Sienna Rhodes
Lung sounds are the noises produced by the structures of the lungs during breathing. They can be assessed by a healthcare provider using a stethoscope, a process called auscultation. Lung sounds can be heard in all parts of the chest area, including above the collarbones and at the bottom of the rib cage. The pitch of lung sounds can indicate different things, with high-pitched sounds indicating narrowed airways, for example. Lung sounds can be difficult to hear in certain situations, such as in a vehicle or on the field, or when the patient is obese. However, it is important to listen to lung sounds regularly to maintain skills and identify any abnormalities.
| Characteristics | Values |
|---|---|
| Auscultation location | Multiple locations on the anterior and posterior chest walls, including above the collarbones, at the bottom of the rib cage, and at the mid-axillary line (below the armpit) |
| Patient position | Patient should cross their arms and lean forward |
| Stethoscope type | Stethoscopes with both bell and diaphragm are ideal. The bell is used for low-pitched sounds, while the diaphragm is used for medium or high-pitched sounds |
| Clothing | Clothing can muddle sounds, so it is better to have skin-to-scope contact |
| Hearing ability of the observer | The observer should classify the sound or murmur's pitch as low, medium, or high |
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What You'll Learn
Lung sounds are best heard with a stethoscope
A stethoscope's bell can be helpful for listening to low-pitched sounds, while the diaphragm is used for medium or high-pitched sounds. For example, high-pitched sounds can indicate narrowed airways. Many stethoscopes have chest pieces with both bell and diaphragm, and it is recommended to start with the diaphragm but switch to the bell to hear lower-pitched sounds.
When checking lung sounds, it is important to listen in multiple locations on the anterior and posterior chest walls, including above the collarbones and at the bottom of the rib cage. Additionally, you can auscultate at the mid-axillary line for the bases. However, it may be difficult to hear lung sounds clearly through clothing or in a noisy environment, such as in a vehicle or on the field.
To improve the accuracy of lung sound auscultation, it is recommended to ask the patient to cross their arms and lean forward. This position, known as the triangle of auscultation, is found on the dorsum of the thorax and has a relatively thin layer of muscle, making it an ideal location for listening to lung sounds.
While lung sounds can provide valuable information, they are just one part of a patient's assessment. It is important to combine this with other techniques, such as percussion, and consider the patient's medical history and symptoms to make an accurate diagnosis.
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Ask the patient to cross their arms and lean forward
To check for lung sounds, healthcare professionals use a technique called auscultation. This involves placing a stethoscope on the patient's body to listen to the internal sounds of their body, such as the heart, lung, and bowel sounds. Auscultation is performed in a quiet, warm, and private environment.
To check for lung sounds specifically, the patient should be asked to sit upright, if possible. The healthcare provider will place a stethoscope on the patient's chest and ask them to take deep breaths through their mouth. The provider will then move the stethoscope to different pulmonary (lung) auscultation points, starting at the top of the lungs and moving downward, comparing the sounds of each lung.
The patient should then be asked to cross their arms and lean forward. This position exposes the triangle of auscultation, a small region on the back where the trapezius, latissimus dorsi, and scapula muscles meet. When the patient crosses their arms and leans forward, these muscles thin out, allowing for clearer lung sound auscultation.
The provider will then place the stethoscope on the patient's back, again starting at the top and working their way down, going from side to side. They will listen to one complete breath cycle at each auscultation site and compare the sounds between the front and back of the lungs. This process allows for a comprehensive assessment of lung sounds and aids in the detection of any abnormalities.
It is important to note that the patient's position during auscultation may vary depending on their medical condition. For example, female patients may be asked to lie down to make it easier to listen to lung sounds in the anterior fields. Additionally, patients with kyphosis will naturally lean forward due to the curvature of their spine. Thus, healthcare providers must adapt the auscultation process as needed to ensure a thorough and accurate examination.
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Listen to lung sounds on every patient
Listening to lung sounds on every patient is a good habit to get into. It is a basic assessment that can provide valuable information. Lung sounds are the noises produced by the structures of the lungs during breathing. Normal lung sounds occur in all parts of the chest area, including above the collarbones and at the bottom of the rib cage.
When listening to lung sounds, it is important to use a stethoscope and to classify the pitch of the sound as low, medium, or high. The stethoscope's bell is helpful for low-pitched sounds, while the diaphragm is used for medium or high-pitched sounds. For example, high-pitched sounds can indicate narrowed airways.
