Nowadays, innovative research methods are emerging, based on long-term development and multi-million dollar investments. However, a good doctor does not neglect the simplest, but quite informative ways to identify pathologies, such as auscultation of the lungs, percussion of the heart or palpation of the abdomen. Carrying out these manipulations is of great importance in the diagnosis of diseases.
I would like to dwell in detail on the method, which translates as “listening”, and is called auscultation of the lungs. It is carried out using a stethoscope (tube) or phonendoscope. Previously, doctors tried to listen to the chest by simply putting an ear to the body, but once Rene Laannek could not hear anything from a young patient with a lot of weight, then he twisted a piece of paper into a tube, put one end to the girl’s chest, and the other to his ear. The doctor was pleasantly surprised, the audibility was better than ever.
The method is based on capturing those sounds that form in the larynx and lungs, and then are transmitted to the surface of the chest.
Auscultation of the lungs, general rules
- Convenient position of the doctor.
- The patient is sitting or standing.
- The room where the procedure is performed should be warm and quiet, it is noticed that after 5 minutes spent in complete silence, the hearing is aggravated.
- It is desirable that the listening surface be free of hair, because they give friction and the appearance of extraneous noise.
- A phonendoscope or a bell of a stethoscope is applied to the surface of the body tightly, but without unnecessary effort.
- The doctor must have listening skills and a phonendoscope to which he is accustomed.
- The lungs are heard first from the front, then from the back, and then along the lateral lines, from top to bottom and to the sides.
Determination of the type of breathing
- Vesicular - normal, is heard on inspiration and on one third of the exhalation, resembles the sound "f".
- Hard - the sound "f" is heard on inhalation and exhalation, this type is typical for children under 6 years old.
- Bronchial - resembles the sound "x".
- Amphoric - such a sound can happen if air is blown into the narrow neck of an empty vessel. This auscultatory picture is associated with the presence of a cavity (cavity, abscess) in the lungs.
- Saccadic - an intermittent breath consisting of several phases is heard, which is associated with a foreign body and a tumor in the large bronchus or trachea.
Auscultation of the lungs, pathological murmurs
All of them are associated with diseases of the respiratory system.
- Wheezing can be dry (wheezing, wheezing, buzzing) - this phenomenon occurs when the lumen of the bronchi is narrowed or sputum accumulates in them. Also, wheezing can be wet (small, medium, large bubbles), they are heard if there is liquid sputum in the lungs.
- Crepitus is a kind of crunch that occurs during the inspiration phase and speaks of the pathological process in the alveoli.
- The pleural friction noise is also a crunch, however, it is heard both on inhalation and on exhalation. It occurs with pleural pathology.
A distinctive feature of wheezing is that they can disappear if the lungs have cleared sputum, i.e. after coughing. Wheezing and crepitus cannot be heard if the nose and mouth are closed, and the stomach is in motion, whereas it is in such conditions that the pleural friction noise is heard.
Auscultation of the lungs, a comparison of domestic and western schools
Two classifications of noise in pathologies of the respiratory system in children have some differences. Thus, the division of wheezing in European literature is simplified, the nature of dry wheezing is not specified, and in the description of wet there is no concept of “medium-bubble”. In a specially conducted research work, doctors Zaikov, Katilov and Dmitriev found that our doctors adhere more to the Western model of diagnosis, omitting a detailed description of the auscultation picture. The authors propose to review and amend the existing classification. This must be done for a better understanding between medical colleagues from different countries and states.