A Basic Guide to Chest Auscultation
Published: 31 May 2020
Published: 31 May 2020
Chest auscultation involves using a stethoscope to listen to a patient’s respiratory system and interpreting the lungs sounds heard (Physiopedia 2015).
Auscultation is a fundamental component of physical examination that can assist in the diagnosis of respiratory issues. It is a non-invasive, safe procedure dating back to the era of Hippocrates (who used his ear rather than a stethoscope), making it one of the oldest diagnostic techniques (Physiopedia 2015; Sarkar et al. 2015; Proctor & Rickards 2020).
In addition to the respiratory system, auscultation can also be used to examine the heart, circulatory system and gastrointestinal system (Physiopedia 2015).
Despite being a fairly straightforward assessment, chest auscultation is a skill that requires considerable practice and understanding of the respiratory system so that you can differentiate normal respiratory sounds from abnormal and adventitious sounds (e.g. wheezes and crackles), and accurately diagnose patients (Sarkar et al. 2015).
The more lung sounds you listen to, the easier it will be to identify an abnormality and report it to a member of the medical team.
It is important to remember that auscultation is just one component of respiratory assessment; ensure you also monitor the rise and fall of the patient’s chest and identify any potential difficulties they may be experiencing (shallow breathing, pain, use of accessory muscles, reduced ability to follow instructions, sputum production, asymmetry of the chest etc.)
Chest auscultation should be contextualised to a patient’s medical history and form one component of a holistic assessment (Proctor & Rickards 2020).
Lung sounds are caused by vibrations of the vocal cords during inspiration and expiration, which are transmitted to the trachea and bronchi. These sounds can be used to monitor airflow through the trachea and bronchial tree (Proctor & Rickards 2020).
Problematic lung sounds may be abnormal (meaning they are absent, sound different to normal sounds or are heard in a different location to what is normal) or adventitious (additional sounds that are heard over the top of regular sounds) (Prakash, Mullick & Pawar 2015).
Common causes of problematic lung sounds include:
Ideally, chest auscultation should be performed on all patients as part of a head-to-toe assessment. This will ensure you have adequate insight into patients’ condition at the commencement of your shift and will be able to escalate care if any deterioration is identified.
Other situations where chest auscultation may be used include:
(Tsotsolis et al. 2015; Prakash, Mullick & Pawar 2015)
(Proctor & Rickards 2020)
If the patient experiences sudden or severe difficulty breathing or stops breathing, this is an emergency. Perform a respiratory assessment and commence basic life support if required.
Chest auscultation is an important component of respiratory assessment. By having a baseline of the patient’s condition, you should be able to recognise any early signs of deterioration.
Ensure you familiarise yourself with lung sounds, as the more you practice, the better you will become at identifying abnormalities.
Question 1 of 3
True or false? Chest auscultation should be performed on all patients.
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