hi there my name is Nico and Michael and we're medical students at the University of Michigan
in this video we're going to be discussing and demonstrating a pulmonary auscultation so using
a stethoscope like we did for the cardiac auscultation we can listen to the anterior
and posterior chest to get a pretty good idea of what's going on in the lung tissue unlike
in a cardiac auscultation a normal pulmonary auscultation is gonna be pretty uneventful healthy
breathing should shop should sound like a subtle whooshing sound going in and out as the patient
breathes some abnormal findings that we might see our crackles which is like crinkling rice krispies
wrapper if there's fluid that pools in the lungs or wheezing like if the patient has asthma if
their Airways aren't narrowed so we'll have Mike here remove his shirt and then we'll start
the demonstration so whenever we do a pulmonary auscultation the first thing we do is a general
inspection of their breathing so first thing we're going to look at is their respiratory rate so we
want to see how frequently they're breathing per minute and with that rate we want to analyze the
how shallow or how deep that breath is so if they're taking very short quick breaths or very
long deep breaths those could be indicative of some issues additionally when they're breathing we
want to see if they're using any accessory muscles so dr. Fox mentioned in the video using the
sternocleidomastoid or the scalene muscles when breathing in can be indicative of a disease state
or when breathing out if they're really forcing air out using their abdomen and that can also
be because of breathing issues so now that we've talked about things that we're looking for we're
gonna actually do the demonstration so I'll have Mike turn around so we can see his posterior chest
and so as you learned with dr. Fox the posterior chest you're actually still listening to the lower
lobe mostly because as you remember the anterior lobe the sorry the upper lobe is kind of layered
on top on mic it would be like this and the lower lobe would be like this so we're still listening
mostly to lower lobe in the back so when when I auscultate someone I'm going to listen to
about three to four sites on their posterior chest on either side of their spine so on a
full auscultation exam I would do one here one here one here one here one here and one here and
the reason I don't go lower than this is because now I'm passed the diaphragm and the lung tissue
is only on top of the diaphragm so listening under it would not be useful additionally on
the posterior chest I'm going to listen to the middle lobe of the right lung and the lingula
of the left lung and remember that the middle lobe is gonna be on the right side because the
left upper lobe or the left lung does not have room for a middle lobe because the hearts on the
way so again to auscultate his posterior chest I would listen here here here here here in here
and then the lingula right about on the side of the chest right here and the middle lobe on the
right side again on the side of the chest wall so I'll have him take a couple breaths for me
when I place my stethoscope and when you ask someone to do this you want them to breathe in
through their nose and out through their mouth and the reason you do that is because other
breathing techniques will make more noise in the airway and it'll be more confusing
when you're listening for abnormal sounds so I'm gonna have them take two or three breaths for me
and notice how I'm trying to keep it at the same level on both sides and go across so I
can compare it bilaterally so I would do the same for the posterior for the rest of the
chest then I would have them take one at the lingula and then once again on the middle lobe
obviously I would have the earpieces in my ears and you want to be cautious that with patients who
are elderly or who are having trouble breathing not to make them take too many breaths because
they might get lightheaded or dizzy okay and now if you want to turn around to your front side now
we're gonna auscultate the anterior chest and to do that we're gonna locate his clavicles and
we're gonna listen immediately superior to it and then inferior to it and the reason we don't
go any lower on the anterior chest is because at that point we start to hear heart sounds
as well and that makes the findings of the auscultation exam confusing so I'll just one
more time have them take a couple more breaths and notice in through the nose out to the mouth
and on a healthy patient like Mike I would hear that subtle whooshing sound with no crackles or
rails or rhonchi or wheezes all these clinical findings that you can use with the stethoscope
once again a very useful tool and then one more thing on to discuss another clinical tidbit is
percussion so Michael have you turned around one more time and so for this you don't use
your stethoscope but instead you actually use your own hands and what you'll do is
you'll place a finger firmly on the posterior chest you don't do this on the anterior chest
and you'll tap your finger like that and you'll go just like you did for the rest of the back
and listen for resonance in a healthy patient it's gonna be fairly resonant and you you get
better at this with practice somebody who has a bacterial pneumonia per se there will be a lot
of fluid and pus in the lung and so it won't really make much sound which is a clue that
there's some disease process if it's too resonant it means their lungs are very empty and cavernous
and they could have something like COPD and you can practice this at home if you have drywall
in your home you would just do the same and move horizontally along the wall and normal wall will
be pretty resonant but if you get to a stud where the wall is attached then it's going to be pretty
quiet so once again this has been an introduction into pulmonary auscultation as well as percussion