This could be either on inspiration or expiration. The same thing happens in the airways and we hear a whistling sound. Think about blowing through a large milkshake straw versus a small soda straw - the pressure increases in the smaller straw. When we talk about Asthma or COPD we’ll discuss what makes them narrow. Wheezing happens when the small airways in the lungs are narrowed. So it’s SO important that you actually listen to all lung fields, otherwise you might miss it. So if they’re sitting up it would be at the bases and if they’re bedridden and supine, it would be posterior. If you fill a sponge with water, then hold it vertically - where does the water go? It goes down, right? So if the patient has fluid in their lungs, you are more likely to hear it in a dependent area.

One thing to note here is that the lungs are like a sponge. Now rhonchi and crackles get confused sometimes, so just remember crackles are fluid in the alveoli so it’s a smaller, finer sound, rhonchi is fluid in the airway so it’s more harsh sounding. It’s liquid being pushed around in the airways by the air. Think about the sound of sputum in the back of your throat - it’s that *** sound. Rhonchi are a harsh gurgling noise that are indicative of fluid or sputum in the air passages. If you have short hair, find a friend with hair you can borrow - just be sure to give it back. If you take a section of hair and rub it between your fingers next to your ear, you can hear what this should sound like. So when your little alveoli get filled with fluid, they tend to stick and when the patient breathes deep that pressure pops them open - that’s the noise you’re hearing. Crackles are a fine popping noise that is caused by fluid in the alveoli. So, what does it mean when we hear something different, or nothing at all? We’re gonna cover the 4 main breath sounds you’ll encounter, as well as talk about why they might be absent. You should be able to hear them all the way into the bases when the patient takes a deep breath. They’re a low-pitched blowing or rustling noise. Then you have vesicular - these are heard everywhere else in the majority of your lung fields, anteriorly, posteriorly, and laterally. They’re lower pitched, but still hollow sounding. Then you have bronchovesicular - these are heard over the smaller bronchioles and can be heard along the sternum in the center of the chest, as well as between the shoulder blades on the back. They’re high-pitched, loud, and also sound hollow. These are heard over the bronchi, so you’d hear them right at the top of the sternum below the clavicle. They’re harsh and hollow, like blowing through a big pipe, which is exactly what the trachea is. Tracheal lung sounds, as you would assume, are heard over the trachea. If it doesn’t, we know there’s a problem. What’s important to know here is that each area of the lung should sound a certain way. So there are four main normal lung sounds. Just don’t ‘diagnose’.Įach area of the lung should have a specific sound - if any other sound is heard in that location, there is a disease process occurring.

It’s okay to teach the patient about what you are hearing and what it usually means.

Identify and treat cause of adventitious sound.

hemothorax, pneumothorax, pleural effusion

Indicates fluid or air around lung, preventing expansion.

Indicates inflammation of lining or presence of mass.

High-pitched, loud, usually inspiration.

Indicates narrowing of main airways (trachea, bronchi).Indicate narrowing of small air passages.Indicate sputum or fluid in air passages.Center of anterior chest, 3rd and 4th ICS next to sternum.Over bronchi, 1st and 2nd intercostal spaces (ICS).Each area of the lung should have a specific sound – if any other sound is heard in that location, there is a disease process occurring.

Lung crackles sound