diminished-->Breath sounds will be reduced if air entry is compromised by either an obstruction or a decrease in airflow. Caused by pneumothorax, pleural effusion, emphysema, collapse with occluded bronchus, atelectasis, inability to breathe deeply, obesity. 

Added sounds

Crackles--> Heard when airways that have been narrowed or closed, usually by secretions are suddenly forced open on inspiration. Usually classified as fine (originating from small, distal airways), coarse (from large, proximal airways),  localized or widespread. They can be further  defined as being early or late, depending on when they are heard on inspiration or expiration. 

Early inspiration-- reopening of large airways (example..bronchiectasis and bronchitis) 

Late inspiration-- reopening of alveoli and peripheral airways (example.. Pulmonary oedema, pulmonary fibrosis, pneumonia, atelectasis) 

Early expiration--secretions in large airways

Late expiration-- secretions in peripheral airways

Wheeze-->Caused by air being forced through narrowed or compressed airways. Described as either high or low pitched and monophonic (singh note) or polyphonic (where several airways may be obstructed). Airway narrowing can be caused by bronchospasm, mucosal oedema or sputum retention. An expiratory wheeze with prolonged expiration is usually indicative of bronchospasm, while a low- pitched wheeze throughout inspiration and expiration is normally caused by secretions. 

Pleural rub--> If the pleural surfaces are inflamed or infected the become rough and rub together, creating a creaking or grating sound. Heard equally during inspiration and expiration. 

Voice sounds-->In normal lung tissue, voice sounds are indistinct and unintelligible. When there is consolidation, sound is transmitted more clearly and loudly and speech can be distinguished. Voice sounds can be diminished in the presence of emphysema, pheumothorax and pleural effusion. They can be heard through a stethoscope (vocal resonance) or felt by hand ( vocal fremitus). To test voice sounds patients can be asked to say or whisper 99 repeatedly. 

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