009 obhg chest auscultation-11- 2006

8/7/2019 009 OBHG Chest Auscultation-11- 2006

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OBHG Education Subcommittee

ONTARIOBASE HOSPITAL GROUP

Mike Muir AEMCA, ACP, BHSc

Kevin McNab AEMCA, ACP

Reviewed- November 2006

Donna L. Smith AEMCA, ACP

References Emergency Medicine

2007 Ontario Base Hospital Group

ADVANCED ASSESSMENT

Chest Assessment and Auscultation


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EVALUATE THE PATIENT

LOOK FOR SIGNS OF DISTRESSVisual Assessment

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Workload

Position

Ability to speak

Check for surgical scars

General Appearance

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Normal 12-24

Respiratory pathologies may cause rate to be

increased and shallow

Rate of

Respirations

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Accessory Muscles=

Distress

Inspiratory

Sternocleidomastoids

Scalenes

Trapezius

Expiratory

Internal Intercostals

Abdominal Muscles

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Oxygen consumption with

breathing

Normal 5%

Distress 25%

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Resistance = Prolongation I:E Ratio

Purse-lip breathing

Prolonged expiratory phase

Inspiratory Expiratory

Ratio 2:3

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Bronchoconstriction/Wet Heavy Lungs

=

Increased workload of breathingdecreased gas exchange

leads to

LOA

NEED POSITIVE PRESSUREVENTILATION

LOA and workload of breathing

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Blue = Bad

(CYANOSIS)

Diaphoresis

=

Sympathetic Stimulation

Skin condition in distress

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Palpation

Predominantly used to find traumatic injuries

Tenderness, pain, crepitus

Subcutaneous emphysema

Physical Exam

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Breath Sounds

Produced by air passing through respiratory system

Sound on inspiration (louder)

Expiration (Quieter)

Auscultation

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Breath Sound Location I/E Ratio Description

Bronchial Heard over trachea I E Loud, Harsh

2 to 3 High pitched----------------------------------------------------------------------------------------------------------------

Broncho- Anteriorly: near I E Soft, Breezy

Vesicular 1st and 2nd IC spaces

Posteriorly: 1 to 1 Pitch is lower than BronchialBetween scapulas

----------------------------------------------------------------------------------------------------------------Vesicular Lungs periphery I E

Softer, swishy

Not over sternum Pitch is lower

over scapulas 3 to 1 than Broncho vesicular

Normal Breath

Sounds

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Breath sounds to the bases

Equal breath sounds

Inspiration

Expiration

Abnormal breath sounds

Absent or diminished breath sounds

Displaced bronchial breath sounds Adventitious breath sounds

Listen with intent for

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Most common cause air passing through fluid (other?)

Fine = Smaller airways

Coarse = Larger airways

Predominantly heard on inspiration

Can be equal both lungs

Can be isolated to one area

Crackles

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Produced by air forcing its way through narrowed airways

(bronchoconstricted)

High pitched musical sounds heard on expiration Can be heard on inspiration

Smooth Muscles Irritation = Bronchoconstriction

Wheezes

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High pitched continuous crowing sound that is heard

over the trachea and larynx

Stethoscope not normally needed Best heard over neck

Partial airway obstruction from:

Stridor

foreign objects, swelling

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Constant grating sound that is heard on inspiration

and expiration

Caused from parietal and visceral pleura rubbingtogether

Pleura inflamed (loss of serous fluid)

Usually localized

Pleural

Rub

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Attempt to place patient in sitting position

Attempt to minimize as much outside noise as

possible Encourage patient not to make any moaning and

groaning noises

*Auscultation should take place within the first 2minutes

Proper Auscultation

Procedure

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WHERE

SHOULDI

LISTEN?

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Posterior Chest

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Question # 1

Why do sick asthmatics often have very little wheezing?

A

B

C

D

Severe bronchoconstriction resulting in decreasedventilation and movement of air resulting in

decreased wheezingThe patient is faking it

The patient has used their Ventolin and no longerhas wheezes

Asthmatics have crackles

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Question # 1

Why do sick asthmatics often have very little wheezing?

A

B

C

D

Severe bronchoconstriction resulting in decreasedventilation and movement of air resulting in

decreased wheezingThe patient is faking it

The patient has used their Ventolin and no longerhas wheezes

Asthmatics have crackles

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You are called for a child choking. You note small toysaround the child. Which of the following breath soundsare you most likely to hear with a foreign body aspiration?

A

B

C

D

Question # 2

Crackles

Wheezing

Stridor

Friction rub

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You are called for a child choking. You note small toysaround the child. Which of the following breath soundsare you most likely to hear with a foreign body aspiration?

A

B

C

D

Question # 2

Crackles

Wheezing

Stridor

Friction rub

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A high pitched airway noise that results from lower airwaynarrowing is known as:

A

B

C

D

Question # 4

Rales

Stridor

Crackles

Wheezing

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A high pitched airway noise that results from lower airwaynarrowing is known as:

A

B

C

D

Question # 4

Rales

Stridor

Crackles

Wheezing

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End inspiratory sounds associated with fluid in the smallairways are known as:

A

B

C

D

Question # 5

Crackles

Vesicular

Wheezes

Stridor

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End inspiratory sounds associated with fluid in the smallairways are known as:

A

B

C

D

Question # 5

Crackles

Vesicular

Wheezes

Stridor

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Chest wall diameter may be increased in patients withwhat condition?

A

B

C

D

Question # 6

Pregnancy

Heart Disease

Rib fractures

Obstructive Pulmonary Disease

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Chest wall diameter may be increased in patients withwhat condition?

A

B

C

D

Question # 6

Pregnancy

Heart Disease

Rib fractures

Obstructive Pulmonary Disease

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During inspiration, the major muscle utilized in the healthynormal patient is the:

A

B

C

D

Question # 8

Diaphragm

Intercostals

Scalenes

Sternocleidomastoid muscles

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During inspiration, the major muscle utilized in the healthynormal patient is the:

A

B

C

D

Question # 8

Diaphragm

Intercostals

Scalenes

Sternocleidomastoid muscles

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When wanting to auscultate the chest at the bases, thebest location would be:

A

B

C

D

Question # 9

The eighth rib mid-axillary

The sixth rib anterior chest wall

T3 posterior chest wall

The eighth rib anterior chest wall

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When wanting to auscultate the chest at the bases, thebest location would be:

A

B

C

D

Question # 9

The eighth rib mid-axillary

The sixth rib anterior chest wall

T3 posterior chest wall

The eighth rib anterior chest wall

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Abnormal breath sounds can be:

A

B

C

D

Question # 10


Displaced bronchial breath sounds

Adventitious breath sounds

All of the above

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Abnormal breath sounds can be:

A

B

C

D

Question # 10


Displaced bronchial breath sounds

Adventitious breath sounds

All of the above

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ONTARIOBASE HOSPITAL GROUP

Ontario Base Hospital Group

Self-directed Education Program

Well Done!Well Done!

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009 obhg chest auscultation-11- 2006

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