Technique of auscultation

The design of the stethoscope recommended lor routine clinical use provides the choice of a bell or diaphragm. As most of the sounds reaching (he chest wall from the bronchi and lungs are in the low--frequency range, the bell with a rubber rim cover should normally be used in preference to the diaphragm. Another reason for selecting the bell is that stretching of the skin and hairs under the diaphragm during deep breathing is apt to produce sounds which may be difficult lo distinguish from a pleural nib and/or crackles. Ii is also impossible in some thin patients to achieve full contact between the diaphragm and the skin of the chest wall and where this is the case, nothing may be heard.

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