Auscultation Of The Chest

Auscultation Of The Chest
If Any One Is Asked To Auscultate The Chest, He/She Has To  Auscultate For Both The Respiratory System And CVS During Auscultation Of Left Side Of Chest And Only Respiratory System During Auscultation Of Right Side Of The Chest.
auscultation-of-the-chest

Auscultate Over –
·       Front (Infraclavicular Area To Lower Costal Margin)
·       Sides ( Axillary And Infraxillary Areas)
·       Back ( Supra-, Inter-  And Infra Scapular Areas)
Always Compare With The Other Side.
Always Say Vocal Resonance As Normal, Increased Or Decreased After Comparing With The Other Side.
For Respiratory System, The Description Will Be In The Order Of:
1. Breath Sounds – For Details CLICK HERE
2. Vocal Resonance
3. Adventitious Sounds – For Details CLICK HERE
For CVS, The Description Will Be In The Order Of:
1. Heart Sounds – S₁, S₂, Any S₃ Or S₄ (Quality, Intensity & Splitting)
2. Murmur
3. Pericardial Rub, Ejection Click, Opening Snap & Pericardial Knock
During Auscultation Of The Chest, Direction Given To Patient:
The Clinician Will Stand On The Right Side Of The Patient. Before Auscultation, The Patient Is Asked To:
·       Turn The Face To The Left Side
·       Breath Through Open Mouth
·       Breath Regularly And Deeply Without Any Noise
Caution During Auscultation Of Respiratory System:
·       Always Try To Auscultate With The Diaphragm Of Stethoscope.
·       Ask The Patient To Cough –
To Clear The Throat ( If Throat Sounds Appear )
To Note The Changes In Crepitations ( Often Helps In Differentiation With Pleural Rub)
For Auscultating Post-Tussive Crepitations (Especially In Tuberculous Cavity )

     VOCAL FREMITUS & VOCAL RESONANCE
Vocal fremitus
Vocal resonance
Palpation of laryngeal vibration on the chest wall when the patient speaks some words repeatedly in a constant tone and voice ( e.g., ‘one, one’ or ‘ninety-nine, ninety-nine’ )
Auscultation of laryngeal vibration on the chest wall when the patient speaks some words repeatedly in a constant tone and voice ( e.g., ‘one, one’ or ‘ninety-nine, ninety-nine’ )
Place the palm of the hand or the ulnar border of the right hand over the intercostal spaces on the chest, comparing the corresponding areas on both sides.
Both sides of the chest are auscultated area by area, comparing with the corresponding site on the other side. It is better to start from the apparently healthy side.
Start from above downwards in the front, sides and back of the chest
Start from above downwards in the front, sides and back of the chest
Causes for changes in vocal fremitus are exactly the same as that of vocal resonance
Normal vocal resonance
Quantitative changes in vocal resonance
Qualitative change in vocal resonance
   – The sound seems to be produced at the chest piece of stethoscope
   – Heard as indistinct rumble
   – Individual syllables are indistinguishable
Diminished – pleural effusion, pneumothorax, hydropneumothorax, thickened pleura, fibrosis of the lung, emphysema, collapse with obstructed bronchus
Aegophony – consolidation
–  Qualitative change in vocal resonance with nasal intonation mimicking the bleating of a goat.
Increased – consolidation, collapse with patent bronchus, open pneumothorax
   1. Bronchophony – seems to appear from the earpiece of stethoscope
   2. Whispering pectoriloquy
    – Patient whispers
    – Increased sound heard clearly or distinctly, i.e., syllable by syllable (pectoriloquy)
    – Seems to be spoken right into the auscultator’s ear.
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