Auscultation should be performed in a quiet environment. The patient is asked to breathe in and out through the mouth. The examiner should concentrate first on the length of inspiration and then on expiration. Very soft breath sounds are referred to as distant. Distant breath sounds are commonly found in patients with hyperinflated lungs, as in emphysema.
The examination should proceed from side to side and from top to bottom, comparing one side with the other. The positions are illustrated in Figure 13-16. Because most breath sounds are high-pitched, the diaphragm is used to evaluate lung sounds.
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