# Lung Sounds



## Alas (Sep 25, 2010)

I've checked youtube, google, etc, and didn't learn much. 
Question is, how to identify/differentiate (what do they sound like) between- rales, crackles, wheezing, rhonchi, locations of the sounds and possible diagnosis, from an ems point of view?

Thanks for all the help community of emtlife.


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## Scott33 (Sep 25, 2010)

http://www.youtube.com/watch?v=GP8Gqb9-saY

http://www.youtube.com/watch?v=4a8mahH-VEo&feature=related


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## LonghornMedic (Sep 25, 2010)

You learn most of this through good old fashioned experience.


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## johnrsemt (Sep 25, 2010)

If you work in an area where you can go and hang out at an ED,   do it.   talk to ED manager,  shadow docs and listen to different breath sounds.

  best way to get experience on listening to them:  most docs will tell you what  you are hearing while you are hearing it;  and show you the best ways and places to listen.
   Also you get more experience on seeing differential diagnosing;  and helps to build medical knowledge.  

   I used to do it about every 6 months for an 8 to 12 hour shift.    but we had 8 EDs in county to do it in.

Most ED docs like to teach


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## Sassafras (Sep 25, 2010)

We practiced on each other in class.  Given we had an asthmatic, someone with chronic bronchitis from smoking too much and a slew of other smokers with various weird stuff going on in their lungs....actually, there were only two of us with normal lung sounds in the whole class LOL.


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## medicRob (Sep 25, 2010)

*Overview of Pulmonary Anatomy & Physiology*

Major Structure and Function of the Respiratory System
[YOUTUBE]http://www.youtube.com/watch?v=kZzn_8ztPMA&feature=related[/YOUTUBE]

Basic Respiration
[YOUTUBE]http://www.youtube.com/watch?v=4a8mahH-VEo&feature=related[/YOUTUBE]

Gas Exchange
[YOUTUBE]http://www.youtube.com/watch?v=bwXvqSqAgKc&feature=related[/YOUTUBE]


*Auscultation Videos from Bate's Guide to Physical Examination*

Breath Sounds - Normal & Adventitious
[YOUTUBE]http://www.youtube.com/watch?v=h7BtrWATfg8&feature=fvw[/YOUTUBE]

Anterior Auscultation of the Thorax & Lungs

[YOUTUBE]http://www.youtube.com/watch?v=NzEBjXKGz4U[/YOUTUBE]

Posterior Auscultation of the Thorax & Lungs

[YOUTUBE]http://www.youtube.com/watch?v=3tvLpbOZ7fA&feature=related[/YOUTUBE]

*Audio of the various breath sounds*

Crackles
[YOUTUBE]http://www.youtube.com/watch?v=9C5RFb1qWT8[/YOUTUBE]

Wheezing
[YOUTUBE]http://www.youtube.com/watch?v=YG0-ukhU1xE&feature=related[/YOUTUBE]

Rhonchi
[YOUTUBE]http://www.youtube.com/watch?v=QPBZOohj2a0&feature=related[/YOUTUBE]


*Other Lectures*

Lecture on Lung Sounds Pt 1

[YOUTUBE]http://www.youtube.com/watch?v=GP8Gqb9-saY&feature=related[/YOUTUBE]

Lecture on Lung Sounds Pt 2

[YOUTUBE]http://www.youtube.com/watch?v=4a8mahH-VEo&feature=related[/YOUTUBE]


Short Lecture on Breath Sounds and Clinical Manifestations

[YOUTUBE]http://www.youtube.com/watch?v=0Q6J0ybSuNo&feature=related[/YOUTUBE]


*Some Other Useful Resources*

Types of Breath Sounds

http://www.nlm.nih.gov/medlineplus/ency/article/003323.htm

Breath Sounds (Audio)
http://www.rale.ca/Repository.htm

Information about breath sounds along with .wav files from digital stethoscopes
http://faculty.etsu.edu/arnall/www/public_html/heartlung/breathsounds/contents.html

----
I hope this helps.


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## redbull (Sep 25, 2010)

This is a good thread.


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## Julma (Sep 27, 2010)

Best way to get comfortable with listening those sounds is to listen them. I do often listen lungs even if there is no clear reason for that, just for practise. And when you know what they are supposed to sound when normal, it is easier to clarify whats wrong with them. 

