Kid breath sounds

[RoyalNurse]

I went to ENPC last weekend, and was told repeatedly that children's chest walls are so thin, that they can refer back and forth, so the only way to listen to their lungs is under their axillae. Yet I never see MD's listen that way, and it really doesn't make perfect sense, once you think about it. How will you hear the upper lobes that way? Anyone else hear this?

Thanks for any replies

[Lunah, MSN, RN]

I heard the same thing in ENPC last week, too. But you're right -- I don't often see that, or do it myself.

[4theBetterGetter, RN]

This is true. Also use a pediatric stethescope. Kids are not little adults and you have to do things a little different.

[Lunah, MSN, RN]

Also use a pediatric stethescope.

I do at least have a good stethoscope that has both adult and pediatric chestpieces! :)

[tewdles, RN]

Use a peds head...listen to the entire chest.

[EricJRN, MSN, RN]

In the ENPC classes I've helped teach, we emphasize the midaxillary line as part of verifying ET tube placement.

I need to look through the book again, but I don't think they mean to suggest that auscultating under the axillae constitutes a complete assessment of breath sounds in a non-intubated patient.

[Lunah, MSN, RN]

I need to look through the book again, but I don't think they mean to suggest that auscultating under the axillae constitutes a complete assessment of breath sounds in a non-intubated patient.

I have my book handy. :) Page 42, under the "B" (breathing) part of the primary assessment, the text states, "Auscultate bilaterally over the axilla. The chest wall of infants and young children is thin: breath sounds may be transmitted from one side to the opposite side, leading to 'equal breath sounds,' even in the presence of a pneumothorax."

So it sounds like it's a standard part of the primary assessment to do it this way; I think the best idea is what tewdles wrote -- listen to the entire chest, and include the axilla.

[RoyalNurse]

Thanks, that makes sense, does Littman sell a stethoscope with adult and peds pieces combined into one?

Thanks again :)

[Lunah, MSN, RN]

Mine is a Littman Cardiology III -- http://www.allheart.com/31273134.html -- kinda pricey, but mine was a gift from my partner at my fire station when I graduated from nursing school. It's nice!

[traumaRUs, MSN, APRN]

I used to use the Littman Cardiology III also but when I went to dialysis, I got a Littman 3000 - one of the electronic ones. However, though it is wonderful for adults, its not for kids.

So...I went and invested in a Littman Peds scope - and it is fantastic! My electronic steth is so lightweight that when I work in the ER, I have both of them either around my neck or one in my pocket.