Breath Sounds -- Module 6 Health Assessment

Inspiration & Expiration:

Bronchial Sounds

Inspiration < Expiration

Inspiration & Expiration:

Bronchovesicular

Inspiration = Expiration

Inspiration & Expiration:

Vesicular

Inspiration > Expiration

Inspiration & Expiration:

Tracheal

Inspiration < Expiration

Location:

Bronchial

Larynx and trachea

Location:

Bronchovesicular

Anteriorly between 1st and 2nd ICS; Between scapula 

Location:

Vesicular

Over most of the lung fields

Location:

Tracheal

Above the trachea

Intensity and Pitch:

Bronchial

Loud

High

Intensity and Pitch:

Bronchovesicular

Mod

Mod

Intensity and Pitch:

Vesicular

Soft

Low

Intensity and Pitch:

Tracheal

VERY HIGH

VERY HIGH

Which breath sound location sounds coarse and tubular and includes a gap?

Bronchial

Which breath sound location sounds like whispering undertones?

Vesicular

Describe (fine) crackles

High-pitched, soft, brief crackling

“Rolling a strand of hair near the ear”

What is the mechanism of (fine) crackles?

Deflated small airways and alveoli popping open during inspiration

Early CHF specifically: small amounts of fluid in the alveoli may cause fine crackles

What conditions are associated with (fine) crackles?

• Fibrosis

• CHF

• Asthma

• COPD

• Pneumonia

Describe (coarse) crackles

Low-pitched, moist, longer crackling

“Velcro slowly being separated”

Mechanism of (coarse) crackles

Small air bubbles flow through secretions or narrowed airways

Conditions associated with (coarse) crackles

• Respiratory fibrosis

• Respiratory edema

• COPD

• Pneumonia

Describe wheezing

Musical sounds heard during inspiration

Wheezing Mechanism

Air passes through narrowed airways

“Similar to a vibrating reed”

Conditions associated with wheezing

• Asthma 

• Bronchitis

• Emphysema

Rhonchi description

Low-pitched snoring or gurgling sound that may clear with coughing

Rhonchi Mechanism

Airflow passes around or through secretions

Associated conditions for Rhonchi

Pleuritis

Describe pleural friction rub

Loud, coarse, low-pitched grating/creaking sound

Mainly in lower anterolateral thorax

“Squeaky door”

Pleural Friction Rub Mechanism

Inflamed pleural surfaces lose their normal lubrication and rub together during breathing

Pleural friction rub associated conditions

Pleuritis, pleurisy

Describe Stridor

Loud, high-pitched, crowing/honking sound louder in upper airway

Emergency!

Stridor mechanism

Laryngeal or tracheal inflammation or spasm

Stridor associated conditions

• Epiglottitis 

• Croup

• Partially obstructed airway