hey everyone it's the Earth registered nurse rn.com and in this video I'm going to talk about the different types of adventitious lung sounds so let's get started adventitious lung sounds or abnormal sounds that you hear during auscultation that shouldn't be there and I want to cover five main types that you want to be familiar with the first type is known as crackles these are also sometimes called rels and you can further divide them into fine crackles and coarse crackles there's also wheezes rhonchi Strider and pleura friction rub now whenever your auscultating lung sounds and you're trying to identify that particular abnormal sound that you're hearing you want to make sure that you ask yourself the following questions the first question deals with timing ask yourself are you hearing this mainly on inspiration or expiration or even both then try to determine the pitch of the sound is it high pitch or low pitched followed by if this sound is considered discontinuous or continuous this refers to the length and the nature of that sound or sounds produced for example if the abnormal sounds are distinguishable individually and occur in succession such as the individual pops and fine crackles and those sounds generally last less than 250 milliseconds the sound is considered discontinuous however if the sound is more constant in nature generally lasting longer than around 250 milliseconds it is considered continuous and then another question you want to ask yourself is about location of that sound where are those sounds mainly heard are they mainly heard in the large Airways like the trachea the large bronchi or those smaller Airways which involves the alveoli and the bronchioles and then lastly try to determine if this sound has a defining characteristic to it that's just really hard to ignore for example the sound sounds like a harsh grading noise or squeaky musical whistling or snoring or squawking which could hopefully help you determine what kind of sound you're hearing so first let's go over crackles fine crackles are sometimes referred to as rails and the first thing what I want to do is I want you to listen to an example of what fine crackles may sound like foreign how do you know that you're hearing fine crackles well you want to pay attention to the timing with fine crackles you're going to hear those towards the end of inspiration and they're going to be really brief you also want to pay attention to that pitch fine crackles are going to be high pitched you also want to make sure that they are discontinuous meaning that you're able to distinguish those individual popping cracking sounds that are occurring in a series so they're intermittent and these sounds tend to be located in small Airways plus they're going to have this defining characteristic they're going to sound very similar to popping or light crackling of a fire and they cannot be cleared with coughing and again let's listen to that sample of fine crackles oh now what's causing this sound well whenever the patient breathes air into those small Airways like the bronchioles or the alveoli which are deflated or clapsed it causes them to all of a sudden crackle or explode open which allows you to hear that high-pitched crackling noise and Vine crackles can occur in cases of congestive heart failure actilectasis pneumonia and Pulmonary Fibrosis next up is coarse crackles let's listen to some audio of what coarse crackles may sound like foreign course crackles well you want to pay attention to their timing coarse crackles tend to occur around the beginning of inspiration but they can extend into expiration and they tend to be longer than fine crackles also their pitch is low and they are discontinuous in addition they tend to be located in the large Airways such as the bronchi and they have specific defining characteristics these coarse crackles tend to sound like a gurgling or bubbling sound that is not cleared with coughing and again let's listen to this audio of course crackles foreign foreign well it tends to occur whenever patients breathe air in to partially blocked Airways like those large Airways such as the bronchi that are filled with fluid or really thick mucus so whenever you're trying to think of lung conditions that will cause this sound think of lung conditions that present with fluid or thick mucus and these conditions could include heart failure due to pulmonary edema which is fluid in the lungs or severe cases of pneumonia or bronchiectasis which is a chronic lung condition where the bronchi are enlarged due to Chronic lung disease for example like cystic fibrosis or infections that result in mucus secretions now let's talk about wheeze sounds first let's listen some sample audio of what wheezes may sound like oh now how do you know that you're hearing wheezes well you want to pay attention to the timing with wheezes you're mainly going to hear them on expiration where they're going to be the loudest but you can note them on inspiration and expiration and their pitch is going to be high in addition they're going to be continuous and located throughout the respiratory system and they will have a defining characteristic when you listen to them they will have this squeaky musical Whistling noise to them and you may even be able to hear them without a stethoscope especially if your patient's having an active asthma attack now it's important whenever you hear these sounds that they're not mainly coming from the throat area because this may indicate Strider and again let's listen to that audio of what wheezes could sound like so why is this sound occurring well it occurs because the Airways have started to narrow meaning they have started to get smaller so as air is squeezed through those Airways it creates this squeaky musical whistling sound and it can occur in cases of asthma COPD or any type of lung infection that narrows those Airways like with a viral respiratory infection next is rhonchi so let's listen to some audio of what rhonchi may sound like um now how can you know that you're hearing rhonchi well you want to pay attention to the timing ronkar mainly heard on expiration but you can hear them along with inspiration and they're going to have a low pitch and be loud in addition they're going to be continuous and located in large Airways like the trachea and the bronchus and they're going to have a defining characteristics where when you listen to that sound it's going to sound like a snoring or a snorting sound that can decrease or go away with suctioning or coughing now it's important to know that some literature will actually classify rhonchi as a type of course crackle or a type of wheeze so whenever you're trying to identify these lung sounds always go by your facility or your professor's recommendations for how they want you to categorize rhonchi so again let's listen to that audio of ronkai um now what causes this sound well it occurs whenever air leaves the trachea and bronchus and it hits secretions like mucus and fluid and whenever it does this it creates this snoring like sound that you're hearing and this can happen in cases of bronchitis pneumonia and COPD next is Strider so let's listen to some audio of what Strider may sound like now how do you know that your hearing Strider well you want to pay attention to a few things first thing is timing Strider can be heard on inspiration or expiration and it's going to have a high pitch in addition it's going to be continuous and located mainly in that upper respiratory system like the trachea slash throw area and it's going to have a defining auditory characteristic that you really can't ignore it's going to sound like this screeching squawking noise that's coming mainly from that throat area so again let's listen to this audio of Strider foreign so what causes this sound well it's occurring because there's narrowing of the larynx and the trachea from swelling due to some type of infection or blockage from an object and it can actually progress where that Airway will be completely blocked off therefore some cases of Strider are life-threatening and require immediate attention so it depends on the severity of the Strider how severe does it sound and what is actually causing it now Strider can be caused by cases of epiglottitis or croup where you may hear it referred to as a barking cough in the Pediatric population it can also be caused in cases of anaphylaxis or if there is an object stuck in this throat region finally we have pleura friction rub so let's listen to some audio of what a pleura friction rub may sound like oh now how do you know that you're hearing a pleura friction rub well you want to pay attention to the timing with plural friction rubs they can occur on inspiration and expiration and they're going to have a low pitch to them in addition they can be discontinuous or continuous it really depends on the severity of the rub and what's going on with your patient and it's located in the pleura layer which are the layers that surround your lungs which is made up of the viscera pleura and the parietal pleura in addition it's going to have a defining characteristic that you're going to be able to know on auscultation you're going to hear this harsh grading sound in addition your patient's probably going to have pain especially when they take deep breaths in or they cough now let's listen to that audio of a pleura friction rub again foreign so what causes this sound well it occurs whenever those plural layers become inflamed and rub up against each other because normally the visceral and the parietal pleura are separated by a small space so as the patient breathes in those layers will just Glide over one another but when those layers become inflamed that space shrinks which allows those layers now to rub up against each other creating pain and that harsh grating noise that you're going to hear and it can happen in cases of pleurisy which just means inflammation of those pleural layers pneumonia pulmonary embolism tuberculosis and some forms of lung cancer okay so that wraps up this video and if you'd like to watch more videos in this respiratory series you can access the link in the YouTube description below