Understanding Lung Sounds: Third Edition

review by Tee L. Guidotti, MD, MPH University of Alberta Edmonton JAMA 1995; 273(12):971. Understanding Lung Sounds, by Steven Lehrer, 2nd ed, 150 pp. with Illus, paper, and 1 audiocassette, $35.95 ISBN 0-7216-4902-5, Philadelphia, Pa, WB Saunders, 1993. Steven Lehrer's introduction to auscultation is a primer of pulmonary diagnosis using lung sounds as its unifying theme. Intended to educate the ear as much as the mind, his kit is a self-contained learning experience for the medical student. It may also be useful for critical care and pulmonary service nurses. The kit is an excellent learning system and is highly recommended as an introduction to the topic. The book begins with an homage by Victor McKusick to the Golden Age of auscultation, introduced by Rene Theophile Hyacinthe Laennec in 1816. The sketch is too brief to elaborate on the fascinating history of auscultation, which at the time was a monumental undertaking. Laennec codified his work in 1819 in his book Traité de l'auscultation médiate, an effort that exhausted him and extracted a two-year period of recovery from his career. Laennec was a pupil of Jean Nicholas Corvisart, the leading advocate and systematizer of chest percussion. Mentor and student defined the chest examination as we know it. Lehrer continues the work, as the transmitter of a grand tradition. The first chapter reviews the anatomy of the lung and the physiology of ventilation, omitting blood gas interpretation. Lehrer also introduces common pathological conditions, briefly exploring their auscultatory findings. The second chapter shifts attention to the other end of the stethoscope: the listener. Lehrer discusses sound characteristics, the hearing mechanism, and the stethoscope as an instrument. In the third chapter, he introduces the history and physical examination of the patient with chest disease. Here he departs from the emphasis on auscultation to provide the student with a context for the auscultatory examination--an appreciation for the findings that are likely to accompany the abnormal sounds. Chapter 4 discusses normal breath sounds. This is a fine outline of physical examination of the chest, worth a complete physical diagnosis teaching session with students. It also introduces a simple graphic system of notation. The interested specialist may welcome the discussion of recording systems and waveform analysis. The novice may find this tedious, but the visual display of a waveform does help to prepare one for informed listening. Chapter 5 is what most students will consider the meat of the program, an outstanding and comprehensive treatment of abnormal lung sounds that does not ignore minor phenomena such as mouth noises. Mixing clinical observation with experimental findings, Lehrer explains the origins of abnormal lung sounds and interprets them in keeping with structural and functional changes in the lung. The script to the accompanying tape, a glossary, and an index round out the book. The script and ta

Steven Lehrer's introduction to auscultation is a primer of pulmonary diagnosis using lung sounds as its unifying theme. Intended to educate the ear as much as the mind, his kit is a self-contained learning experience for the medical student. It may also be useful for critical care and pulmonary service nurses. The kit is an excellent learning system and is highly recommended as an introduction to the topic.The book begins with an homage by Victor McKusick to the Golden Age of auscultation, introduced by Rene Theophile Hyacinthe Laennec in 1816. The sketch is too brief to elaborate on the fascinating history of auscultation, which at the time was a monumental undertaking. Laennec codified his work in 1819 in his book Traité de l'auscultation médiate, an effort that exhausted him and extracted a two-year period of recovery from his career. Laennec was a pupil of Jean Nicholas Corvisart, the leading advocate and systematizer of chest percussion. Mentor and student defined the chest examination as we know it. Lehrer continues the work, as the transmitter of a grand tradition.The first chapter reviews the anatomy of the lung and the physiology of ventilation, omitting blood gas interpretation. Lehrer also introduces common pathological conditions, briefly exploring their auscultatory findings. The second chapter shifts attention to the other end of the stethoscope: the listener. Lehrer discusses sound characteristics, the hearing mechanism, and the stethoscope as an instrument. In the third chapter, he introduces the history and physical examination of the patient with chest disease. Here he departs from the emphasis on auscultation to provide the student with a context for the auscultatory examination--an appreciation for the findings that are likely to accompany the abnormal sounds.Chapter 4 discusses normal breath sounds. This is a fine outline of physical examination of the chest, worth a complete physical diagnosis teaching session with students. It also introduces a simple graphic system of notation. The interested specialist may welcome the discussion of recording systems and waveform analysis. The novice may find this tedious, but the visual display of a waveform does help to prepare one for informed listening. Chapter 5 is what most students will consider the meat of the program, an outstanding and comprehensive treatment of abnormal lung sounds that does not ignore minor phenomena such as mouth noises. Mixing clinical observation with experimental findings, Lehrer explains the origins of abnormal lung sounds and interprets them in keeping with structural and functional changes in the lung. The script to the accompanying tape, a glossary, and an index round out the book.The script and tape provide examples of the more important normal and abnormal lung sounds, followed by a short quiz. Each lung sound is introduced, demonstrated, and explained. Lehrer has the student listen to the tape through a stethoscope to ensure realism.For the more exp

Simply superb CD/booklet for lung sounds. I recommend it to all students (interns, respiratory, etc) and clinicians who need perfect their skills on chest chest sounds (eg, respiratory therapists and "new young" MDs).

Understanding Lung Sounds 2nd edition review from Chest:"Understanding Lung Sounds is a paperback with accompanying audiotape that provides an introduction to the art of auscultation of lung sounds and physical diagnosis of chest diseases. The book affords a written explanation of the mechanics of respiratory findings and couples it with the schematic representation of sophisticated lung sound analysis. The audiotape provides examples of the described auscultatory findings.In this edition, Dr. Lehrer covers both normal and abnormal lung sounds, which allows the novice a unique experience in physical diagnosis of the chest. His text is concise and very understandable for the medical student, nursing student, or physician. The accompanying tape is of excellent quality and provides findings that would be hard to assemble at one time, if patients were required. This variety of findings allows the listener, for instance, to compare and distinguish normal from abnormal and low pitched crackles from high pitched crackles.This text would be a good addition to any medical student's library. As a teacher of Physical Diagnosis, this reviewer also found it to be a highly recommendable adjunct text for the course. Although a bit simplistic for the experienced practitioner, it is well written. This text is an excellent introduction to understanding lung sounds through sight and sound.Tim Ferguson, MD Evansville, Indiana/ Chest 1995; 107:20

This book-and-tape package guides readers through the sounds and skills of chest auscultation. They get an easy-to-follow, 60-minute cassette that presents actual lung sounds and an accompanying manual that gives them the background to understand what they hear. The reader will be better able to differentiate between normal and abnormal noises, detect pulmonary disorders early, and help plan a management strategy immediately. The 2nd Edition presents how to examine patients by auscultatory percussion, frequency differences between adults and children and the Fourier transformation method of lung sound analysis."The content is timely but relatively timeless; it will not soon go out of date." Annals of Internal Medicine