The technique involves using a pediatric stethoscope as indicated.
If the tool is too big, you won't be able to isolate the breath sounds.
You'll ask the patient to open their mouth
and you're going to listen directly on their skin.
You don't want to be listening over a gown or clothing
because this can cause sounds similar to rhonchi.
You want to make sure the patient is sitting up, if they're able,
and this is going to allow them to fully expand their lungs.
In each position, you're going to listen for 1 complete respiratory cycle.
That includes a full inhalation and a full expiration.
Don't forget about the apices of the lungs, and these are found above the clavicles.
You also want to listen all around the rib cage under the axilla,
so that you get every lung field.
You're going to compare the sounds bilaterally
and you're going to be listening for any adventitious or abnormal breath sounds.
You're also going to be checking, during this exam, does your patient cough?
When you listen to a child,
you're going to be comparing the equality of the breath sounds
and you're always comparing the right with the left in the same level of the lung.
You're going to be listening for diminished sounds,
and this can show up in the setting of a pneumothorax or a consolidation.
And you're going to be checking for air exchange bilaterally.
The normal breath sounds.
We have bronchial, bronchovesicular, and the vesicular.
The bronchial sounds are a tubular and hollow sound heard over the trachea
and sometimes, the mediastinum.
The expiratory phase and bronchial sounds is slightly longer
than the inspiratory phase.
The next, as you move down the chest, is the bronchovesicular sounds.
These sounds are heard over the main bronchus region.
These are the normal sounds in the mid-chest area
and these are heard also on the back between the scapula.
In this phase, the inspiration and expiration are of similar duration.
Last, you'll listen for vesicular sounds, and these are found over the lesser bronchi,
the bronchioles, and the actual lobes of the lung.
The inspiratory phase is longer than the expiratory phase.
And these are low frequency, non-musical, and they're barely audible at rest.
Next, you're going to listen for wheezing,
and similar to turbulent wind and airflow whistling through a chimney,
the airway can also cause a whistle.
And this is a high-pitched sound that's flow-dependent,
and it can be present on inspiration, on expiration, or both.
Next, you'll listen for crackles and these are high-pitched, short-duration sounds.
They can indicate that the patient is trying to move secretions.
You're also going to listen for rales, and these are discontinuous rattling,
bubbling, or clicking sounds, heard usually during inspiration.
Next, you'll check for rhonchi, and these are low-pitched wheezes.
They're continuous and they often sound like snoring.
They can be present on inspiration and expiration,
and sometimes, these clear with a cough.
Last, you're going to check for stridor, and this is a high-pitched wheezing sound
caused by a disruption of airflow in the upper airway.
There may be a foreign body obstruction, mucus, or edema
that blocks the airflow through the upper airway.
And this can usually be heard on the other side of the room
without needing your stethoscope.
Next, you're going to listen for a cough.
Is it present or absent?
You can also ask the parents about this
if the patient isn't currently coughing in the clinic.
Characteristics.
You want to ask, "Is this a wet cough, or is it a dry cough?"
Certain conditions are associated with each.
Is it paroxysmal?
Does the patient get coughing spasms?
And we worry about this in the setting of pertussis.
Is the cough worse at night?
This is typically the condition, and it's usually from the post-nasal drip.
As the patient lays flat, the cough will worse at night.
This is really frustrating for patients and for their parents.
They're always asking, "What can I do to help my child stop coughing at night?"
And we encourage symptomatic care as propping pillows,
honey in warm water or tea, or taking sips of water.
Is the cough barking or does it sound croupy?
These patients may have croup, which is a tightening of the upper airway.