[Applause] [Music] Now, for abnormal lung sounds, in this video, we're going to be listening to the top five most tested lung sounds, including the need to know key points and the top missed questions at the very end of this video. So, be sure to stick around to the end of this video to get the need to know info on exit exams, your nursing exams, as well as the end clicks. And be sure to pause the screen and focus on the highlighted key points here. First up is the wheezes, which we call the whistle, sounding a lot like this. As you can hear, it's described as a high-pitched musical flute located throughout the entire lung. But key term here, it's heard mainly on exhalation or basically breathing out. Now, the patho is very simple. Narrowed airways from bronco constriction, basically those inflamed lung tissues. And the disease process is typical for asthma attacks as well as COPD exacerbation. Now the treatment for asthma attack this one is always tested on. So write this down. The memory trick we use is AIM. A for albuterol. This one is given first for birutal asthma attacks. Remember butol. It's the one and only rescue drug for asthma attacks. I is forroprium our anticolinergic to dry out secretions. So just think you can't pee with a tropeium since it dries the body out. And M is for methoprenazolone. Brand name is Cellumedrol. Just think it's a slow acting steroid to treat the swelling. You like that, did you? Well, click here and get access to over a thousand fun visual videos, 300 study guide cheat sheets, and a massive quiz bank loaded with detailed rationale to test your knowledge. Neatly organized in our new app. Click here to get started for free. Next up is Crackles, also called RS. So, just think crackles is for crazy fluid, described as liquidy bubbling or crackling. Now we have two types. Fine crackles is described as highpitched like rubbing hair between fingers sounding like this. And coarse crackles is that low pitch sounding like velcro being pulled apart sort of like this. Now the location of these crackles are typically in the lower loes or the base of the lungs also called basilary and the patho is simple it's basically the alvoli that are popping open from inflammation and congestion and the disease process is typical for pulmonary edema that fluid in the lungs like with patients in heart failure that CHF or pneumonia where we have deep infection inside the lungs. So the treatment we give diuretics like feroseamide for that heart failure patient with pulmonary edema and for the infection like in pneumonia we give antibiotics. Next we have strider which we call the serious squeak. This one is a medical emergency because it indicates an airway obstruction sounding like this. [Music] As you can hear, it's described as a high-pitched harsh inspiratory whistle. The key term there is inspiratory when you breathe in. Now, it's located near the throat region during inhalation. And the patho is simple here. Blockage of the larynx or basically that voice box or trachea, that wind pipe. And it's caused by a choking obstruction, epiglatitis, that inflamed epiglatus, croo found in kids with a whooping cough, and after a thyroid surgery. This includes thyroid as well as parathyroid. Huge enclelex tip. I would write that one down. It came up a lot on many different question banks. Now, the key treatment is endotraccheial inhibation as well as surgery. Next up, we have Ronai, which we call the rumble, sounding like this. [Music] This one's described as a low-pitched rattling or rumbling, kind of like a snoring, located in the bronchi, not the alvoli here. So, the patho is mucous secretions or obstruction. The typical diseases that we see this in is bronchitis, COPD, pneumonia where we have infection as well as cystic fibrosis where we get serious mucus in cystic fibrosis. Now the treatment we use is chest percussion or basically vibrating the chest with a vest and fluids to loosen and thin that mucus. Next, we have plural friction rub, which I call the pebble friction rub because it sounds like two pebbles being grinded together, sounding a lot like this. As you can hear, it's described as low pitched dry rubbing. Again, like two rocks being grinded together. Now this is located in the front side of the lung during inhalation and exhalation basically in and out. And the patho is very simple here. Just think of infection causing inflammation in that plural layer of the lungs and that is what's rubbing together causing that grinding sound. Now the disease to focus on is worsening pneumonia that infection. So a lot of test questions will ask indication of worsening pneumonia or signs and symptoms that indicate worsening pneumonia and the answer usually always includes plural friction rub. Now the key treatment is for TCDB that turn cough and deep breathe to cough out all that infection as well as use of the is incentive sperometer and antibiotics. Okay, now for the good stuff here. The top four missed Enclelex questions regarding abnormal lung sounds. So, the enclelex will give you an exhibit button and play an audio clip of abnormal lung sounds and then ask you a specific question about that lung sound. So, let's play our first clip here. [Music] Okay. Now according to this lung sound the question asks this lung sound is indicative of which condition? Now before looking at the options here it sounds like a ronai rumble. So with ronai you have to think bronchi specifically bronchitis. So option two is the correct option here. Now option one is incorrect. It's not a whistle sound. So, we know it's not asthma, that wheezing whistle. And it doesn't