Listening spots when patient is sitting: 





Usually i just use spots 1, 2, 7 and 8 from back, it is enough on the field. 

When patient is lying on its back (for example to check that intubation tube is properly set) I just listen about 15 cm/6 inches under armpits.


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## gary1969 (Sep 27, 2010)

Lung Sounds are very important.  I agree with longhorn, to learn LS you have to listen to a lot of them. For the sake of not looking foolish when you arrive at the ER, you can say congested, wheezes, clear and/or hard to hear in the back of the unit. The most important thing is that they are present and adequate air is being exchanged. You can hold the back of your hand up to their mouth to get an idea of their end total volume. When a pt is intubated check LS often !


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## MSDeltaFlt (Sep 27, 2010)

http://www.rale.ca/Repository.htm

http://www.stethographics.com/main/physiology_ls_introduction.html

The absolute best teacher of breath sounds is to get in a hospital and find an experienced respiratory therapist and have him/her show you as many patients as possible and listen to each and every lung field on each and every patient.

If you were near me and my hospital, I'd swing you by HR after clearing it with the RT manager, sign all the necessary HIPAA forms, and go to each and every pt room in the hospital to listen to their lung fields.

I've said it before and I'll say it again.  You can't teach experience.  Go out and get some, it is at all feasible.

Good luck.


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## redbull (Sep 27, 2010)

This should be a sticky thread if there isn't one already.


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## 18G (Sep 28, 2010)

Best thing to do is listen to lung sounds on just about all of your patients. The more you listen the more familiar you will become with sounds of the chest. You need to know what normal sounds like before getting a good grasp on abnormal. 

Also as a tip... having an understanding of pathophysiology of lung diseases like Asthma, COPD, CHF, pneumonia, bronchitis, etc. will help you correlate what your hearing with the disease process. 

Here is a simplified way of starting to understand some of the more common breath sounds:

Wheezes - high-pitched musical sounds... musical meaning constant in their sound. Indicate bronchoconstriction. Air is squeezing through very narrow passages.

If you know a chronic smoker, listen to their lungs! I almost guarantee you will hear wheezes on a daily basis. 

Crackles (newer term for rales) - non-musical meaning they are interrupted sounds... like a crackling or popping and often described as rubbing a piece of hair close to your ear. They can be fine (higher pitched) or course (lower pitched). Indicate fluid/infection/inflammation of the smaller airways (alveoli). 

** Remember with crackles.... that fluid is gravity dependent. This is why with CHF patients we always want to sit them upright to isolate the fluid to the most gravity dependent regions to allow some of the airways to be fluid free and enhance gas exchange. If the patient was flat the fluid would be present throughout the entire lung whereas sitting up the fluid is only present on the lower lobes of the lungs. 

The exception is when a patient is filled to the brim with fluid but u still want to sit these patients up.....  I mention this because when your assessing lung sounds and hear crackles all the way up into the upper lung fields... this is bad... or if you start assessing and only hear crackles in the lower lung fields (bases) and 30mins later you have crackles in the upper fields (apices) you can use that as a sign that the patient is progressively worsening. 

Rhonchi - course, harsh, non-musical sounding. Indicate mucus/congestion in the bronchioles and larger airways.  

Some patients you will hear more than one type of adventitious sound. In a pneumonia patient its common to hear wheezing from bronchconstriction and also crackles from the inflammation (fluid) at the same time.


All lung sounds that are in addition to the normal breath sounds are known as adventitious. For example, when documenting if you have a patient with clear breath sounds you can put as a pertinent negative that "lungs were clear with no adventitious sounds present" or something similar. 

I seen some good links posted in this thread...


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## TransportJockey (Sep 28, 2010)

johnrsemt said:


> If you work in an area where you can go and hang out at an ED,   do it.   talk to ED manager,  shadow docs and listen to different breath sounds.
> 
> best way to get experience on listening to them:  most docs will tell you what  you are hearing while you are hearing it;  and show you the best ways and places to listen.
> Also you get more experience on seeing differential diagnosing;  and helps to build medical knowledge.
> ...


THis. Following around RRTs works as well. When I worked in the hospital, I was always asking and since I carried ears with me on a regular shift, the RRT or MD that I was talking to would usually tell me to take a listen and explain exactly what I was hearing. 
It also helped that I wound up working almost every floor of the hospital I worked at.


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