4/9/2024 0 Comments Auscultate lung soundsYou need to intervene here with some pulmonary hygiene interventions. There are several tones and types, but overall, they indicate airway obstruction of some degree. Wheezes (also known as “high pitched continuous sounds”) are a fairly common adventitious sound that many people have heard. If this patient has a trach, they will need suction. And sometimes you just need a good cough. ACBT is really useful here, as well as FETs or a PEP if your patient is too weak to perform FETs well. These types of sounds are good indicators that some pulmonary hygiene is needed. Rhonchi are heard when large amounts of mucus are present in the larger airways. Rhonchi (also known as “low pitched continuous sounds”) are what I’ve always termed “the goose honk”. Hopefully, they will be moving toward the end of it. If stridor is just beginning, your patient may need some urgent medical intervention. However, it may also be present in extubated patients who come home after being hospitalized. Stridor is typically associated with upper airway narrowing. Stridor is going to be a very important sound to know when assessing or treating patients with COVID-19. These sounds should tell you that you need to perform some interventions. Crackles can be fine (like bubbles gently popping) or course (like tearing Velcro apart). Crackles can be a sign of COPD, bronchitis, CHF, Pneumonia, or atelectasis depending on when they happen in the breath cycle. Adventitious SoundsĪn advantage for you, not for your patient… Adventitious sounds can be used to determine what pathology is present and what treatment needs to be performed.Ĭrackles (also known as “Discontinuous sounds”) can be heard over the peripheral airways also. It is important to remember that a normal sound that is auscultated in a place not considered to be normal is an adventitious sound. Other normal sounds include bronchial (which are only normal when auscultated over the bronchials) and bronchovesicular (which are only normal when auscultated over the bronchioles). If they are not utilizing much lung volume, this is a great opportunity for you to intervene with some diaphragmatic breath training and/or IMT use for diaphragm strengthening! Vesicular Normal lung sounds (named “vesicular” sounds when auscultated over the peripheral segments) should be somewhat quiet, but sounds that are too quiet are what we term “diminished.” It can be typical to hear diminished sounds in a patient who is obese or who doesn’t utilize much lung volume. If your patient is bradypnic, you may have to wait longer. This is one breath about every 4 seconds. A typical respiratory rate is 12-16 breaths per minute. Ask your patient to take a deeper breath.You can also lift the ear pieces upward, same effect. This helps reposition the ear pieces to channel the sound directly in to your ears. If the head got turned, you won’t hear anything. Check your stethoscope! Some have heads that swivel to channel sound toward different sides (bell vs.Shallow breaths don’t move air in the bases of the lungs so you don’t typically hear sounds there! However, hearing NOTHING is also a problem! If you don’t hear anything, here’s what to do: Keep in mind that WHAT you hear depends on what depth of breath is being taken. Listen at each point for two full breaths. When auscultating, you want to start in the same place every time, typically the patient’s right upper lobe, then traveling across the sternum to the left upper lobe, then inferiorly, and then across. What is most important is that you listen to all segments and compare sides. We aren’t going to spent too much time here. So let’s start with the basic anatomy refresher. If you don’t, you may miss the left lingular segments which is where stuff likes to hide. You also MUST listen to both the front and back of the lungs to ensure you are getting all the segments. This includes listening from top to bottom and left to right with the ability to compare right and left sides of the same lung segment. The method of performing auscultation that gives you the most information is to use the “S” pattern. There are a lot of variables when it comes to disease state, but if you have a stethoscope, just start listening to all your family members to get an idea of what “normal” sounds like. You have to know WHAT you are listening for and you have to know HOW to listen. The importance of this is pretty paramount. If you are going to be providing pulmonary interventions, you should probably have a strong idea of how to auscultate the lungs.
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