W6: Auscultations & Lung Sounds Flashcards
When observing a patients breathing what are we looking for?
- Frequency- respiratory rate, inspiratory: expiratory ratio (1:2)
- Drive – depth of breathing (shallow vs lateral basal expansion)
- Symmetry - mode of breathing, symmetry of chest wall
- Rhythm – regularity of breathing pattern
- Accessory muscle use
- Audible noises during breathing
- Tactile fremitus – detects changes in lung density – good for assessing vibrations.
What is the normal inspiratory to expiratory ratio?
1:2 (COPD 1:3)
One rise and fall of the chest = one breath. Consider inspiratory and expiratory ratio (1:2 – expiration is twice as long as inspiration –> common for COPD patients for the ratio to be 1:3 – airway obstruction and increased resistance)
Which lung is larger and how many lobes in each side of the lungs?
What are the lobes of the lungs
- The R) lung is larger and has three lobes: upper, middle, and lower lobes.
- The L) lung is smaller and has two lobes: upper and lower lobe.
When we auscultate, we divide the lung fields into the upper, middle and lower zones.
o C7 to T3- upper lobe
o T3-T6 middle lobe
o T6-T10 lower lobes
What side of the stethoscope do we use?
Diaphragm side
How many respiratory cycles should be completed at each site during auscultation?
- At least one complete respiratory cycle should be completed at each site during auscultation.
What do crackles (or rales/crepitations) indicate?
What does it sound like?
When can it be heard?
What is often associated with?
If the sounds don’t clear after coughing and expectorating what may this indicate?
- Caused by fluid/ viscous material in the small airways or atelectasis (The popping sounds are heard when air passes through the respiratory passages that are narrowed as a result of increased fluid, mucus or pus)
- Discontinuous/intermittent sound, non-musical and brief.
- Can be heard on inspiration or expiration.
- This is often associated with inflammation and infection of the small bronchi, bronchioles and alveoli.
- If the sounds don’t clear after coughing and expectorating, this may indicate pulmonary oedema or fluid in the alveoli due to heart failure or acute respiratory distress syndrome (ARDS).
Describe the types of crackles?
Fine crackles:
- Soft pitched and brief, normally heard more towards end inspiration
- Indicative of less viscous material
- To simulate the sound, roll two strands of hair between your fingers near your ear.
- congestive heart failure? Infections eg pneumonia?
Coarse crackles:
- Louder, lower pitch and are generally heard earlier in inspiration and remain throughout expiration.
- Indicative of viscous sputum.
- To simulate the sound, it is opening up a Velcro fastener. At times can also sound like a gurgle.
What is a wheeze (rhonchi)
What are the two types?
- Sounds that are heard continuously during inspiration and expiration.
- Caused by air moving through airways narrowed by constriction or swelling of the airway or partial obstruction.
- Sibilant rhonchi & Sonorous rhonchi
What is a sibilant rhonchi?
High pitched wheeze with a shrill or squeaking quality. Musical in nature and heard throughout inspiration and expiration continuously. Commonly heard during bronchospasm from airway narrowing in an acute asthma attack.
What is a sonorous rhonchi?
Low pitched wheeze with a snoring or moaning quality. Relates to mucous within the larger airways commonly heard in populations suffering from bronchitis. Sounds may clear with coughing and expectoration of phlegm.
What is a stridor?
Where is it loudest?
What is it caused by?
What is it a sign of?
High pitched harsh sound heard during inspiration
Loudest over trachea
Caused by the obstruction of the upper airway
Sign of respiratory distress & requires immediate attention.
Where are vesicular breath sounds most commonly heard?
- Vesicular breath sounds can best be heard in most areas of the lungs
- However they are most prominently heard at the lung bases & periphery
What does a normal breath sound like?
Soft with a low pitch (rustling quality)
What is a rhonchi?
- Rhonchi are continuous breath sounds heard during inspiration and expiration
- Compared to wheezing they are lower in pitch
- The sound often comes from copious secretions in large airways or bronchi
- They are often heard in patients with: COPD, cystic fibrosis, bronchiectasis, pneumonia
- As air rushes past these secretions it creates turbulent flow
- This is what leads to to the classic description of rhonchi as snoring, gurgling or rumbling
What happens to the airways during rhonchi?
Occurs due to narrowing airways
Caused by secretions in large airways
Loudest towards the center of the chest instead of the periphery
