Breath Sounds

Stethoscope

Bell: low frequency sounds. Diaphragm: high frequency sounds. Tubing. Binaurals. Ear pieces. Your brain!

Stridor

A high pitched wheezing. Caused by the obstruction of the trachea either by inflammation or foreign object. Just enough air passes the obstructed point to cause a high-pitched whining wheeze. Inspiratory sound.

Adventitious Sounds

Added sounds. Crackles, wheezes, rhonchi, stridor, pleural rub.

Egophony

Ask the patient to say E continuously. Ascultate over each lung. You should hear a muffled E sound. Hearing a nasally A sound is referred to as E to A and indicates egophony is present. Indicates fluid in the pleural space.

Bronchophony

Ask the patient to say ninety-nine several times in a normal voice. Ascultate over each lung. the words should be muffled and indistinct. Distinct, loud, clear sounds indicate bronchophony is present. Indicates increase lung density.

Whispered Pectoriloquy

Ask the patient to whisper ninety-nine several times. Ascultate over each lung. The words should sound faint, muffled, and indistinct. Distinct, clear sounds indicate whispered pectoriloquy is present. Indicates inceased lung density.

Normal Breath Sounds

Breath sounds are described as normal when the expected sound is heard in the expected area. Tracheal, bronchial, bronchovesicular, vesicular

Auscultation

Characteristics to listen for: intensity, length of inspiration compared to expiration, distinctive features. Lengthe of I compared to E: depends on the location, in the lung periphery the inspiratory sounds appears longer than expiratory sound. Distinctive feature: note the location of any sounds, is the sound continuous or discontinuous? was the sound heard during inspiration, expiration, or both?

Wheezes

Continuous sound. High pitched whistle. Usually heard on expiration. Prolongs the expiratory sound. Common with: asthma, COPD, CHF (cardiac asthma).

Rhonci

Continuous sound. Often during expiration. Prolongs expiratory sound. Considered to be central airway sounds. Low pitch wheeze. A snoring/groaning type of sound, harsh - sonorous wheeze.

Crackles

Discontinuous sound. Due to airways and alveoli popping open. Most often heard during inspiration. If fine crackles: atelectasis. If harsh crackles (bubbling): CHF/secretions. Lung Collapse.

Pleural Friction Rub

Due to inflammation of the visceral and parietal pleurae - the two membranes rub together. Leather-on-leather sound. Heard on I and E. Intensity increases with deeper breaths.

Bronchial Breath Sounds

Expiration longer than inspiration with a pause between inspiration & expiration. Thoracic Geography: over the manubrium and the sternum. Sound Characteristics: high pitch, loud intensity.

Tracheal Breath Sounds

Expiration longer than inspiration with pause between inspiration & expiration. Thoracic Geography: over the trachea on the throat. Sound Characteristics: high pitched, tubular, loud and harsh.

Bronchiovesicular Breath Sounds

Inspiration equal to expiration with no pause between inspiration & expiration. Thoracic Geography: above and below the clavicles (anterior), between the scapulae (posterior). Sound Characterisitcs: softer intensity compared to T or B, intermediate pitch.

Vesicular Breath Sounds

Inspiration sounds longer than expiration with no pause between inspiration & expiriation. Thoracic Geography: everywhere on the thoracic wall. Sound Characterisitcs: low pitch, low intensity, breezy sound.

Intensity

described as: loud/coarse, fine, diminished, absent, sometimes the pitch of the sound will be described: high or low.