Breath Sounds
Don Hudson, D.O., FACEP/ACOEP
Why is Listening to Breath Sounds
Important







What do you hear?
Where do you listen?
Does it make any difference?
Can you treat what you hear?
Who can do this?
What equipment do you need?
Can you base all of your treatments on what you
hear?
Breath Sounds




What are you hearing
Remember all that wheezes is not asthma
Cystic fibrosis, emphysema, & chronic
bronchitis also wheeze
Wheezing basically means obstruction or
narrowing of the airway.
Other causes of wheezing



Endobronchial tumors, foreign bodies, local
mucosal edema, pulmonary edema &
pulmonary emboli.
All wheezing can be labeled as dry rales or
musical rales & they are continuous, noninterrupted adventitious sounds.
Crepitant rales or fine moist rales are high
pitched crackling sounds heard during
inhalation. Cause- opening snap of alveoli
Rales continuing



Subcrepitant rales- medium pitched,
inspiration, & caused by sudden opening of
the bronchial walls.
Both Crepitant & Subcrepitant rales are
thought to be caused by fluid in alveoli &
bronchioles.
If this were pulmonary edema they become
louder as the edema worsens.
Absent Breath Sounds




Consider Endotracheal tube
placement
Atelectasis, complete obstruction
Laryngeal spasm, morbid obesity
Paralyzed diaphragm, pleural effusions,
Pneumothorax, severe pleural fibrosis,
pneumonectomy
Now what



Listen
Where
What are you listening
for ?
Think about what is inside

Imagine what you
are hearing
Where do you listen


There at least 4 separate areas on both
sides of the body, top & bottom, front &
back, right & left.
Each area should be listened to in both
inspiration & exhalation phases
Think about what you are listening for
What would you expect to hear ?
OUR TOOL
The Stethoscope




We all have one, but how is the best way to
use it.
The sounds you hear depends on it
functioning properly.
The ear piece is frequently the source of a
problem if you cannot hear well.
They should fit well, be comfortable, be air
tight & angled slightly forward.
How do you augment the sounds



You are listening for several types of
sounds these may include:
Normal breath sounds, decreased or
absent breath sounds & abnormal breath
sounds.
These sounds need to be defined by when
they occur, loudness, wet or dry, associated
cough, etc..
Use of the Stethoscope



The diaphragm- most suitable for listening
to high-pitched sounds & murmurs.
These include high pitched rales, 1st &
2end heart sounds, some stenosis &
regurgitation murmurs.
It should be applied to the skin of the chest
wall with firm pressure.
Use of the stethoscope



The bell- is best suited for low-pitched
sounds & murmurs.
These include absent breath sound areas,
3rd & 4th heart sounds, fluid filled chest
cavity, i.e. tumors, blood etc.
It should be applied with very light pressure
barely making an air tight seal.
What do you hear with the stethoscope



Sound is perceived according to its pitch,
loudness & quality.
These are subjectively equated to the
physical properties of sound waves,
frequency, intensity, & harmonics.
You must train to have selective hearing, to
listen for a single sound & then focus on it.
Now you hear them, what next?



Obviously we have all been trained to think
& that is what we need to do here.
This is like a slide rule it gives you data but
it is left up to you to interpret what you hear.
You need a whole picture of the patient to
make a good diagnosis.
Remember the physical is important
What do you hear & why?
What happened & What do you hear
What do you hear? Why?
What do you hear & why?
Describe What the sound is & how
you hear this sound
Diagnosis & Sounds.
How do you hera them best?
Listen & Percuss the chest
Pulmonary Edema
DIAGNOSIS & TREATMENT
DIAGNOSIS & TREATMENT
DIAGNOSIS & SOUNDS HEARD
Is listening to Breath Sounds
Important






What do you hear?
Where do you listen?
Does it make any difference?
Can you treat what you hear without other
input?
Who can do this & what equipment do you
need?
Can you base all of your Tx on what you
hear?
Nothing is ever really SIMPLE
Thank You for your
Attention