Breath Sounds
Heart Sounds
A normal cardiac cycle includes two sounds, often referred to as "lubb-dupp," caused by blood turbulence as valves close. It should be noted that in children, it is common to hear a third sound. When auscultaing the heart, the clinician position should be on the right side of the patient, who is in a seated or semi-reclined position and breathing normally. When listening to the heart, the stethoscope should be placed over four general areas:
1. Over the mitral region in the fifth left intercostal space, 1 cm medial to the midclavivular line
2. Over the tricuspid region in the fourth intercostal space, at lower left sternal border
3. Over the aortic region in the second right intercostal space
4. Over the pulmonary region in the second left intercostal space.
(Prentice, 2011)
The rate of breathing should be even and consistent. Both sides of the back should be examined. Positions for auscultation should be over the apex, centrally, and at the base of each lung, both anteriorly and posteriorly.
Abnormal breathing patterns include:
Cheyne-Stokes breathing: the rate speeds up then slows down over a one-three minute period.
Biot's breathing: a series of breaths at the normal rate are followed by complete cessation of breathing.
Apneustic breathing: pauses in the respiratory cycle at full inspiration are present
Thoracic breathing: occurs without diaphragmatic breathing.
Adventitious breathing sounds include:
Crackles: popping sounds
Wheezes: high-pitched musical tones
Stridor: intense, continuous, monophonic wheezes
Stertor: harsh, discontinuous, crackling sounds
Ronchi: resembles snoring
Rales: crackling or bubbling sounds
(Prentice, 2011)
Percussion is performed by placing a finger of one hand over an organ and then use one or two fingers from the other hand to strike that finger. The resulting sounds provides insight to the status of the organ being percussed. A solid organ, such as the liver, will produce a dull sound, whereas a hollow organ, such as a lung, will produce a tympanic sound. Special training is required to know exactly what to listen for during auscultation and percussion. However, an athletic trainer should be able to determine whether a sound is normal or abnormal. (Prentice, 2011)
Percussion
Bowel Sounds
Auscultation
Auscultation involves listening to body sounds through a stethoscope. Auscultation is often used to listen to heart sounds, breathing sounds, and bowel sounds. Most stethoscopes have two surfaces, a diaphragm and a bell. The bell of the stethoscope is better for detecting lower-frequency sounds, while the diaphragm is better for higher frequencies.
(Prentice, 2011)
Normal bowel sounds are liquid-like, guggling sounds created by peristaltic actions. Following abdominal injury, bowel signs may be absent or diminished, which may indicate:
Paralytic ilieus: pseudo-obstruction
Peritonitis: inflammation of the peritoneum
High-pitched tinkling sounds are associated with intestinal obstruction. If there are no bowel sounds over a thirty second period, the patient should be referred to a physician.
(Prentice, 2011)