Breath Sounds -Part 3- location

Breath Sounds -part 3

Continuing on with our series on breath sounds. Today we look at stethoscope position.

First, knowing your stethoscope. The  flat disk like part of your stethoscope is called the diaphragm, and is the surface that is used for high pitched sounds. Lung auscultation and bowel sounds are examples.

If your stethoscope is a dual head, with the cone shaped bell, then low pitched sounds are heard best through this part of the scope.  Heart sounds can usually be heard better with the bell.

Anatomic placement

Listening to breath sounds is as simple or as complex as you want to make it.

Start with anterior (front of chest) for a quick listen for normal.

Location 

2nd intercostal space in the mid clavicular line.  Listen left then right in a patient sitting upright.

Then 5th Intercostal space in the mid axillary line (same spot you place the V6 lead on an ECG).

Again listen left then right.

You are listening for equality between two anatomically opposite locations. Read that again.... It's important!

R=L at the 2nd ICSMCL

R=L at the 5th ICSMAL

Listen to a couple of breaths in and out with the patient breathing through their mouth.

Focus on the duty cycle (time taken to breathe in vs out, focus on the equality between left and right and listen for abnormal sounds like wheeze or crackles.

Record any adventitious sounds or inequality.

These two locations complete a basic respiratory auscultation.  If a comprehensive assessment is needed (usually not) then the patient should be propped forward and auscultation is performed on the back.

This allows you to hear the largest portion of lung fields.  The posterior chest is called the base, which is often erroneously confused with the inferior aspect of the anterior chest.  More alveolar area is in the base of the lung.

Now say out loud... "2,4,6,8,10"

Did you say it? Are people looking at you funny? 

2,4,6,8,10.

These are the intercostal spaces.  Either side of the vertebral column, you listen at the 2nd ICS left then right 

4th ICS left then right

6th ICS left then right

8th ICS left then right

8th ICS at the Axillary line .

10th ICS left then right

Then finish at the 10th ICS out on the widest part of their chest - the posterior axillary line.

Don't be daunted by these 6 sites.  You are only listening to compare Left to right at each spot. 

Practice these locations on your partner or kids. Listen to normal chests to get your ear in for the nuances of normal.

Know normal so you can recognise abnormal sounds as they arise.

Next episode we will discuss classic consolidation/pneumonia and the funky sounds you can experience to identify a pneumonia in your patient.