1. Breath Sounds and stethoscope

2. Listening to lung sounds
How?
Where?
What are you listening
for ?

3. OUR TOOL

4. The Stethoscope
You will all have one, but how is the best way to use it.
The sounds you hear depends on it functioning properly.
The ear piece is frequently the source of a problem if you cannot hear well.
They should fit well, be comfortable, be air tight & angled slightly forward.

5. How do you augment the sounds
You are listening for several types of sounds these may include:
Normal breath sounds, decreased or absent breath sounds & abnormal breath sounds.
These sounds need to be defined by when they occur, loudness, wet or dry, associated cough, etc..

7. Think about what is inside
Imagine what you
are hearing

9. Think about what you are listening for

10. Where do you listen
There at least 4 separate areas on both sides of the body, top & bottom, front & back, right & left.
Each area should be listened to in both inspiration & exhalation phases

12. LIstening
Be sure to listen to each full cycle of inspiration and expiration before moving your stethoscope, as just one part of the respiratory cycle might generate abnormal sounds.
You should hear breath sounds over all lung tissue, and the quality of the breath sounds should be similar as you listen from side to side.

13. Use of the Stethoscope
The diaphragm- most suitable for listening to high- pitched sounds & murmurs.
These include high pitched rales, 1st & 2end heart sounds, some stenosis & regurgitation murmurs.
It should be applied to the skin of the chest wall with firm pressure.

14. Use of the stethoscope
The bell- is best suited for low-pitched sounds & murmurs.
These include absent breath sound areas, 3rd & 4th heart sounds, fluid filled chest cavity, i.e. tumors, blood etc.
It should be applied with very light pressure barely making an air tight seal.

15. What do you hear with the stethoscope
Sound is perceived according to its pitch, loudness & quality.
These are subjectively equated to the physical properties of sound waves, frequency, intensity, & harmonics.
You must train to have selective hearing, to listen for a single sound & then focus on it.

16. When its not normal
Diminished or hard-to-hear lung sounds are most common with thick chest walls (in either muscular or obese patients), or when the patient is not taking deep breaths. However, diminished breath sounds can also be associated with disease.
Occasionally you might not hear any breath sounds at all over a particular part of the lung; this can result from airway obstruction, with collapse of lung tissue (such as pneumothorax)

17. Odd sounds
Note the quality of the lung sounds and listen carefully for any abnormal sounds, such as crackles or wheezes. 
Crackles, which are sometimes called rales, are wet, popping sounds created by air moving through liquid
or by collapsed alveoli snapping open on inspiration.
They are most common at the end of inspiration.

18. Wheezes
Wheezes are continuous sounds caused by air moving through constricted airways. Airways can be narrowed by a number of causes: the bronchial constriction that accompanies asthma, bronchial inflammation, mucus accumulation or mucous plugs, or tumors.
Wheezes can be high-pitched, which is common with asthma, or low- pitched with almost a snoring quality.
Low-pitched wheezes are sometimes called rhonchi.
Mild wheezing is often limited to the expiratory phase of respiration, while more severe wheezing can be heard throughout the respiratory cycle.
Both wheezing and crackles may clear with coughing, so ask the patient to take a deep breath and cough a couple of times, then listen again

19. Others
Stridor is a high-pitched sound typically generated when a larger airway is blocked by a foreign body, severe inflammation, or a mass.
A friction rub may result when the pleural membranes covering the lungs and lining the thoracic cavity are inflamed. A friction rub is a scratching or squeaking sound that persists throughout the respiratory cycle and does not clear with coughing.