It’s been years since you’ve thought about heart sounds, and in all honesty, they were kind of confusing to begin with. Chest Sound Assessmentĭepending on your specialty, your cardiac assessment probably consists of listening to an apical pulse over the mitral valve and sagely nodding your head. A pleural friction rub is best heard in the lower anterior lungs and lateral chest during both inspiration and expiration. Potential causes include pleural effusion and pneumothorax. If you still hear the rubbing sound, then the patient has a pericardial rub and requires a different treatment. A pleural friction rub often causes a great deal of pain, and the patient will splint their chest and resist breathing deeply to compensate.Ī pericardial rub and a pleural rub will often sound similar, and the best way to distinguish between the two is to make the patient hold their breath. These membranes are usually coated in a protective fluid, but when inflamed, they stick together and make a sound like a harsh grating or creaking. ![]() Pleural Friction RubĪ pleural friction rub is caused by the inflammation of the visceral and parietal pleurae. It’s typically loudest over the anterior neck, as air moves turbulently over a partially-obstructed upper airway. It is also the most common type of breath sound heard in children with croup, though it is important to differentiate between croup and a foreign body airway obstruction. Stridor usually indicates the partial obstruction of the larger airways, such as the trachea or a main bronchus, and requires immediate attention. ![]() Stridor may be a sign of a life-threatening condition and should be treated as an emergency situation. Stridor is a continuous, high-pitched crowing sound heard predominantly on inspiration, over the upper airway. ![]() This lung sound is often a sign of adult respiratory distress syndrome (ARDS), early congestive heart failure, asthma or pulmonary oedema. Coarse CracklesĬoarse crackles are lower-pitched and moist-sounding, like pouring water out of a bottle or ripping open velcro. The sound quality of fine crackles is similar to the sound of hair rubbed between your fingers near the ear and may be heard in congestive heart failure and pulmonary fibrosis. They are commonly heard in the bases of the lung lobes during inspiration.Ĭrackles can be further categorised as coarse or fine: 1. The cause of crackles can be from air passing through fluid, pus or mucous. The sound crackles create are fine, short, high-pitched, intermittently crackling sounds. Crackles (Rales)Ĭrackles, also known as alveolar rales, are the sounds heard in a lung field that has fluid in the small airways. Sibilant wheezes are caused by asthma, chronic bronchitis and chronic obstructive pulmonary disease (COPD). These are the typical wheezes heard when listening to an asthmatic patient. Sibilant wheezes differ from sonorous wheezes as they are a higher-pitched, shrill, continuous whistling sound that occurs when the airway becomes obstructed and narrowed. Sibilant Wheezes (Wheezes)įormerly referred to as simply ‘ wheezes’, sibilant wheezes are very closely related to the sonorous wheeze. Pneumonia, chronic bronchitis and cystic fibrosis are patient populations that commonly present with rhonchi.Ĭoughing can sometimes temporarily clear this breath sound and alter its quality. ![]() Sonorous wheezes are caused by blockages to the main airways by mucous secretions, lesions or foreign bodies. Sonorous wheezes are named thusly because they have a snoring, gurgling quality to them, or are similar to a low-pitched moan, more prominent on exhalation. What was once called ‘ rhonchi’ are now mostly referred to as sonorous wheezes (though the terms are still used interchangeably).
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