Hear the Lung Sounds
Mr. Donovan was a 76 year old man who was just in the hospital for congestive heart failure. When I listened to his lungs, I could still hear some fine crackles at the bottom of his lungs. Peggy Rowley was a 52 years old recovering from pneumonia. Except for a little congestion in her upper airways, the rest of her lungs were clear. John Shaffer, age 61, has emphysema. I struggle to hear breath sounds when I listen to his lungs. The sounds are very diminished. He asks me what I’m listening for when I listen to his lungs. Good question, I tell him.
When I put my stethoscope on a patient’s back, I expect to hear the sound of someone breathing in and out. Nothing else. I work from the top of the lungs to the bottom of the lungs because abnormalities can be heard throughout the lungs or in just one area. I complete my listening to lung sounds by listening to the sounds in the upper airways in the front of the body. Generally, abnormalities start in the lower lungs and progress upwards. Take Mr. Donovan. Typically a person with congestive heart failure may have fluid in the lung bases. This sounds like rubbing your hair between your fingers. When congestive heart failure is left untreated, the fluid could fill the lungs.
John Shaffer doesn’t have fluid in his lungs. His disease is nasty. When he breathes, his airways are narrowed, inflammed. Breathing for him is like breathing through a tiny straw. Not much air gets in. And because not much air comes into his lungs, his lungs don’t expand very well. And so I hear very diminshed breath sounds. Emphysema is a chronic, progressive disease. Many emphysema patients end up on oxygen so they can take in
When lungs are infected, I can hear a variety of sounds. There can be wheezing, one side of the lung could have lung sounds that are more diminshed than the other side, or I could hear noises that get better or worse with coughing.
So when I listen to the lungs, I am listening for sounds that tell me that there is congestion from infection, sounds that tell me there is fluid that shouldn’t be there, and for sounds that tell me the lungs are fully expanding or not.