It is also important to identify your landmarks when listening to lung sounds. You can auscultate at the mid-axillary line (below the armpit) or at the triangle of auscultation, found on the dorsum of the thorax. To listen at the triangle of auscultation, ask the patient to cross their arms and lean forward.
Keep in mind that clothing can muddle sounds, so it is best to have direct skin contact with the stethoscope when possible. Additionally, it can be difficult to hear lung sounds in a noisy environment, such as in a vehicle or on the field. In these cases, it is important to treat the patient based on how they are presenting and feeling, rather than relying solely on lung sounds.
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Listen to lung sounds during primary and secondary assessments
Listening to lung sounds is an important part of both primary and secondary assessments. It can help predict chest pathology and should be conducted over multiple locations of the anterior and posterior chest walls. The patient should be sitting upright, and the stethoscope should be placed flat on the body at different locations. The ideal location for lung sound auscultation is the triangle of auscultation, found on the dorsum of the thorax, as it has a relatively thin layer of muscle. To listen effectively, the patient should be asked to cross their arms and lean forward.
The stethoscope has two sides: the bell and the diaphragm. The diaphragm is the larger, flat side and is used to hear normal and high-pitched sounds, such as those that occur in the lungs. The bell is cone-shaped and is used to hear low-pitched sounds, like heart murmurs. The pitch of a lung sound is an important characteristic, and the observer should classify the sound as low, medium, or high pitch. The diaphragm is used for medium or high-pitched sounds, while the bell can be helpful for low-pitched sounds.
During auscultation, the healthcare provider will listen for a full cycle of inspiration and expiration, using a stepladder pattern to compare the different sides of the lungs. Normal breath sounds include bronchial, bronchovesicular, and vesicular lung sounds. Bronchial sounds are loud, high-pitched, and heard over the trachea, while vesicular sounds are soft, low-pitched, and appreciated at the posterior lung bases. Bronchovesicular sounds have a mid-range pitch and can be heard during inspiration and expiration.
It is important to note that clothing can muddle sounds, so it is best to avoid listening over clothes or hair. Additionally, listening over bones, such as the scapulae or clavicles, should be avoided to ensure adequate sound transmission. For infants, it is important to assess respiratory rate while the infant is at rest, as crying can enhance breath sounds. Older patients may also have weakened respiratory muscles, so it is important to allow them to rest between listening to anterior and posterior lung sounds.
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Lung sounds can sometimes be heard without a stethoscope
Lung sounds are typically heard using a stethoscope, a medical instrument used to listen to the internal sounds of the body. The diaphragm of the stethoscope, the larger flat side, is used to hear normal and high-pitched sounds, while the bell of the stethoscope, the cone-shaped side, is used to hear low-pitched sounds.
However, in some cases, lung sounds can be heard without a stethoscope. Wheezing, for example, is a high-pitched sound produced by narrowed airways that can often be heard without the aid of a stethoscope. Other abnormal breathing sounds may also be audible without the use of a stethoscope, and it is recommended that individuals contact their healthcare provider if they experience any abnormal breathing sounds.
Auscultation is the term used to describe the technique of listening to the internal sounds of the body, such as the heart, lungs, arteries, and abdomen. During auscultation, a healthcare provider will typically use a stethoscope to listen to the sounds of the lungs from both the front and back of the body. They will ask the patient to sit upright and take deep breaths through their mouth while moving the stethoscope to different pulmonary auscultation points.
The auscultation points of the lungs include the area around the trachea, the area between the 1st and 2nd intercostal space on both the anterior and posterior sides of the chest, and bilaterally over the entire lung fields. Lung sounds can also be heard at the mid-axillary line, below the armpit. It is important to note that clothing can sometimes muddle sounds, and it may be difficult to hear lung sounds through layers of fabric.
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Frequently asked questions
Lung sounds are best heard with a stethoscope, also known as auscultation. Normal lung sounds can be heard in all parts of the chest area, including above the collarbones and at the bottom of the rib cage.
Ask the patient to cross their arms and lean forward. Make sure to check multiple locations on the anterior and posterior chest walls. If the patient is wearing a lot of clothing, it may be best to place the stethoscope directly on the skin, as clothing can muddle the sounds.
Lung sounds should be checked during the primary assessment if the patient is in respiratory distress. If there is no respiratory distress, lung sounds can be checked during the secondary assessment.
