Lung/breath sounds Competency

Lung sounds collection

• T

• F

Match the following

• crackles (coarse)

• -loud, brassy

  -sound travels better over liquid

  -could indicate pneumonia if heard lower in chest.

• diminished

• not as loud as normal

• bronchial

• 2:1 ration (longer inhale, shorter exhale)

  -"wind" sound through leaves

• crackles (fine)

• -large airways w/ mucous

  "walking through snow"

  -coarse sound

  -pneumonia, pulmonary edema

• vesicular

• pop/bubble sounds

  boiling sound

  short

  (vesicular)

  -pulmonary fibrosis

Match the following

• expiratory wheezing

• -can be any place

  -sounds like a whale

  -obstruction

  -COPD, Asthma

• pleural rub

• -heavy secretions, large airways

  -"rales"

  -under water sound

• stridor

• -pleura is inflamed/causes friction when breathing

  -sharp pain

  -"rocking chair" or moving on leather sound

• Ronchi

• sounds like seal

  -emergency

  -racemic epinephrine treats this

  -almost completely closed airway (obstruction)

Match the following

• B inside a circle

• bilateral

• LLL

• right, middle, lobe

• RML

• left, lower, lobe

why should you start at the bottom of lungs when listening?

• you might miss a significant sound resonate from the bottom if you start at the top.

• there is not a reason, you can listen at any point

Match

• tactile fremitus

• -patient says 99 front/back

  -hear it clearly = fluid, abnormal, atelectasis,pleural effusion

  -sound can't travel over air

  -can't hear/faint=no liquid/pneumo?

• chest percussion

• May be shifted from middle with atelectasis, pneumothorax, pleural effusion, lung tumors

  -atelectasis pulls towards (evacuation of air)

  -pneumothorax pushes it away

  -pleural effusion fluid, push away

  -lung tumor push away

• lung expansion

• (grab sides of ribs (back) space should form between thumbs

  -if hands don't spread = fluid/atelectasis

  -both hand move = good

• Vocal fremitus

• -dull sounds=fluid/atelectasis "full"

  -resonant=normal

  -hyper resonant=a lot of air=pneumothorax, hyperinflation, "hollow"

• Tracheal deviation

• -vibrations = fluid/atelectasis

  -hands on chest to feel vibrations

match

• measure barrel chest

• (BS-breath sounds)

  -start at lower back

  -atelectasis=fine crackles=fluid

  -bronchial BS un lower lobes = fluid/atelectasis

• ascultation

• from the side, use hands to get thickness of chest, turn sideways, should be no more than half back

  -A/P=width of chest

  -commonly seen in patients with emphysema

• .....

• ...

chest percussion/auscultation

• y

• n

Respiratory exam

• a

• b