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Examining the Lungs
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Listen to several areas over each lung
field. Avoid the scapula.
In this case of right hemothorax, the
left lung will be clear while the right lung sounds will be muffled or
absent in the lower half of the lung fields.
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Fit the
stethoscope earpiece to your ears. The tubing should angle
slightly upward and toward the front of your head.
Instruct the patient to take slow, deep breaths through
the mouth while you listen. The breaths should be deep so the air will
completely fill the lungs. They should be slow to prevent
hyperventilation. The mouth should be open to minimize the noisy
turbulence created whenever air moves quickly through the nose.
Listen to each lung in several areas of the back. Compare
the left side to the right side at the same level. Listen to the apex
of each lung over the anterior chest. Avoid trying to listen through
the scapula (shoulder blade) as sound does not conduct well through
the bone. Avoid listening through chest hair or clothing as they
introduce acoustic artifact.
Normal breath
sounds are clear. Crackles (rales) are high-pitched sounds similar
to the sound of hairs being rubbed together.
Wheezes have a musical quality to them, reflecting narrowed air
passages vibrating like the reeds on a musical instrument. Pleural
friction rubs are the soft sounds with each breath that resembles two
pieces of leather rubbing against each other.
Stridor are the loud, coarse sounds coming from the upper airway
indicating swelling or obstruction. These can be heard without a
stethoscope, some distance from the patient.
Absent or significantly diminished breath sounds over
part or all of the lung fields may indicate fluid (pleural effusion,
hemothorax) in the chest, or a collapsed lung (air in the pleural
space).
If you are connected to the Internet, you can hear additional breath
sounds at this web site.
For further information, read:
The
Respiratory System, in Hospital Corpsman Sick Call
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