Rules and features of conducting auscultation of the lungs in pulmonary pathologies

  • Rules and features of conducting auscultation of the lungs in pulmonary pathologies

    One of the most common medical procedures used even a hundred years ago is auscultation of the lungs. To carry out this simple manipulation, a specialist only needs a stethoscope, with which you can hear specific sounds and determine the peculiarity of breathing. Auscultation of the lung is used to diagnose pulmonary, bronchial, circulatory and cardiac abnormalities. The information received is relevant for propaedeutics.

    The specialist who conducts this procedure should not only have a good theoretical orientation, but also have a good ear.

    Key points for performing the procedure

    For the competent conduct of auscultation of the lungs, the listening points should be well known to each specialist.

    Abnormal conditions

    Auscultation of the lungs allows diagnosing the following pathological conditions:

    1. Tuberculosis.
    2. Pulmonary edema.
    3. Pneumonia.
    4. Lung infarction.
    5. Malignant tumor in the organ. Benign tumor in the organ.
    6. Accumulation of pleural fluid.
    7. Heart failure.
    8. Pneumothorax.
    9. Abscess.

    In order to correctly diagnose this or that anomaly, the specialist is obliged to listen to the patient's breathing at various points. Determine the nature of violations of the functioning of both the respiratory system and the whole organism as a whole, sound phenomena allow. It can be both healthy noises, and specific wheezing.

    Methods of performing the procedure

    Two methods of auscultation are known to modern physicians:

    • direct or direct, in which the doctor begins to listen to the patient's breathing, attaching the hearing organ to his skin( today this method is no longer used);
    • is indirect or mediocre, in which the doctor begins to listen to the patient's breathing with a stethoscope and other auxiliary equipment.

    In the case of using the first method of listening, a patient is expected to have a large number of auscultation points. This is due to a decrease in accuracy when listening to the patient. When a mediocre method is used, the number of auscultation points varies from 8 to 10.

    When examining a patient, a specialist listens to breathing at each of the points, progressing progressively from the clavicular cavity to the sternum. The transition from point to point must be symmetrical.

    What to remember about

    Today, there are general rules for auscultation of the lungs. The basic rules are just a little over ten, and following them is not anything complicated.

    So, it's important to remember about:

    1. Tom, that in the room in which this manipulation is carried out, there should be peace and absolute silence.
    2. Tom, that for the correct conduct of the procedure the patient should be naked, as the friction of the device about clothes causes side sound phenomena.
    3. The need to pay attention to the hair area of ​​the current zone( in order to avoid side effects, the hair on the chest should be soaped or soaked).
    4. Maintaining the correct room temperature( if a person is shivering from the cold, this will interfere with the listening of the organs).
    5. The fact that the position of the patient and the specialist who listens to the organs should be as convenient and comfortable as possible.
    6. Uniformly applying the stethoscope to the surface to be listened( this should be done as tightly as possible, but without pressure).
    7. Volume that it is better not to touch the hard tool during the procedure, as this may contribute to the occurrence of side sound effects.
    8. The fact that you do not need to put pressure on the instrument, because the patient will not only be uncomfortable, but also painful.
    9. Using the same tool.
    10. Controlling the patient's breathing.
    11. Systematic and persistent listening to current organs.

    If the patient is tapped in an upright position, the doctor should clasp it as tightly as possible. This will help to hear all the sound phenomena.

    In order to hear all the noise, the specialist must abstract from the surrounding reality and concentrate on the field of research.

    If the patient has pneumonia

    In pneumonia, manipulation is performed by means of a special instrument called a stethophonedoscope. This tool consists of:

    • sound amplifying membrane;
    • system of tubes made of high-quality plastic.

    When a person's lungs are normal, the specialist hears a clear sound, indicating that the breath has not undergone any abnormal changes. And with pneumonia, it is normal for an exudate to interfere with a person. In this case, the specialist clearly hears the sound of weak, labored breathing. Specific rales are also heard.

    If the patient has bronchitis

    In bronchitis, the patient's breathing can be either uniform or uneven. In some places it is hard, and the exhalation is slightly elongated. Noises that accompany breathing are either continuous or intermittent.

    The interrupted sound phenomena are:

    • group;
    • single;
    • have non-permanent localization.

    They are caused by specific discharges of a more liquid consistency.

    Sometimes in bronchitis, sound phenomena that are not interrupted by the respiratory phases are listened to. They are formed against the background of a sufficiently viscous secretion.

    This symptom indicates the development of dry bronchitis.

    Sounds can sometimes be squeaky, and sometimes - purring. Often, the doctor hears a sound similar to the noise of a working spindle.

    If the patient has bronchial asthma

    In bronchial asthma, due to the weakened breathing of both lungs during inhalation and exhalation, the specialist clearly hears wheezing dry rales in a variety of shades.

    In the event that the attacks of suffocation proceed for a long time, then the symptomatology of the failure of the right heart is observed.

    Conduction of

    Auscultation of the lungs occurs when a person is in a standing or sitting position. In the absence of such an opportunity, the patient is recommended to turn on his side.

    It is necessary to breathe during the procedure moderately, as otherwise oxygen saturation may occur. If a person feels dizzy, then he is allowed to go to the standard manner of breathing. When a patient experiences difficulty with breathing through the nose, he is allowed to breathe with the mouth.

    Passes auscultation of the lungs in 4 stages:

    1. Investigation of actual points in the normal state( at this stage the specialist can determine the presence of fluid or neoplasms).
    2. Study with deep breathing( actual for pneumonia).
    3. Study during cough.
    4. Study when changing a position.

    Using auscultation of the lungs, the specialist determines not only the presence, but also the degree of the pathological condition.

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