We call the sounds heard with the stethoscope while listening to the chest for breathing as lung sounds. Auscultating is the doctor word for listening with a stethoscope. Lung sounds involve identifying sounds on both lungs and different lobes in each lung. In clinical settings, medical personnel should attempt to listen to 13 points to get a complete set of lung sounds. For first aid and prehospital emergency care, we are suggesting a simplified basic version of listening to 4 points for a quick assessment while balancing other factors of the emergency scene.

For those that forget anatomy class, the trachea comes down from the neck into the chest and separates into the left and right bronchi, bronchi separate further into bronchioles entering the different lobes and lobe sections, the right lung has 3 lobes and the left lung has 2 lobes. For the emergency provider we are trying to identify quickly if there is a serious problem in any of these areas we need to address before transporting the patient.

We can quickly listen to the upper and lower lung sounds on both sides. Upper sounds can be heard between the back bone and the scapula. Compare the left to the right. Sometimes we do not always have immediate access to the patient’s back, for example a patient that is backboarded. In these cases, listen to the upper lung sounds from the front under the clavicle. For rapid lower lung sounds listen under the point of the scapulas. If the back is not accessible, listen to lower lung sounds under the arm along the midaxillary line mid-way down the rib cage.

Sounds to listen for include:

Inform the patient you will be listening to their breathing before shoving your hands up their shirt. Make sure the diaphragm is flipped the correct way with a quick finger tap. Place the diaphragm against the skin and press to listen. Listening often requires 2 hands with a hand pressing the diaphragm and the other hand holding the spring to adjust for better hearing. We can encourage patients to take deep breaths making it easier to hear or you can show off your listening skills by listening to normal shallow breaths.

This is a skill that requires practice, please do not lie about what you do or do not hear.

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