![]() ![]() Focus on breath sounds, their quality, intensity and pitch. Listen to and compare identical places on each sides. At each place listen to at least one complete breath cycle. The key is to listen to the all of the chest. Listen to the front or back of the chest first, from apex to base or vice versa based on your preferences and clinical judgement. When listening to the back, ask the patient to cross arms over the chest to evert the shoulder blades. Ask the patient to breathe deeply through the open mouth. Even if it’s not cold it’s a nice gesture of special care. Warm up the cold stethoscope by rubbing the membrane. If the patient is not able to sit up, roll the patient to each side to examine the back. Female patients should have only front or back of the chest exposed at once. Room should be quiet and patient sitting up, decently exposed. The key to detailed and correct examination is systematic approach. Some physicians prefer to listen back to front, top to bottom or vice versa. There is no best way of listening to the lungs. The physician is listening to the body wall indirectly through the stethoscope which is composed of the bell or membrane, the tubing and the earpieces. It’s the method of auscultation as known today. However, since the discovery of stethoscope this method was replaced by more accurate, convenient and hygienic mediate auscultation. ![]() In this method the physician is listening to the body wall directly with the unaided ear. There are two methods of auscultation – the immediate and mediate auscultation. ![]() Laennec examing a young boy by “mediate” auscultation with his stethoscope. In 1819 he published his famous work A Treatise on the Disease of the Chest. Finally, unsatisfied with the names given by his colleagues he decided to call it the “stethoscope”. It was a two part 12 inches long and 1.5 inches thick wooden cylinder for listening of the lungs with another removable cone-shaped plug used for listening of the heart. His particular sets of skills were useful in developing new instrument for auscultation he called “Le Cylindre”. To his surprise the sound was conveyed louder and clearer than with immediate auscultation. Instead he rolled up 24 sheets of paper and placed one end to her chest and the other one to her ear. In 1816 when examining young female patient he felt embarrassed to place his ear to her chest. Laennec was a French physician, skilled woodturner and also a flutist. This immediate auscultation was the only method of auscultation until the discovery of stethoscope in 1816 by René Laennec. Hippocrates tried to listen to the body sounds by applying the ear directly to the chest trying to detect any accumulation of fluid within it. Lung Auscultation – Adventitious Breath SoundsĪuscultation was known to the physicians even in the times of the ancient Egypt.Lung Auscultation – Normal Breath Sounds. ![]()
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