An introduction to using the stethoscope History What

Stethoscope – what do you hear? • Breath sounds • Added sounds from lung

Stethoscope – what do you hear? Breath sounds • Vesicular • Bronchial May be

Stethoscope – what do you hear? Added sounds from the lungs • Crackles –

Stethoscope – what do you hear? Added sounds from elsewhere • Pleura – rub

How do you describe what you hear? • What heard • Where heard •

Where do you listen? Over the lungs! Other structures may interfere • Superficial –

Surface anatomy • Vertebra prominens - C 7 • Sternal notch – overlies trachea

Warning! You cannot tell everything from your stethoscope. The history and other physical signs

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An introduction to using the stethoscope • History • What it is • How to care for it • Normal and abnormal breath sounds • Added sounds • Surface marking of the lungs

Immediate auscultation

Stethoscope – what do you hear? • Breath sounds • Added sounds from lung • Added sounds from elsewhere

Stethoscope – what do you hear? Breath sounds • Vesicular • Bronchial May be modified in volume– increased or decreased

Stethoscope – what do you hear? Added sounds from the lungs • Crackles – ‘wet sounds’ [crepitations] • Wheezes – ‘dry sounds’ [rhonchi]

Stethoscope – what do you hear? Added sounds from elsewhere • Pleura – rub [creaky shoe] • Chest wall – fractured rib • Superficial tissues – surgical emphysema • Clothes!!

How do you describe what you hear? • What heard • Where heard • When heard E. g. Inspiratory crackles at the left base

Where do you listen? Over the lungs! Other structures may interfere • Superficial – breast, fat, scapulae • Underlying - liver, heart

Surface anatomy • Vertebra prominens - C 7 • Sternal notch – overlies trachea • Manubrio sternal angle - T 4/5, bifurcation of trachea, 2 nd costal cartilage, upper order of atria, aortic arch • Xiphoid process – T 9

Warning! You cannot tell everything from your stethoscope. The history and other physical signs derived from observation, palpation and percussion are essential to make a diagnosis.