Adventitious Lung Sounds

Presented by: Earth Registered Nurse RN

Overview

• Adventitious lung sounds are abnormal sounds during auscultation.
• Five main types to be familiar with:
  1. Crackles (also known as rales)
     • Fine crackles
     • Coarse crackles
  2. Wheezes
  3. Rhonchi
  4. Stridor
  5. Pleura Friction Rub

Identifying Adventitious Lung Sounds

• Key Questions to Ask:
  • Timing: Is the sound heard during inspiration, expiration, or both?
  • Pitch: Is the sound high-pitched or low-pitched?
  • Nature: Is the sound discontinuous or continuous?
  • Location: Where are the sounds primarily heard (large airways, small airways, etc.)?
  • Defining Characteristics: Does the sound resemble a harsh grading noise, musical whistling, snoring, etc.?

Types of Adventitious Lung Sounds

1. Crackles

Fine Crackles

• Timing: Heard towards the end of inspiration.
• Pitch: High-pitched.
• Nature: Discontinuous (individual popping/cracking sounds).
• Location: Small airways.
• Characteristics: Sounds like popping or light crackling of fire.
• Conditions: Congestive heart failure, atelectasis, pneumonia, pulmonary fibrosis.

Coarse Crackles

• Timing: Beginning of inspiration, may extend into expiration.
• Pitch: Low-pitched.
• Nature: Discontinuous.
• Location: Large airways (bronchi).
• Characteristics: Gurgling or bubbling sound.
• Conditions: Heart failure (pulmonary edema), pneumonia, bronchiectasis.

2. Wheezes

• Timing: Mainly on expiration; can be heard on both inspiration and expiration.
• Pitch: High-pitched.
• Nature: Continuous.
• Location: Throughout the respiratory system.
• Characteristics: Squeaky musical whistling noise.
• Conditions: Asthma, COPD, lung infections.

3. Rhonchi

• Timing: Mainly on expiration, can be heard with inspiration.
• Pitch: Low-pitched and loud.
• Nature: Continuous.
• Location: Large airways (trachea, bronchus).
• Characteristics: Snoring or snorting sound.
• Conditions: Bronchitis, pneumonia, COPD.

4. Stridor

• Timing: Can be heard on both inspiration and expiration.
• Pitch: High-pitched.
• Nature: Continuous.
• Location: Upper respiratory system (trachea/throat).
• Characteristics: Screeching squawking noise.
• Conditions: Epiglottitis, croup, anaphylaxis, foreign object blockage.

5. Pleura Friction Rub

• Timing: Can occur on inspiration and expiration.
• Pitch: Low-pitched.
• Nature: Discontinuous or continuous.
• Location: Pleura layer around lungs.
• Characteristics: Harsh grading sound with associated pain during breathing or coughing.
• Conditions: Pleurisy, pneumonia, pulmonary embolism, tuberculosis, lung cancer.

Conclusion

• Understanding and identifying different adventitious lung sounds is crucial for diagnosing various respiratory conditions.
• Further resources available through video series link in the YouTube description.