Auscultation Proforma – Respiratory System

1. Preparation and Positioning

• Ensure a quiet environment to minimize extraneous noise.

• Patient should be seated upright (preferred). If not possible, examine in the supine or lateral position.

• Instruct the patient to breathe slightly deeper than normal through an open mouth.

• Expose the chest adequately for direct contact with the stethoscope.

2. Technique

• Use the diaphragm of the stethoscope for most breath sounds.

• Place the stethoscope firmly on the chest wall.

• Auscultate systematically from top to bottom, side to side, comparing corresponding areas on both sides.

• Listen to at least one full respiratory cycle (inspiration and expiration) at each area.

• Examine all areas: anterior, lateral, and posterior chest.

3. Areas to Auscultate

• Anterior chest: Supraclavicular, infraclavicular, mammary, and inframammary regions.

• Lateral chest: Axillary and infra-axillary regions.

• Posterior chest: Suprascapular, interscapular, and infrascapular regions.

4. Breath Sounds

• Assess the type of breath sound in each area:

  • Vesicular: Soft, low-pitched; inspiration longer than expiration; no pause.

  • Bronchial: Harsh, high-pitched; inspiration = expiration; pause between phases; normally only over trachea/manubrium.

  • Bronchovesicular: Intermediate; inspiration = expiration; no pause; heard over main bronchi.

• Assess intensity (normal, diminished, or absent).

• Compare for symmetry between both sides.

5. Added (Adventitious) Sounds

• Listen for abnormal sounds, noting their location and timing:

  • Crackles (crepitations): Fine or coarse; note if during inspiration/expiration; whether they clear with cough.

  • Wheeze (rhonchi): Continuous, musical, mainly expiratory.

  • Pleural rub: Harsh, grating, heard in both phases.

  • Stridor: Loud, high-pitched, mainly inspiratory.

6. Vocal Resonance

• Ask the patient to repeat a phrase (e.g., “ninety-nine” or “one-one-one”) while auscultating.

• Assess for:

  • Normal resonance: Muffled and indistinct.

  • Increased resonance: Bronchophony (louder, clearer sounds).

  • Whispering pectoriloquy: Whispered words heard clearly.

  • Egophony: “E” heard as “A”.

  • Diminished or absent resonance.

7. Documentation

• Clearly record findings for each area.

  • Specify type of breath sound, intensity, and the presence of any added sounds.

  • Note any asymmetry or abnormalities in vocal resonance.