# Lung sounds?



## musicislife (May 4, 2012)

When are these checked? Do you check them as part of respiratory vitals or initial assessment of breathing? For both Trauma and medical


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## Aprz (May 4, 2012)

In some areas, they are considered a vital sign and taught in an acronym called PRBELLS (that's one I forgot to mention in our acronym list on this site I think, lol). PRBELLS: pulse, respiration, blood pressure, eyes, lung sounds, level of consciousness, and skin signs.

I don't think you would be called out if you did assess it on every patient, you may even be praised for assessing airway further than "they are talking to me". I don't think it needs to be assessed on every patient; it could be done as part of a focus to rule in/out conditions like congestive heart failure, COPD, pneumonia, etc.

In school, you would normally do it while assessing the chest in your physical exam and then the patient's back when you get to that. I've seen some instructors insist on doing it while assessing ABCs in your initial assessment, I've seen students do both the front and back once they get to the chest, and when they c-spine/log roll the patient.

I attended two EMT programs. In one, it was a critical fail if you didn't do it. In the other, it was part of physical exam and done at the chest (so if you did a focus on the hands e.g. hand trauma scenario, you didn't have to do it) and was only 5 points if you missed it (not a critical criteria). At work, nobody ever got on me if I wrote "did not examine" or crossed it out, lol. If you're a student, I'd ask your instructor where they'd like to see you do it since it can vary when and what part of the assessment when you do it. If you are working, ask your company what they would prefer.


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## RustyShackleford (May 4, 2012)

I do it on every patient, it takes about 6 seconds and can actually give me some clinical enlightenment on a patients condition, as a paramedic we only have a few diagnostic tools to use, your stethoscope being one, why waste it.


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## Aprz (May 4, 2012)

At the same time, it could be viewed as wasting your time doing an assessment that may not be warranted based on the complaint and general impression of the patient. A patient assessment can be dynamic and changed based on what you start with. A full (prehospital) physical exam takes a minute or two, yet a lot of us do focus assessments. It takes a minute or two and it tells you a lot about the patient, why waste it?

I do it on every patient because I want to distinguish between the different usually clear breath sounds in each section of the lung. Listen real carefully the difference between inspiratory and expiratory sound and how long they last, it's an acquired skill, but at the same time, I don't believe it's warranted on every patient. I also do a full (prehospital) physical exam because I also believe it is also an acquired skill too.


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## Veneficus (May 4, 2012)

I wonder what the utility or the proficency would be at the first responder level...

It is not that I am anti-going above and beyond, but I have come to learn that inderstanding of pathophysiology is what guides physical findings, not the other way around.


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## Aprz (May 4, 2012)

Veneficus said:


> I wonder what the utility or the proficency would be at the first responder level...


I work on a dedicated critical care transport unit (2 EMTs, 1 RN). The nurse expected us only to describe the lung sounds as "sounds like crap/doesn't sound like crap", or at least that's what he told us when we first started working with him, haha.


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## Veneficus (May 4, 2012)

Aprz said:


> The nurse expected us only to describe the lung sounds as "sounds like crap/doesn't sound like crap", or at least that's what he told us when we first started working with him, haha.



:glare:

truly a credit to his profession...


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## bigbaldguy (May 4, 2012)

Veneficus said:


> I wonder what the utility or the proficency would be at the first responder level...
> 
> It is not that I am anti-going above and beyond, but I have come to learn that inderstanding of pathophysiology is what guides physical findings, not the other way around.



Simple, "sounds normal", or "sounds funny" is usually enough to get somebody with better ears to listen in my experience. If for no other reason than so the nurse/doc/tech can look at you with that "your an idiot" stare and say I don't hear anything unusual.


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## RustyShackleford (May 4, 2012)

We obviously operate on different types of service/care then, I don't worry about performing tasks based on whether or not things may be seen as this or that.  I provide ALS and BLS care to a patient who needs my assistance and based on my education and protocols decide what is best for my patient, not whether I am wasting time or not, most of my transports are >20 min to a ED, I would rather auscultate lung/cardiac sounds than twiddle my thumbs.  Luckily though where I work RN's usually require a more detailed report from me than "sounds like crap"......


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## Aprz (May 4, 2012)

I didn't literally mean how people view what you do.


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## musicislife (May 4, 2012)

my instructor said clear or unclear..remember im a first responder, so there would most definitely be other guys coming that are higher trained





Aprz said:


> I work on a dedicated critical care transport unit (2 EMTs, 1 RN). The nurse expected us only to describe the lung sounds as "sounds like crap/doesn't sound like crap", or at least that's what he told us when we first started working with him, haha.


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## Veneficus (May 4, 2012)

musicislife said:


> my instructor said clear or unclear



That adds nothing. Why bother?

especially don't run out and buy a $100 stethoscope for that.


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## musicislife (May 4, 2012)

well yes, but it will be enough in my opinion to warrant an EMT to listen when i provide them the hand off report. And i have a scope for BP anyway 





Veneficus said:


> That adds nothing. Why bother?
> 
> especially don't run out and buy a $100 stethoscope for that.


