Lung sounds on extremely large patients.

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exodus

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I needed to get lung sounds on an extremely large patient, and had a very hard doing it even in the quiet snf. I heard gastric sounds no problem, but was unable to hear lung sounds at ALL! Any tips?
 
Try and listen on the back instead of the chest. If you do have to listen on the chest, try and have the pts legs hanging. I found this helps keep their abdominal tissue from pushing up to the chest.
 
Also listen in the axillary area. I've had good luck hearing with larger patients there as well
 
Chances are some obese patients are hypoventilating or have smaller tidal volumes with a higher respiratory rate as their lungs may only extend to the 6th or 7th rib at best. Their size gives them a restrictive component to lung capacity. Upper anterior, axillary and posterior may be the best one can do especially in a sitting position.
 
Yes, and for those of you that follow "The Biggest Loser" on TV, one season they showed an image of what Vent's talking about.
 
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