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Understanding Lung Sounds (Booklet with Audio CD): Steven Lehrer

UNDERSTANDING LUNG SOUNDS is a practical, straightforward guide to understanding and interpreting normal and abnormal lung sounds. The package consists of 60-minutes of actual lung sounds on audio, plus a 160-page book. The audio teaches the user how to interpret, differentiate, and identify both normal and abnormal lung sounds step-by-step. The accompanying book expands on that foundation to provide a thorough background with a review of pulmonary anatomy and physiology, instruction in the use of the stethoscope, a guide to assessment of the thorax, and a comprehensive guide to the recognition and differentiation of breath sounds. A new CD delivers the audio component in a convenient, contemporary format. Completely revised and updated content includes the use of esophageal stethoscopes for quantification of lung sounds during anesthesia and surgery, phonopneumography, interpretation of tracheal wheezes during methacholine airway challenge after exposure to occupational hazards, and much more. The book includes new line drawings for a total of more than 100 drawings and photographs, and new Chapter Review and Critical Thinking Questions at the end of each chapter, with answer guidelines at the back of the book.

(Includes a FREE SIMON website at: www.harcourthealth.com/SIMON/Lemmi/) Book and CD-ROM •

Summary: JAMA review of second edition

Rating: 5

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 experienced reader, the text reminds one how unsatisfactory the usual descriptors of lung sounds have become. After Laennec's elegant system in French, his English-speaking disciples (who are legion) seemed determined to add their own vocabulary. Both the American Thoracic Society and the American College of Chest Physicians have tried to standardize the terminology, in so doing unfortunately reducing it to an impoverished few words: rales (or crackles), wheeze, and rhonchus. Lehrer is wise to use British descriptors, which are more precise. However, there is something evocative about terms like "consonating rales," and one misses the poetry of authors like J. Milner Fothergill, who wrote in his Chronic Bronchitis (New York, NY: GP Putnam's Sons; 1882: pp.23-24): "Careful percussion . . . tells much about the complications of chronic bronchitis; even when it has nothing to say about the malady itself. Auscultation, however, is eloquent, even loquacious, about the disease.... Sometimes, especially when the patient is asleep, there may be quite a musical note...." Medical texts will never be written like that again, but Lehrer's prose is as clear and precise as Fothergill's and on occasion even gets mildly carried away with the romance of its subject. Tee L. Guidotti, MD, MPH University of Alberta Edmonton

JAMA 1995; 273(12):971

Summary: A must have

Rating: 5

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).

Summary: CHEST review

Rating: 5

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

Summary: Learn how to examine the chest

Rating: 5

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

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