For a patient with a medical condition, you will obtain a complete
set of vital signs and auscultate breath sounds. If your protocols
allow, pulse oximetry and blood glucometry can be helpful. A complete
physical exam may include:
Auscultate breath sounds starting at the bases
Blood pressure in both arms (note difference of 10 mm Hg or
more)
Skin color, moisture and temperature
Pulse oximetry
Blood glucometry
Head, neck-to-toe exam
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Elaboration — Importance of Proper Auscultation Technique
EMS providers must be able to distinguish normal breath
sounds from abnormal breath sounds. Although you
do not need to positively identify every abnormal breath
sound by name, it is helpful to practice listening and trying to distinguish
the major differences.
The proper technique for auscultating the chest using a stethoscope includes:
Listen at six locations on the back and four locations on the front
Start in the back at the base first in sitting patient
Instruct patient to take a deep breath through the mouth then exhale
Listen to one or two inspiration/expiration cycles per location
Move to the other side and compare
Try to avoid listening through clothing
Changing airflow patterns inside the lungs produce normal breath sounds. They make a "swishing" sound as air flows in or out. Absent breath sounds can indicate apnea, pneumothorax, hemothorax, or lung removal.
Once you have auscultated the lungs, record breath sounds as either normal or abnormal, which includes the presence of wheezing. Document the absence of breath sounds when none are heard.
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Elaboration— Why Begin Auscultation at the Bottom?
When auscultating the chest, start in the back at the base first. This will allow the opportunity to hear subtle rales. Otherwise after several, deep breaths the fluid can redistribute throughout the base of the lungs. This will make the rales more difficult to detect.
