Help with lung auscultation

indpndntrd

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Not sure if this is the appropriate place for this thread. I've read several related threads on the forum and also searched online. I am a relatively new EMT and would like your input about LS on more "difficult" patients.

Before auscultating, I always ask the patient to take deep breaths nice and slow with their mouth open. Not commonly, but I find that some of the older patients will not be able to take deep breaths. Instead, they will breathe at a moderate rate (~20) but not "deep." I hardly can hear anything from any of the fields. Even without breathing deeply, I can hear LS just fine on a young healthy person. Tips?

Second, just as it can be difficult to auscultate LS on an obese patient, I find it hard to listen on a "malnourished pt." I had a very thin pt recently and I could basically see the outline of each of his ribs. This did not result in very good sound quality. Tips?

Lastly, for the folk working BLS IFT, how many fields do you listen to? Do you have the patient sit upright if possible? I find that the front uppers and lowers tend to be enough but I wanted to know if it is standard practice to listen to midaxilliary and posterior fields as well.


Much appreciated,
Newbie
 

NYMedic828

Forum Deputy Chief
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Not sure if this is the appropriate place for this thread. I've read several related threads on the forum and also searched online. I am a relatively new EMT and would like your input about LS on more "difficult" patients.

Before auscultating, I always ask the patient to take deep breaths nice and slow with their mouth open. Not commonly, but I find that some of the older patients will not be able to take deep breaths. Instead, they will breathe at a moderate rate (~20) but not "deep." I hardly can hear anything from any of the fields. Even without breathing deeply, I can hear LS just fine on a young healthy person. Tips?

Second, just as it can be difficult to auscultate LS on an obese patient, I find it hard to listen on a "malnourished pt." I had a very thin pt recently and I could basically see the outline of each of his ribs. This did not result in very good sound quality. Tips?

Lastly, for the folk working BLS IFT, how many fields do you listen to? Do you have the patient sit upright if possible? I find that the front uppers and lowers tend to be enough but I wanted to know if it is standard practice to listen to midaxilliary and posterior fields as well.


Much appreciated,
Newbie

When you listen for lung sounds you need to kind of drown out everything else around you. Try closing your eyes. It may look silly but it will help you focus on your hearing alone.

Also don't put the bell of the scope on bone if you don't have to. For example the clavicles, go directly below them not on them. Trying to hear something through a wall is harder than just open space.

As far as where you listen, just make sure you listen to the whole lung. Plenty of people think they just listen superior and hear clear they must be good to go. Fluid accumulation starts down low not up high. I like to listen to 4 rear lung sounds and 2 front. It takes all of 5 seconds to check 2 more.
 

Tigger

Dodges Pucks
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If the patient is able, I like to have them exhale fairly aggressively (making a sort of "huuuh" sound) after each deep breath. An ED nurse turned me on to this, and I think it makes it easier to hear expiration sounds.
 

BLS Systems Limited

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Make sure you have good equipment, get the patient to do what you need to do and concentrate. Never go through clothes (obvious, but have seen it far too many times).

Also, make sure you know what parts you are listening to and where they are located. If you look at a picture of the left lung for example, the upper lobe drops down the front and almost reaches the bottom area and the lower lobe reaches up from behind. Therefore, if the lower is socked in or collapsed, you might not hear lower lung sounds even though they are located at the top of the thoracic cavity. The right middle lobe is virtually missing from behind while the right lower lobe can't be auscultated from the front medial region. Knowing what you are supposed to hear and where is extremely important (not unlike reading an ECG...certain squiggly lines are normal in certain areas but not in others).
 

BLS Systems Limited

Verified Vendor
58
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Make sure you have good equipment, get the patient to do what you need to do and concentrate. Never go through clothes (obvious, but have seen it far too many times).

Also, make sure you know what parts you are listening to and where they are located. If you look at a picture of the left lung for example, the upper lobe drops down the front and almost reaches the bottom area and the lower lobe reaches up from behind. Therefore, if the lower is socked in or collapsed, you might not hear lower lung sounds even though they are located at the top of the thoracic cavity. The right middle lobe is virtually missing from behind while the right lower lobe can't be auscultated from the front medial region. Knowing what you are supposed to hear and where is extremely important (not unlike reading an ECG...certain squiggly lines are normal in certain areas but not in others).
 

NYMedic828

Forum Deputy Chief
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Don't know what you wear around your neck, but it helps to have something better than this:

200907-omag-cheap-stethoscope-350x263.jpg
 

medichopeful

Flight RN/Paramedic
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If the patient is able, I like to have them exhale fairly aggressively (making a sort of "huuuh" sound) after each deep breath. An ED nurse turned me on to this, and I think it makes it easier to hear expiration sounds.

Just beware that this can cause even a healthy person to wheeze if they're blowing too hard! :ph34r:
 

medichopeful

Flight RN/Paramedic
1,863
255
83
Don't know what you wear around your neck, but it helps to have something better than this:

200907-omag-cheap-stethoscope-350x263.jpg

Hey! I get better sound with that than my Littmann! :lol:
 

Tigger

Dodges Pucks
Community Leader
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Just beware that this can cause even a healthy person to wheeze if they're blowing too hard! :ph34r:

Yes I found that out the hard way, now I demonstrate it first so they're not overdoing it.
 

JPINFV

Gadfly
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OP... are you listening to the chest or the back? If you're having trouble with a patient... or it's a respiratory patient, listen to the back... not the chest.
 
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