1. Breath Sounds Don Hudson, D.O., FACEP/ACOEP

2. Why is Listening to Breath Sounds Important What do you hear? Where do you listen? Does it make any difference? Can you treat what you hear? Who can do this? What equipment do you need? Can you base all of your treatments on what you hear?

3. Breath Sounds What are you hearing Remember all that wheezes is not asthma Cystic fibrosis, emphysema, & chronic bronchitis also wheeze Wheezing basically means obstruction or narrowing of the airway.

4. Other causes of wheezing Endobronchial tumors, foreign bodies, local mucosal edema, pulmonary edema & pulmonary emboli. All wheezing can be labeled as dry rales or musical rales & they are continuous, non- interrupted adventitious sounds. Crepitant rales or fine moist rales are high pitched crackling sounds heard during inhalation. Cause- opening snap of alveoli

5. Rales continuing Subcrepitant rales- medium pitched, inspiration, & caused by sudden opening of the bronchial walls. Both Crepitant & Subcrepitant rales are thought to be caused by fluid in alveoli & bronchioles. If this were pulmonary edema they become louder as the edema worsens.

6. Absent Breath Sounds Consider Endotracheal tube placement Atelectasis, complete obstruction Laryngeal spasm, morbid obesity Paralyzed diaphragm, pleural effusions, Pneumothorax, severe pleural fibrosis, pneumonectomy

7. Now what Listen Where What are you listening for ?

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

9. 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

11. Think about what you are listening for

12. What would you expect to hear ?

13. OUR TOOL

14. The Stethoscope We 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.

15. 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..

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

17. Use of the stethoscope The bell- is best suited for low-pitched sounds & murmurs. These include absent breath sound areas, 3 rd & 4 th 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.

18. 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.

19. Now you hear them, what next? Obviously we have all been trained to think & that is what we need to do here. This is like a slide rule it gives you data but it is left up to you to interpret what you hear. You need a whole picture of the patient to make a good diagnosis.

20. Remember the physical is important

21. What do you hear & why?

22. What happened & What do you hear

23. What do you hear? Why?

24. What do you hear & why?

25. Describe What the sound is & how you hear this sound

26. Diagnosis & Sounds. How do you hera them best?

27. Listen & Percuss the chest

28. Pulmonary Edema

29. DIAGNOSIS & TREATMENT

31. DIAGNOSIS & SOUNDS HEARD

32. Is listening to Breath Sounds Important What do you hear? Where do you listen? Does it make any difference? Can you treat what you hear without other input? Who can do this & what equipment do you need? Can you base all of your Tx on what you hear?

33. Nothing is ever really SIMPLE

34. Thank You for your Attention