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## RustyShackleford (May 4, 2012)

It really provides no information whatsoever, you are better off letting the medic know the patients current respiratory effort, 02 sat, ETCO2 if your service uses it.


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## mycrofft (May 4, 2012)

Not sure why a chest auscultation provides no information whatsoever, unless it is because the auscultator is not trained. I've even auscultated with my ear on the chest when a scope was unavailable and gotten valuable data in an emergency. But I have more training and experience than a first responder.

If you are serious about this, get past first responder! Move on up.


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## RustyShackleford (May 4, 2012)

No if you go back and read the posts I was commenting that the "clear or not clear" doesn't offer me much as a receiving medic.


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## Aidey (May 4, 2012)

RustyShackleford said:


> We obviously operate on different types of service/care then, I don't worry about performing tasks based on whether or not things may be seen as this or that.  I provide ALS and BLS care to a patient who needs my assistance and based on my education and protocols decide what is best for my patient, not whether I am wasting time or not, most of my transports are >20 min to a ED, I would rather auscultate lung/cardiac sounds than twiddle my thumbs.  Luckily though where I work RN's usually require a more detailed report from me than* "sounds like crap".*.....




I admit to being 100% guilty of doing that :unsure:. 

We use a paper run form, and then later fill out an ePCR. We are required to write at least minimal info on the paper form. I have been known to write "bad" in the lung sounds box, mostly because the box is about that [     ] big. Of course my actual verbal reports are more detailed, but some times I will start out with "Lung sounds are crappy, blah blah blah"


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## mycrofft (May 4, 2012)

Got it Rustyshackleford. I took the single reply by itself, seemed a little disconnected.


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## Akulahawk (May 4, 2012)

I do lung sounds every time I assess the patient. If I'm just taking vitals, no, I don't. I also state a summary of lungs sounds when doing a verbal report using just one or two words to queue the next person in that LS are something that need to be paid attention to... and I then immediately do the report of the lungs/respiratory component of said report.

"Clear/Not-clear" doesn't offer me much either by itself for lung sounds description. I want something more descriptive to follow. All that does is clue me in so that I pay a bit more attention to that follow-on description... and I'm going to check for myself anyway.


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## Handsome Robb (May 4, 2012)

RustyShackleford said:


> I do it on every patient, it takes about 6 seconds and can actually give me some clinical enlightenment on a patients condition, as a paramedic we only have a few diagnostic tools to use, your stethoscope being one, why waste it.



I'm with you here. I listen to every one of my patients. Depending on the nature of their illness determines when. Respiratory complaint it's near the top of my list, something unrelated I'll get to it at some point but always get to it. 

I listen to heart tones all the time too...


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## mycrofft (May 5, 2012)

Doing sick call (where I had the options of calling in the MD later, starting a standardized procedure, or yelling "NEXT!!"), I'd take vitals and primary complaint while looking and listening. Any resp c/o or any resp sign I saw, I'd do a quick ausc of the bilateral bronchial areas; I could from that get an apical pulse, and hear what generally was going on respiratorially, and expand or move on based on what I heard/saw/felt. (also gave me a chance to "squeeze in" a sternal compression to help r/o costrochondritis). Rarely did I need to completely ausc every single field; wheezes were wheezes, rales were rales, silent resps were trouble (or feigned), and I could document and either treat, or refer.


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## Aprz (May 5, 2012)

I wonder if that nurse read this post. He insisted on having me do lung sounds on all our patients today, lol. It was really odd to me.


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## Veneficus (May 5, 2012)

Aprz said:


> I wonder if that nurse read this post. He insisted on having me do lung sounds on all our patients today, lol. It was really odd to me.



Good, it is nice to know somebody here listens from time to time.


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## mycrofft (May 5, 2012)

Another closet EMTLIFE lurker?


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## Aprz (May 5, 2012)

Possibly. I didn't ask, but I did tell him about the site awhile ago so maybe.


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## Brandon O (May 5, 2012)

musicislife said:


> When are these checked? Do you check them as part of respiratory vitals or initial assessment of breathing? For both Trauma and medical



A quick listen to both sides during your rapid trauma assessment (as you move down the chest) would be wise to rule out pneumothorax.

For a focused medical assessment in a respiratory complaint, do it early.

For a general and unrelated medical complaint, do it whenever, if at all (i.e. as part of your detailed assessment).


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## ZootownMedic (May 14, 2012)

NVRob said:


> I'm with you here. I listen to every one of my patients. Depending on the nature of their illness determines when. Respiratory complaint it's near the top of my list, something unrelated I'll get to it at some point but always get to it.
> 
> I listen to heart tones all the time too...



How is the heart tone listening coming?? I am not knocking it, in fact I think its great. I just find it incredibly hard to differentiate normal and un-normal heart tones. Almost every ER physician I know says its takes years and thousands of patients to become proficient(which is why its great you do it now). Other than Beck's triad...I don't see how it could really help us out anyways as far as field treatment or diagnosis goes. I guess my question is....how has it been working for you, and has it changed anything you have done for your patients? Since I can't really tell normal vs un-normal I just don't do it....and I doubt it would change my care as a pre-hospital provider anyways even if I could.


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