Treating Bronchitis & Pneumonia in Preppers: Medical Devices
How to Use a Stethoscope, Pulse Oximeter and other Medical Devices
In this post we’re going to show you how to use your stethoscope, pulse oximeter, peak flow meter and teach you exam techniques so you can diagnose and treat Bronchitis, pneumonia and several other lung conditions that are serious business for preppers.
After all, other than trauma, lower respiratory tract infections confer the greatest risk to life for preppers. Smoke from smoldering ruins, musty closed in spaces, and a frequent and close proximity to one another predisposes you to Bronchitis, which in austere conditions often progresses to life-threatening pneumonia.
But with the inexpensive equipment we discussed previously and a few exam skills, you can easily make sense of any respiratory problem. Best of all, understanding these conditions is not difficult… it’s all mechanical. We will be using a stethoscope and chest percussion to differentiate Bronchitis from pneumonia. Let’s start with what you’ll hear in each with your stethoscope, then what you’ll hear with percussion:
How to Use Your Stethoscope & Perform Chest Percussion
Using Your Stethoscope
Select the diaphragm and tap it with your finger as discussed in the using your stethoscope section. If you hear a loud thumping sound, begin your exam by placing it on the person’s back; after they’ve removed their shirt. Ask them to take deep breaths through their mouth. If they breathe through their nose, you often won’t be able to hear the subtle sounds revealing what type of illness they have.
Remember to listen all the way through the persons complete inhalation and exhalation. Many problems in the lung can only be heard, or are heard best, during the end phases of respiration. Try to force yourself to wheeze right now, and you’ll see what I mean.
Healthy lungs produce soft and gentle breath sounds which you can barely hear. Any change from that indicates something’s wrong. Listen to your own lungs with your stethoscope to see what normal lungs sound like. If you don’t have a stethoscope yet, put your ear to someone’s chest and listen.
Start on the anterior chest wall, move to the sides, then work your way down the back from areas 1-4 as shown.
As you get farther down, you’ll notice the soft breath sounds you heard clearly up in area 1 & 2, will get more and more difficult to hear. This is because the lungs are ending, and the persons diaphragm is beginning.
The following is a high quality low cost stethoscope that I recommend for preppers and survivalists: Click this link to purchase the Omron Sprague Rappaport Stethoscope.
With Bronchitis you’ll often hear a wet cough, and rhonchi when listening with your stethoscope. You might also hear wheezing and rales. Click on the video below to hear rhonchi – this will be what Bronchitis sounds like:
On the right side in the lower level marked by the circled 4, you’ll won’t hear anything. That’s because the liver lives here… and it’s solid. Knowing where it’s at is helpful because you can use it as a reference point. For instance, when we start percussing-tapping over the lung fields-to see if the person has pneumonia, it will sound just like it does over the liver, if pneumonia is present. Let me clarify:
Pneumonia is a collection of puss that localizes in large segments of the lung. When you listen to segments of lung that have pneumonia, they sound just the same as when you’re listening over the liver. Likewise, when you percuss over lung segments that have pneumonia, it sounds just the same as when you percuss over the liver. In both instances they sound dull.
But sometimes you’ll forget what dull is supposed to sound like. In that instance, you can go back and tap over the liver, which always sounds dull. Then use that sound for comparison! If the person has dullness where there are usually soft air sounds, then pneumonia may be present.
Performing Chest Percussion
Now we come to the melon thumping. Percuss over the lung fields, listening for dullness as you do. Areas of lung filled with pus are called “consolidations.”
Chest percussion is done with the middle finger of one hand, tapping on top of the middle finger of the other hand, using a snapping wrist action. The stationary hand is placed firmly on the back between the inside edge of the shoulder blade and the spine.
A dull sound indicates the presence of puss or fluid collections within the lungs or chest. Normally you’ll hear a resonant drum-like sound when percussing over lung fields, indicating these air-containing structures are healthy. The technique was initially used to distinguish between empty and full barrels of whiskey and wine, but works similarly with human lungs.
Telling Between Bronchitis and Pneumonia
Most often resulting from a widespread viral infection of the airways, Bronchitis is the perfect setup for developing a subsequent Bacterial Pneumonia. The ball gets rolling when the viral pathogen invades the cells lining the airways, sometimes all the way down to the air sacks. This leaves delicate lung tissue open to attack from bacteria. The germs all of us normally inhale from time to time. Bacterial invasion of the ravaged lung tissue results in Pneumonia.
Pneumonia begins in the terminal ends of the airways – the air sacs. Known as “alveoli” in medicine, this is the area where the actual exchange of carbon dioxide for oxygen in the bloodstream takes place.
As you might imagine, accumulation of any type of fluid within these alveoli will impede one’s ability to oxygenate. The more fluid, the less oxygen – and the greater the shortness of breath the person will experience.
In the case of pneumonia, the fluid is generally pus. A thick mixture of fragmented bacteria, spent immune cells, and mucus with different degrees of viscosity depending upon its water content.
The mixture doesn’t stay liquid for long though. It quickly consolidates like Jell-O would in a refrigerator. This semi-solid substance must be broken down by the body with enzymes, and is why it can take months for pneumonia to fully resolve.[contextly_sidebar id=”ujr4bHmAVmkY9KC836PXJFk3aMKCtBja”]
When coughed up, the sputum of pneumonia is usually foul-smelling and may be rust or gray colored, depending upon the bacterial species responsible.
