BASIC LUNG SOUND SKIN

However, if the bronchial tubes are blocked, you may not feel increased fremitus (or hear bronchial breath sounds or vocal resonance). Increased fremitus is felt in pneumonia, as the sound waves travel better through consolidated lung than air filled lung.Decreased fremitus may be due to fluid (effusions) or air (pneumothorax) between the lung and chest wall (the extra interface causes some sounds to be reflected rather than transmitted), or increased air (lower density) in the lungs (COPD).If you feel asymmetry, it may be abnormally decreased on one side or increased on the other. You may find one hand works better than the other, and you will need to switch from side to side at the same level. Have the patient say “toy boat” or “ninety-nine” over and over as you feel for asymmetry. Find what part of your hand is most sensitive to vibrations – often it is the portion of your hand that is most ticklish when you lightly stroke one palm with the other hand’s fingertips – and place this on the patient’s thorax. This is the palpable vibrations felt on the chest when patients speak.You may note asymmetric expansion if the patient has pneumonia, pleural effusion, collapsed lung, or other abnormality. Normally the chest wall will expand evenly with inspiration. Asymmetry of chest wall expansion can be assessed by placing the hands on the thorax on either side of the midline and observing how they move with inhalation.

BASIC LUNG SOUND SKIN

Palpation of the chest may reveal areas of pain, rattling, or wheezing from secretion or airway obstruction, or the characteristic popping from subcutaneous emphysema (air tracking under the skin from rupture of an air filled structure).

This is a sign of impending respiratory failure in an unstable patient.Ĭan you hear any audible breath sounds from across the room? How is the patient’s color, including their lips and digits? Do they have a bluish hue of cyanosis, or a yellow-brown discoloration from chronic tobacco use? Do they have clubbing of their digits? Do you see any signs of chronic corticosteroid use, such as thinning or bruising of the skin, or redistribution of fat to their trunks and face? These are Cushingoid features, signs of Cushing’s syndrome, from excess corticosteroids, frequently given for chronic obstructive pulmonary disease. In severe neuromuscular disease, patients may develop what is termed paradoxical breathing, or abdominal paradox, where the abdomen moves inwards on inspiration, due to a weak or paralyzed diaphragm. What is the movement of their abdomen when they are breathing? Normally when we inhale, our chest and abdomen both move outwards, as the diaphragm pushes downwards and the ribs are moved upwards. Do they have redness and swelling of their face, with engorged veins on their chest? This can be seen in SVC syndrome from lung tumors or infections, or these days from intravenous catheters that have become obstructed (catheters for dialysis or chemo or antibiotics).

Do they have Horner’s syndrome? The triad of ptosis, meiosis and anhidrosis can be seen with superior sulcus tumors of the lung (ie, pancoast tumors) from compression of the sympathetic ganglion. How are their teeth? Poor dentition and gingivitis can support the growth of oral anaerobic bacteria. Over time they may develop rough patches or calluses above their knees, termed Dahl’s sign. Start with the patient’s general appearance – do they look sick or well? Is their breathing comfortable or labored? If labored, are they using accessory muscles to help their breathing? Are they breathing through pursed lips? Patients may also find that a tripod position (leaning forward with elbows on thighs) helps with breathing, thought to be due to improved use of accessory muscles (particularly the rib cage muscles) in that position.

Basic lung sound