What are the 5 points of auscultation?
The ability of humans to hear sounds is more than just able to indulge in good music. Sounds serve as warning or signs of an impending danger which was very useful in the old times such as when hunting for animals to get food. In the modern world, sounds are more than music to the ears as even the smallest sound amplified into ASMR videos does bring pleasure to its own audience. Auscultation is important as part of a basic health screening.
What exactly is an auscultation? Auscultation is a method used by healthcare professionals to listen to the sounds of internal sounds of the body such as heart sounds, lung sounds and bowel sounds. It is performed by placing a stethoscope or a medical instrument used for listening to the internal sounds of the body, by placing it flat on the body at different locations that correspond to different organs in the body. Auscultation is performed in a quiet and private environment to get the best clear sound.
Auscultation is usually performed with a stethoscope as it is the easiest and most affordable instrument available in a healthcare facility. Auscultation is one of the most important skills for health professionals to have and is the oldest technique used by healthcare professionals for centuries. Auscultation itself is the safest way of diagnosing medical conditions as it is non-invasive. Auscultation is usually done during routine physical examinations. It helps to confirm or eliminate the many medical conditions.
Auscultation’s best friend is the stethoscope. Thanks to Rene Theophile Hyacinthe Laënnec, we now have a functional and accessible stethoscope. Stethoscope has two sides, a bell and a diaphragm. The diaphragm of the stethoscope is characterised by the larger flat side whereas the bell is the cone shaped side of the stethoscope. The diaphragm part is typically used to hear high-pitched sounds whereas the bell part is used to hear low pitched sounds. Examples of high-pitched sounds are sounds of the heart, lungs and abdomens whereas examples of low-pitched sounds are heart murmurs or extra heart sounds.
Method of auscultations depends on the site of auscultations. For heart auscultations or also known as cardiac auscultations, it is usually done by patients sitting or lying down with 45 degrees angle. Patients may be asked to turn to their left side or be positioned in such a way. This can help the heart sound easier to hear. There are 5 points of auscultation for the heart. These 5 points emphasising on the sounds of the heart valves:
- Aortic- Stethoscope is placed on the right side of the breastbone (sternum) located in middle of chest at the space between the second and third ribs (2nd intercostal space)
- Pulmonic- Stethoscope is placed on the 2nd intercostal space of the left side of the sternum
- Tricuspid- Stethoscope is placed on the lower left sternal border at the space between fourth and fifth ribs (4th intercostal space)
- Mitral- Stethoscope is placed on the left side of the sternum of space between fifth and sixth ribs (5th intercostal space) of the middle of the collarbone line (midclavicular line)
- Erb’s point- Stethoscope is placed between the space of third and fourth ribs (3rd intercostal space) on the left side
The 5 points of heart auscultations are evaluated for heartbeats quality and quantity, and if there is presence of abnormal heart sounds. Apart from heart auscultations that you may be familiar with, as you can see when a doctor places a stethoscope on the chest, there are other auscultations. This includes:
- Lung auscultations- Patients are asked to sit upright whenever possible. Patients take deep breaths through the mouth and a stethoscope will be placed on the chest. Stethoscope is usually moved on a different point on the chest, starting with the top of the lungs and moving downwards. It will also be done from side to side. The same step will be repeated on the back. The sounds obtained will be compared between the front and back of the lungs, and between the right and left side. Normal and abnormal breath sounds are able to be heard clearly. Healthcare professionals will also look for lung sounds during inhalation and exhalation.
- Abdominal auscultations- Patients are usually asked to lie down on their back. Stethoscopes are placed over the abdomen and will be moved over different regions of the abdomen. Sounds of the abdomen are usually the sounds bowel made. Abdominal auscultations can give information of the normal and abnormal bowel function being less active or active than usual.
In essence, auscultations are a safe and reliable procedure done as part of physical examinations. Using a stethoscope is enough to auscultate. Auscultations can give information on the organs affected. Patients might need additional medical tests if healthcare professionals suspect there are problems that need to be investigated further. Do let your healthcare professional know if you are feeling uncomfortable during physical examinations because if you are feeling anxious or scared, it might affect the results.
