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Ohio State University School of Medicine Interactive Learning Center – Lung Sounds R.A.L.E Lung Sound Repository UCLA Heart & Lung Sound Simmulator Other Auscultation “Tools” • Egophany – in setting of suspected consolidation, ask patient to say “eee” while auscultating. Normally, sounds like “eee”.. Listening over consolidated area generates a nasally “aaay” sound. Putting It All Together: Few findings pathognomonic Æ put ‘em together to paint best picture. • Effusion – AuscultationÆ decreased/absent breath sounds – PercussionÆ dull – FremitusÆ decreased – EgophanyÆabsent • Consolidation – AuscultationÆ broncial breath sounds – PercussionÆdull – FremitusÆincreased – EgophanyÆ present Vs Summary of Skills □Wash hands Spine □ Inspect (shape, curves); Examine (range of motion, palpation) Lungs and Thorax Observation & Inspection □ Patient breathing □ Chest shape □ Fingers/nails Palpation □ Chest excursion □ Fremitus Percussion □ Alternating R & L lung fields posteriorly topÆbottom; & anteriorly □ Determines diaphragmatic excursion Auscultation □ R & L lung fields posteriorly, top Æbottom, comparing side to side □ R middle lobe □ Anterior fields bilaterally Time Target: < 10 minutes Lung, Thorax & Spine Exams Exposure Is Key – You Cant Examine What You Can’t See! Anatomy Of The Spine Spine Exam Pathologic Changes In Shape Of Spine Lung Exam Observation� Observation (cont) Pathologic Changes In Shape Of Chest Clubbing and Cyanosis Slide Number 11 Thoughts On Gown Management & Appropriately/Respectfully Touching Your Patients Keys To Performing a Respectful & Effective Exam Slide Number 14 Good Exam Options Palpation Palpation – Assessing Fremitus Lung Pathology - Simplified Fremitus - Pathophysiology Percussion Percussion - Technique Percussion (cont) Expect To Be Frustrated! Percussion: Normal, Dull/Decreased or Hyper/Increased Resonance Ausculatation Lobes Of Lung Lobes Of The Lung (cont) Trachea Auscultation (listening w/Stethescope) - Technique Pathologic Lung Sounds Pathologic Lung Sounds (cont) Lung Sounds Other Auscultation “Tools” Putting It All Together: Few findings pathognomonic put ‘em together to paint best picture. Summary of Skills