Where to Listen for Lung Sounds: The Complete Guide to Respiratory Auscultation Examination

Guide to Respiratory Examination

The Respiratory Assessment and Examination

A respiratory assessment is an integral part of any head-to-toe physical exam. A proper respiratory examination and assessment involves both skill and practice.

The following outlines the steps you should use in performing a respiratory assessment as well as how to identify potential abnormal signs and symptoms suggestive of pathology. But before we start – have you got a stethoscope? If not, check out our guides on how to choose the best stethoscope for every field of healthcare.

STEP 1:  Start with the General Inspection:

You can begin making deductions about what you’re likely to find in the lung auscultation by their age and general appearance:

Young patients – think of Asthma and Cystic Fibrosis (CF)

Older Patients – think of COPD, interstitial lung disease, infection, or malignancy.

Is the patient short of breath? Are they exhibiting other clues such as pursed lip breathing, use of accessory respiratory muscles, or nasal flaring?

Is the patient able to speak full and uninterrupted sentences with one breath? If not, this is already a sign of a moderate or severe respiratory attack.

Check the respiratory rate. Raised respiratory rate is an early sign of problems and should be taken accurately and seriously. Normal adult range is 12-20 breaths per minute.

Important Signs in a Respiratory Examination:



STEP 2: Palpation

Start above the collar bone and palpate from side to side moving towards the costal angle alongside the mid-axillary line.

Examine the patient’s thorax and note whether there are symmetry and configuration. Inspect the posterior thorax and scrutinize presence of any bone deformity. Some abnormal spinal curvatures may result to breathing difficulties.

 

STEP 3: Auscultation  (Where to Listen to Lung Sounds)

Ask the patient to breathe deeply through their mouth.

Listen from the front and back:  Move from side to side, top to bottom, to compare lung sounds at each level. Auscultating from the back will often result in clearer lung sounds.

When the stethoscope is placed in the right position, it will avoid unwanted noise from other body processes such as gastrointestinal activity.  If you place the stethoscope directly on a bone, you will not hear anything, so avoid listening over the scapula.

Ask the patient to cross their arms on their chest and lean forward. This pulls the scapulae apart, exposing more lung are for auscultation.

Listen carefully for the breathing patterns and sound characteristics of your patient’s respiration, paying close attention to the:

Assess sound quality (vesicular vs. bronchial), assess volume (quiet vs increased resonance), and listen for added sounds (polyphonic wheeze and crackles).

Common Respiratory Patterns on Auscultation:

To assess vocal resonance:



STEP 4: Percussion

Press your non dominant hand firmly on the chest wall, nesting your middle finger between ribs. Strike the middle phalanx of your non-dominant hand firmly yet briskly with your other hand to percuss. Make sure you lift the striking finger quickly to not muffle the percussion tone.

Percuss in the same areas as you auscultate, and compare side to side. (See image above.)

Understanding what Percussion sounds Mean:

It is important to corroborate your percussion findings with your auscultation findings.

For instance, did you find percussion dullness over the same area as increased vocal resonance in auscultation?

STEP 5: Further Assessment and Investigations

Based on your examination findings, you will likely want to perform further tests if indicated:

 



 

The Anatomy of the Thorax and Respiratory System

You must understand the basic anatomy of the airways and thorax to interpret your auscultation and examination findings. In particular, you should learn the borders and surface anatomy of the lung lobes. Examiners in particular like to quiz students which lung lobe contains the likely pathology found during the respiratory assessment.

lung surface anatomy

Here are some important fundamentals:

If you place the stethoscope below the 6th intercostal space anteriorly, you will no longer hear respiratory sounds, but instead intestinal sounds.

The ideal place for auscultation is the posterior chest since there are fewer muscles and bones to disperse sound.

Lung Sounds & Auscultation Video

 

One of the most important auscultation skills for medical practitioners to master is Respiratory auscultation. The first step is to learn where to listen to lung sounds and understanding their significance. We hope this above guide was helpful in learning the respiratory examination and lung auscultation.

RELATED POSTS:

Best Stethoscopes for Doctors

Best Stethoscopes for Nurses

Best Stethoscopes for Medical Students

Best Stethoscopes for EMT & Paramedics


Tags:

Categorised in: ,

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.