Rarely do people go from being well, straight to contracting pneumonia. Usually they’ll have had another respiratory infection first. They may have even seemed to be getting better. But then suddenly they become febrile, develop a productive (sputum producing) cough, and feel short of breath.
Dullness to percussion is not the only finding characteristic of pneumonia. You can also use another test, called egophony, to help tease out areas of consolidation. Click image below or click here for a one minute video.
While listening to the chest with a stethoscope, have the patient say the vowel “e” over two or three seconds “e-e-e-e.” Over normal lungs, the same “e” sound (as in “beet”) will be heard with your stethoscope. If the lung is consolidated, indicating the person has pneumonia, the “e” will take on a nasal sound and change to an “a” (as in “say”).
If you’re not sure of the difference, use the same trick we discussed before. Perform egophony first over the patients lung fields until you hear “e-e-e-e,” that will be your normal control spot. Then repeat the test with your stethoscope over the liver. It should sound like “a-a-a-a” due to the liver’s tissue density. That’s your pneumonia control spot. Now return to the lung fields to see if consolidation is present.
I find this technique more accurate and easier to perform than percussion. Both work the same way; they point out abnormal changes in lung density indicative of pneumonia.
Putting it all Together into a Treatment Plan:
You are helping someone with a cough and maybe some shortness of breath. Their cough may or may not be productive, it doesn’t really matter.
The goal is to see how sick they are, so you can gauge how to treat them. For instance, a person with Bronchitis can probably travel by foot for short distances, whereas a person with pneumonia will require bed rest and close monitoring.
Start by measuring their oxygen saturation level with your pulse oximeter. The lower the reading, the sicker they are, and the more rest they need.
Next use your meter to determine their peak expiratory flow. Compare that reading to the chart that came with the device. Record both your patient’s pulse ox and peak flow measurements for future reference. This will help you tell if they’re getting better or worse over the days to come.
Now listen to the lungs. Note any areas you hear rhonchi, wheezes, or other extra breath sounds somewhere in your notes. Percuss over the lung fields and use egophony to see if you can pick up any areas of consolidation.
If you cannot find consolidation, the person probably has bronchitis. If they do have dullness, then presume they have pneumonia.
Now, refer to your initial peak flow and pulse ox readings, then give the person a few puffs from your inhaler. Recheck your readings with both instruments 5-10 minutes later. Compare before and after findings to predict if Albuterol inhalation (or Primatene Mist) is likely to help them. I should note that albuterol and Primatene also come in pill form, for use with uncooperative children. It’s easy to give to them, but has more of the hyperactive and nervous side effects than the inhaled preparation.
How to Treat Bronchitis and Pneumonia
Augmentin and Cipro should both work for treating most cases of pneumonia. Sometimes an erythromycin antibiotic like Zithromax is required. This is especially true if the organism causing the infection is unique. These pathogens don’t fit the typical profile for a “bacteria.”
Click here or on Image for Our Post on Fish Antibiotics:
Also, you can click the following link to learn more about Fish Antibiotics for preppers and where to purchase them!
You may already be familiar with this problem – the infection they produce is called “walking pneumonia.” Mycoplasma is one such organism… and it hates erythromycin type antibiotics. Though, like all organisms, has developed resistance over the years.
Further treatment may consist of albuterol inhalations; if they help increase the person’s peak flow, or if they improve their symptoms of shortness of breath. Pushing fluids to thin secretions, and limiting physical exertion will also be necessary.
Should bronchitis even be treated with antibiotics?
That’s a tough question even for doctors. You know that bronchitis, which looks much like pneumonia without the findings of consolidation, is most often caused by a virus. So many of us base the decision of whether or not to use antibiotics on how long the person’s had bronchitis. Two weeks without improvement is where I have drawn my sandy line, though I may use them earlier if there are compelling reasons.
You’ll want to avoid giving antibiotics to a person who’s recently come down with bronchitis, for the sole purpose of trying to prevent it from progressing to pneumonia. In medicine we did this early on, because like most decisions we’ve made over the years, it seemed like a really good idea at the time. It turned out to be a mistake.
Doctors found out later, regardless of the organ system involved, giving antibiotics prophylactically increases the risk of getting a bacterial infection. They’ll kill off the friendly bacteria living in the area. This is counterproductive, because they normally compete against the harmful ones.
Both good and bad bacteria are always locked in a struggle for resources and living space. We call this “competitive inhibition” and antibiotics can quickly tip the balance in an unfavorable direction. They can do more harm than good.
What if I’ve given someone antibiotics, but they don’t seem to be getting better?
This happens frequently, and is frustrating for everyone involved. As for specific antibiotics, you’ll probably have to try one and watch for a week or so to see if you get a response. If you don’t, and the person doesn’t seem to be getting better, then switch to a different antibiotic.
There is so much antibiotic resistance out there, it’s often hit and miss. Antibiotics belonging to the penicillin, sulfa, erythromycin (Z-Pak and others), and Cipro family’s seem to work best. Seven to ten days is the typical treatment duration.
To learn more about treating bronchitis and pneumonia, click the book image above.