An introduction to using the stethoscope

1. History What it is How to care for it Normal and abnormal breath sounds Added sounds Surface marking of the lungs An introduction to using the stethoscope

3. Immediate auscultation

6. Breath sounds Added sounds from lung Added sounds from elsewhere Stethoscope – what do you hear?

7. Breath sounds Vesicular Bronchial May be modified in volume– increased or decreased Stethoscope – what do you hear?

8. Added sounds from the lungs Crackles – ‘wet sounds’ [crepitations] Wheezes – ‘dry sounds’ [rhonchi] Stethoscope – what do you hear?

9. Added sounds from elsewhere Pleura – rub [creaky shoe] Chest wall – fractured rib Superficial tissues – surgical emphysema Clothes!! Stethoscope – what do you hear?

10. What heard Where heard When heard E.g. Inspiratory crackles at the left base How do you describe what you hear?

11. Over the lungs! Other structures may interfere Superficial – breast, fat, scapulae Underlying - liver, heart Where do you listen?

14. Vertebra prominens - C7 Sternal notch – overlies trachea Manubrio sternal angle - T4/5, bifurcation of trachea, 2nd costal cartilage, upper order of atria, aortic arch Xiphoid process – T9 Surface anatomy

27. You cannot tell everything from your stethoscope. The history and other physical signs derived from observation, palpation and percussion are essential to make a diagnosis. Warning!