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Auscultation - Coggle Diagram
Auscultation
Breath sounds
Terminology "breath sounds" – More accurate than air entry as AMA be entering the lung but transmission is blocked
Breath sounds can be either normal, increased (bronchial), decreased/absent
Breath sounds generated by turbulent airflow in the large airways and then transmitted through air liquid and solid to the chest wall – intensity indicates regional ventilation or factors that affect the transmission of the sound
Normal breath sounds are muffled because in the alveoli is a poor conductor of sound however lung tissue is a good sound conductor – quieter in the base than the apex because of greater volume in the lung bases filters sound further
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Bronchial breathing
Abnormal sound which is distinguished by a hollow blowing quality and expiration and pause prepare to inspiration and expiration
Indicates loss of functioning lung volume could be due to: consolidation, small area of collapse, above a plural effusion
Diminished breath sounds
Heard if: patient obese, import position or not breathing deeply
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Transmission of sound is blocked by an acoustic barrier such as air/solid or air/liquid interface of a pneumothorax pleural effusion
There is a entry but excess air and the long filters the sound e.g. hyperinflation (emphysema, acute asthma)
Added sounds
Crackles
Primary sources due to explosive equalisation of gas pressure between 2 components of the lung – when a close section of airway separating them suddenly opens
May also indicate secretions in the airways (created when air is forced through airways which have been narrowed by excess secretions or oedema
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Added sounds are superimposed on breath sounds, can be more obvious and mask breath sound. They must be respiratory in origin – not confused with non-spiritually sound such as vocal and abdomen noises or water in oxygen tubing
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Pleural Rub
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Occurs when roughened inflamed plural services rub on each other – localised affected area may be heard best over lower lobes
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Used to verify observed and palpated findings – also worth listening at the mouth prior to auscultation
Crackles heard at the mouth should be cleared by coughing in order prevent them from asking other sounds during auscultation
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Interference
Movement of stethoscope on skin, oral cavity sounds, clothing/sheets, talking, hairy skin, water into being, shivering, external sounds