Lung sounds
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Congestive heart failure vector illustration. If the patient is having oxygenation issues despite supplemental oxygen, positive pressure therapy can be suggested by the RT for a patient with persistent fine crackles.
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When an RT hears these sounds in a postoperative patient they might suggest incentive spirometry as post-anesthesia patients can develop atelectasis due to shallow breathing during and after surgery.ĭiuretics may be ordered when these sounds are heard in a patient who has a history of CHF or pulmonary edema. Crackles: Fine, Coarse and Mediumįine crackles (previously called rales) are usually heard upon inspiration and are often described as short, sharp and popping, which makes sense since they are thought to be sounds made as the alveoli “pop” open from a collapsed or fluid filled state.Ĭrackles are usually high pitched and located in the dependent regions of the lungs. These three categories are further broken down by their pitch, location and timing, helping to diagnose the underlying cause for the sound. The NBRC classifies adventitious breath sounds into three categories: Crackles, Wheezes, and Pleural Friction Rubs. This would alert the RT to look further, possibly suggest an X-ray. If they are heard outside of their normal anatomic locations, they are adventitious and point to some kind of consolidation, fibrosis, or atelectasis in that area of the lung.Īn example of this in a charting note might be “Bronchial breath sounds heard over the right posterior mid lung”. Neither sound should be heard in the periphery. Tracheal sounds at the trachea, bronchial sounds at the bronchus. Vesicular sounds are normal when they are auscultated in the proper locations. When auscultating RTs use a side to side technique comparing one lung to the other in order to be able to identify areas where there is a difference leading to possible issues the patient may be having in those areas of the lungs. Vesicular breath sounds can be described as bilateral, increased, decreased, unequal or absent. Expiratory sounds fade quickly and can be difficult to hear. In most of the peripheral lung fields of a normal, healthy patient, vesicular sounds should be soft and lower in pitch with a longer inspiration and a shorter expiration with no pause between. Moving past the segmental bronchi, the sounds become more reduced because the chest wall, muscles and lung tissues muffle the sounds. They can be described as “hollow” or “tunnel like” and there is no pause between inspiration and expiration. Bronchial sounds are loud and can be high or low pitched. Posterialy, bronchial sounds can be heard on either side of the spinal column from the third rib to the sixth rib. Air moves quickly through these airways and the sounds should be easily identifiable.Īt the trachea the airflow sounds high pitched and there is a noteworthy pause at the end of inspiration followed by expiratory flow that is about double the length of the inspiratory time.Īs you move to either side of the sternum, anteriorly, bronchial breath sounds can be heard between the second rib (intercostal space) and the fourth rib. Sounds heard near the large airways will be loud and somewhat harsh. Normal breath sounds can be heard over the large airways such as the trachea and bronchus and bilaterally throughout the lung fields. The NBRC breaks down breath sounds into Normal “Vesicular” and Abnormal “Adventitious” sounds. When it comes to auscultation, just like everything else in respiratory school, knowing what is normal is the best way to recognize when something is abnormal. That said, we cannot stop medical providers who came before us from using obsolete terminology, but we can be sure we don’t confuse ourselves when we sit for our boards. and yet, many of these words no longer have a place on your board exams so they aren’t taught in respiratory class. You know, THESE words: rales, rhonchus, crepitations, wheezes, sonorous exhalations, crackles, etc. In clinical rotations you hear ALL the words that have ever been used to describe lung sounds. It is no wonder that this skill can be such a head scratcher for students. Part of the puzzlement comes from the confusion about terminology over the years.
#Lung sounds how to
Understanding what each sound is, how to categorize it, and what to do about it is such a critical skill in our field and yet it can all be very confusing for students. Auscultating, or listening to, the lung sounds of pulmonary patients is going to be something a respiratory therapist does at least 20 times a day if not much more.