Lung sounds

[A247]

Hey guys, long time no see! I seem to keep popping in and out, but hopefully I'll stay for awhile now! :)

A question for anyone willing to answer! When I took EMT (approx. 2.5 years ago), my instructor always taught us to take the lung sounds on the front of the patient. He used the phrase, "nipple, nipple, side, side" to help us remember where to take lung sounds. For a translation, this would be left mid-axillary and mid-clavicular and right mid-axillary and mid-clavicular.

Lately, I have begun to feel that this may not be quite enough. Does anyone have any suggestions as to how to better my lung sound taking skills? Also, what is your preference when taking lung sounds, taking them on the scene or in the ambulance?

Thanks for any/all input!:)

[DaSharkie]

Your "nipple, nipple, side, side" is woefully inadequate for true and complete lung assessment.

It does not assess each lobe of each lung in multiple areas of that lung. Remember, the right lung has 3 lobes, and the left has 2. You need to assess where the rales, rhonchi, wheezes, diminishment, absence, or rub is present.

Also remember that the apices of each lung extend ABOVE each clavicle. Therefore, if you have a pneumothorax, you must begin assessment there to determine its effects - especially considering that a spontaneous pneumo in a patient can an does often present at the apices.

To begin with, use those 4 locations to assess, if you suspect trauma I would also assess the apices as mentioned. On the back, assess each side, at least in 2 - 3 places, alternating to the exact space on the opposite lung. Do this for each spot that you assess.

The patient should also breathe deeply in and out through their mouth. Obviously, the patient talking makes this difficult. I recommend on scene assessment - only initially since on occassion the back of the truck can be loud while driving 90 mph down the road. Also good since you seem to want to expand your assessment capabilities, this on scene assessment allows for you to broaden your base of knowledge.

To better yourself too, when you pop into the ED to drop off a patient, see if the nurse, PA :D , NP, or MD/DO has a patient with a pneumonia, pneumo, raging asthma, or whatever. Serves as good suck-up points for future respect and guidance.

Oh yeah - neat trick I learned in my assessment class - If you hear diminshment in an area of the lung (cancer or pneumonia) have the patient say "e" while listening to the lung. If there is a solid consolidation, the "e" has a drastic change in tone and often sounds like an "a."

[locomedic21]

if your patient can sit up listen on the back your will hear more clearly, maybe get a better stethoscope also makes things easier!

[WELLAGEDEMT]

I would recommend listening for the lung sounds from as many positions as the patient can accomodate. As soon as you are sure that you have covered all the angles, have the courage to do it again as soon as possible. It helps to have an amplifier scope but you will adjust without it. Do it enough so that you are familiar with the "normal" sounds, so you will be able to detect a deviation from the "norm".

[smurfe]

I very rarely ever listen to the front. I have always listened posterior and mid-axillary. About the only time I ever listened to the front is if someone was in obvious acute distress and you hear Rales or wheezes on the front you knew you had a problem and got right to work.

Smurfe:beer:

[Nate]

I've noticed from watching the BLS crews here work, they often forget lung sounds.

[DaSharkie]

I've noticed from watching the BLS crews here work, they often forget lung sounds.

It just does not seem to be addressed enough either in the classroom or out on the streets in real learning environment.

[btroutm]

I've noticed from watching the BLS crews here work, they often forget lung sounds.

I'm saddened to say that it's not just the BLS crews here. I work with a few medics who routinely forget to check lung sounds. Come to think of it, these are the same people who throw the NIBP cuff on without a manual first. Hmmmm, I'm beginning to see a trend...

[A247]

Thanks for your help guys. I have been using your suggestions out in the field and I can already get a better picture of the patient.

I always try to get lung sounds, mostly because our QA people yell at me when I don't, so....:confused:

[Nate]

I'm saddened to say that it's not just the BLS crews here. I work with a few medics who routinely forget to check lung sounds. Come to think of it, these are the same people who throw the NIBP cuff on without a manual first. Hmmmm, I'm beginning to see a trend...

Tack on pupils to that as well.

[IMABASICEMT]

I was taught to listen to upper, mid and lower on both the front and back, side to side.

I have to admit, the dept. I'm on now rarely listens to lung sounds. They also rely on the automated BP/monitor, etc. Rarely take an ausc. BP.:eek:

[smurfe]

I was taught to listen to upper, mid and lower on both the front and back, side to side.

I have to admit, the dept. I'm on now rarely listens to lung sounds. They also rely on the automated BP/monitor, etc. Rarely take an ausc. BP.:eek:
Shanna,hopefully you can make a change in your department. This is something that needs to be addressed. You can't do a competent patient assessment by leaving this important step out.

Smurfe:beer:

[Nate]

I hate it when people won't just admit they didn't do something or they can't hear lung sounds or a BP.:screams:

[IMABASICEMT]

Shanna,hopefully you can make a change in your department. This is something that needs to be addressed. You can't do a competent patient assessment by leaving this important step out.



Pfffffttt!! Are you kidding me? I'm just the lowly little probie!:rotflmao: :rotflmao: I've already felt the ice treatment for suggesting something should be changed.

Mostly a great bunch of people but all the ALS crew leaders are a challenge. They all have "their way" of doing things and it keeps one busy just remembering what each wants or prefers. A couple of them have egos you don't mess with. Unfortunately, my crew leader is one of the egos. He drives me nuts. I would LOVE to change to another night but there are no openings. I love it when one of the other crew leaders is covering for him on our night. Makes things so much nicer.

[BHFD121]

When I was with my old department...I had just gotten my EMT-B and had a first responder take a BP for me...he gave me some outrageous numbers so I told him to take it again. Still outrageous. I took it myself and it was normal. When we got back to the station, I asked him about it. He said that is what he got. I told him ok well, take mine. He got outrageous numbers again. I asked him to explain what he was doing...turns out the kid didn't know how to take a BP and the other EMT's were just taking him at his word! Needless to say, the next training was on how to take a proper BP!

Shelby

[Kristoffer]

I don't think it's the education. As a NJ EMT Instructor we teach Lung Sounds for every patient as part of the Initial Assessment (ABCs). Since it is not part of the true "Vital Signs" as referenced by the DOT/NHTSA Standard Curricula. But the problem I see, is that it is the students going out and riding, and learning bad behaviors. Such as lack of KEDs when appropriate, lack of full vitals (BP, Pulse, Resps, Pupils, CTC) at least twice. And how many people do a complete patient assessment? Probably ZERO... Complacency is a wonderful thing, and it won't change until more lawsuits come out of it, or we start reviewing patient sheets on the state level and start pulling certs.