This document provides information on auscultating breath sounds and other body sounds. It describes how to properly auscultate breath sounds by placing the stethoscope on landmarks of the chest wall. Normal breath sounds are described as well as adventitious sounds such as crackles, wheezes, and rhonchi. The causes and characteristics of different breath sound types are explained. Proper cardiac auscultation is also briefly mentioned.

1. CHOITHRAM INSTITUTE OF
HEALTH SCIENCES
AUSCULTATION

2. Auscultation is a general term that
refers to the process of listening to
sounds within the body. Specifically to
breath sounds during an examination
of lungs.
Auscultation of the chest must be done
to note the type of breathing and
presence of any foreign sounds.

3. AUSCULTATION OF BREATH SOUNDS-
 Procedure- when assessing breath sounds, be sure
the setting is quiet. Have the patient assume a
comfortable, relaxed position.
 Place the diaphragm of the stethoscope directly
against the patients skin along the anterior and
posterior chest wall.
 Follow a systematic pattern and place the
stethoscope against thoracic landmarks ( T2, T6
and T10) along the right & left sides of the chest
wall.

8. BREATH SOUNDS-
 Breath sounds are created by turbulent air flow.
 In inspiration, air moves into progressively smaller
airways with the alveoli as its final location. As air
hits the walls of these airways, turbulence is
created and produces sound.
 In expiration, air is moving in the opposite
direction towards progressively larger airways.
Less turbulence is created, thus normal expiratory
breath sounds are quieter than inspiratory breath
sounds.

9. 1-VESICULAR-
 The vesicular breath sound is the major normal
breath sound and is heard over most of the lungs.
 They sound soft and low-pitched. (rustling sound).
 This is characterized by active inspiration due to the
passage of the air into the bronchi & alveoli
followed without a pause by passive expiration due
to the elastic recoil of the alveoli.
1
2 3 1-tubular phase
2-alveolar phase on
inspiration
3-on expiration

10. BRONCHIAL-
 Loud, tubular high pitched sounds heard over the
mainstem bronchi & trachea.
 This is characterized by active inspiration due to the
passage of the air into the bronchi. The alveolar
phase is absent (because of consolidation in
alveoli) & hence expiration is also active.
1 3

11.  If these sounds are
heard anywhere other
than over the
manubrium, it is usually
an indication that an
area of consolidation.
 Bronchial sounds are
heard equally during
inspiration & expiration;
a slight pause in the
sound occurs between
inspiration & expiration.

12. BRONCHOVESICULAR-
 Softer than bronchial sounds.
1
2
3
 Active inspiration due to passage of air into bronchi
& alveoli giving vasicular type of inspiratory sound.
 However during expiration there is increase
resistance in the airway due to spasm causing
inspiration to be active & hence equal to or more
than inspiration. There is no pause between
inspiration & expiration.
 They are best heard in the 1st and 2nd ICS
(anterior chest) and between the scapulae
(posterior chest) .

14. ADVENTITIOUS BREATH SOUNDS-
CRACKLES- (rale) -Crackles are
discontinuous, nonmusical, brief sounds
heard more commonly on inspiration. They
can be classified as fine (high pitched, soft, )
or coarse (low pitched, louder, ).
 Crackles are heard primarily during
inspiration as the result of secretion moving
in the airways or in closed airways that are
rapidly reopening.

15.  Causes-asthma
bronchiectasis
chronic bronchitis
consolidation
interstitial lung disease
pulmonary edema
 Types of crackles-
1. Early inspiratory
2. Mid inspiratory
3. Late inspiratory

17. WHEEZE-
 Wheezes are continuous, high pitched, hissing
sounds heard normally on expiration but also
sometimes on inspiration. They are produced when
air flows through airways narrowed by secretions,
foreign bodies, or obstructive lesions.
 Causes:-
asthma
chronic bronchitis
COPD
pulmonary edema

18. RHONCHI;-
 Rhonchi are low pitched, continous, musical sounds
that are similar to wheezes. They usually imply
obstruction of a larger airway by secretions.
 STRIDOR-
 Stridor is an inspiratory musical wheeze heard
loudest over the trachea during inspiration. Stridor
suggests an obstructed trachea or larynx and
therefore constitutes a medical emergency that
requires immediate attention

19. PLEURAL FRICTION RUB-
 Pleural rubs are creaking or brushing sounds
produced when the pleural surfaces are inflammed
or roughened and rub against each other. Sound
generally at the end of inspiration & in beginning of
expiration.
 Conditions:
pleural effusion
pneumothorax
 CAVERNOUS BREATH SOUNDS- deep hollow
sounds like blowing over a bottle.

20. CARDIAC AUSCULTATION-