One of the questions frequently asked by most medical practitioners is where to listen to lung sounds. Many physicians find listening to lung sounds quite challenging especially in obese people where the sounds are not very clear. Most medical schools are taught different methods based on the experience of the tutor. One of the most vital and difficult skills every MD should learn and master is the analysis of lung sounds. This includes the skills of placing the stethoscope in the right position. The best part is that you will not have to worry on where to listen to lung sounds anymore since this post will educate you on the ultimate way to listen to lung sounds. Here is the preview. Respiratory assessment Start above the collar bone and palpate from side to side moving towards the costal angle alongside the mid-axillary line. Next, examine the patient’s thorax and note whether there are symmetry and configuration. Inspect the posterior thorax and scrutinize presence of any bone deformity. Some abnormal spinal curvatures may result to breathing difficulties. It is also vital to observe whether the trachea is deviated or mid-lined. Where to Listen to Lung Sounds Here is the deal… When the instrument is placed in the right position, it will filter out any unwanted noise from other body processes such as gastrointestinal activities. You will therefore be ready to detect the breathing patterns of your patient. If you place the stethoscope on a bone, you will not hear anything. The medical field is an art centered on sciences, and therefore, the final decision lays with you the practitioner. The Anatomy of the Thorax and Respiratory System You must know this! When learning about where to listen to lung sounds with stethoscope, you must be conversant with some fundamentals of anatomy. Here are some of them: The lobes of both lungs; two on the left and three on the right. The anterior (front) viewpoint the lungs are located from the top of the rib cage, directly above the collarbone (clavicle) to the 6th intercostal space. The diaphragm lies below the thoracic cavity. The diaphragm curves to allow the lungs to expand. The above parameters do not change during inhalation. With this knowledge, you will not even think of placing the stethoscope on the sternum, since all you will hear is the heartbeat. When you place it below the 6th intercostal space, you will hear the intestinal sounds. What’s the bottom line? The ideal place for auscultation is the posterior chest since there are fewer muscles and bones to disperse sound. Here is the kicker… Lung Auscultation It is the process of listening to body sounds and distinguishing normal from abnormal. This is done to aid in the diagnosis of a disorder. When listening to the lung sounds reduce the external sounds. For instance, you may switch off the TV and restrict your patient from talking. Place the stethoscope directly on the skin since clothes make the process more difficult. Request the patient to take deep breaths every time you alter the position. Look… Normal breath sounds vary with the location of the stethoscope. For instance, when it is over the trachea, you are supposed to hear a High-pitched, hollow sound referred to as bronchial breath sound. It will be abnormal to hear such a sound when the instrument is placed away from the large bronchi and the trachea. Vesicular breath sounds are heard over the lung tissues and bronchovesicular breath over the large diameter airways. When starting off, it is better to start with slim people or children since their breath is more conspicuous. Auscultate over all parts of the posterior and anterior thorax. During the process ask the patient to cross the hands anterior to the chest. This will pull the scapulae apart, and more lung tissues will be exposed. Listen carefully and note any abnormal sounds such as crackles (rales), wheezes, stridor, and a friction rub. When auscultating the posterior chest, the patient should sit upright and lean forward slightly with arms resting on the laps. Anterior assessment can be done when the patient is sitting or in a supine position. Why it’s Important to Listen in the Correct Locations You might be wondering why this process is done with a lot of attention. Currently, health care professionals are under intensified scrutiny to offer safe and effective healthcare. Most education institutions are pressurized to produce graduates who will offer safe healthcare services. When auscultation is done on the right parts of the body, the doctor will be able to determine the disorder a patient might be suffering from and place the patient under the right medication. The condition will be dealt with early enough, and there will be no further complications. Being able to listen abnormal lung sounds is crucial for proper patient care. Finally!!! During respiration assessment, the medical practitioner should first visualize the patient and note any clues outside the chest that could be leading to breathing difficulties. There are certain steps designed to help the physician through the whole assessment process in an organized and logical sequence. The first step is visualization. This is then followed by palpation, percussion and finally auscultation. Every medical practitioner needs to know where to listen to lung sounds and must ensure the equipment is placed in the right positions. Source