sound like rubbing rocks. So, we know it's not a pebble rub or that plural friction rub. So, option three is incorrect. And option four is also incorrect since a strider sounds like a squeak. So, it doesn't sound like a squeak, so it's not a strider squeak. Okay. Now the next top miss question gives you an audio exhibit and asks for interventions here. So let's play the exhibit. Ooh. Okay. Now that sounds like a whistle for sure. So the question asks based on the lung sounds what priority intervention should be anticipated and the infamous select all that apply. So again this sounds like a wheezing whistle. So you must think either asthma or COPD. Now just think here for any enclelex question what kills the patient the fastest and asthma attack that status asthmaticus. So remember we covered the interventions and remember the memory trick aim. A is for eluterol for that brutal asthma attacks which is the one and only rescue drug for asthma. I is for iatroprium the antiolinergic to dry out secretions and M is for methopredazolone that slow acting steroid to treat the swelling. So the correct options here are option one 2 and four elbuterol iotroprium and methoprenisolone. Now option three is incorrect because we do not need to place a chest tube. So chest tubes are usually for hemo and pneumothoraxes. And option five is incorrect because a chest x-ray is not a priority intervention at this time. Remember priority intervention for that wheezing whistle in asthma is aim. Albuterol, hypertroprium, and methrenisolone. Okay, next top question three of four. Let's play the exhibit here. Oh, that sounds nasty. Okay, the question's asking lung sounds for which condition? So, this definitely sounds like coarse crackles. So, for crackling, you just have to think crazy fluid, those wet lungs. So, which option relates to those wet lungs? Well, let the name help you here. For edema, we get swelling with fluid, right? And pulmonary is for the lungs. So pulmonary edema, those fluid fil lungs, indicates crackles from that crazy fluid. Now, question four of four here. Client with a history of congestive heart failure, key term there, presents with new edema in the lower extremities, sudden weight gain of six pounds in about 2 days, and key term, coarse crackles at the bases of the lungs. What is the first action? So, a lot of key terms here. First things first, heart failure. So, think HF for heart failure, HF for heavy fluid. Now, is the heavy fluid getting worse? Well, yes. Look at the key terms here. Terms like new and sudden. So, new edema and sudden weight gain as well as coarse crackles in the lungs from that crazy fluid. Now, a little side note and enclelex tip here. Words like new and sudden typically always means a priority patient. So, just keep that in mind there. So, the first action is option number three. Anticipate IV ferrosomide. This drug ends in ey. So think it makes the body dried. Now this is the first drug we give for pulmonary edema where we have fluid fil lungs which will kill the patient. So how do we get this fluid out of the body and into the body? Again on the enclelex the number one drug for worsening pulmonary edema specifically with heart failure is eyending diuretics like ferosemide bumedide and torsomide. Just think these end in eyid so it makes the body dried. Now I stress this because a lot of students get this wrong and choose eluterol or bronco dilator. So just think why is this wrong? Well think of the patho here. Bronco dilators dilate tight lungs, right? But is tightness really the issue here? Well, no. Fluid is the problem here, not constriction. If it was constriction, we would hear the wheezing whistle, which is typical for asthma attacks. But an asthma attack is not the problem here. It's that pulmonary edema with the crackles. So, we must drain that fluid with diuretics ending in ey to make that body dried. So guys, always slow down and look at the key words to let the question help you. Now speaking of the wheezes, Hessie mentions sibilent wheezes and the answer is unilateral high-pitched musical and whistlelike sounds during key term there inspiration. Memory trick again is that wheezing whistle. And another question on oscultation lung sounds are similar to hair being rolled between the fingers in a patient with heart failure. And the answer was fine crackles. Again the key term there is heart failure. So just think HF for heart failure, HF for heavy fluid. And crackles means that crazy fluid. Now, Kaplan mentions the cause of crackles is underlying inflammation or congestion. And plural friction rub is that gradient sound or vibrations heard during inspiration and expiration. Yes. Again, think plural friction rub is that pebble friction rub sounding like two stones being grinded together. Now, very lastly, but definitely not least, separate from the rest, is the death rattle, known as Cheney Stokes, also called our death rattle. This signals that death is very near. On average, a person lives only 23 hours or less after this death rattle begins. Typically for the critically ill like those with incraanial pressure, strokes, worsening heart failure or that endstage kidney failure. It's described as an abnormal breathing pattern with increase and decrease in respirations seen as start and stop breathing. Now the patho here is we have apnea that stop breathing leading to an increase in CO2 that carbon dioxide and hyperventilation to blow off that increase in CO2 and the cycle kind of starts over and over again. Now the only treatment that is indicated is inhibation and mechanical ventilation. Basically the patient's going to have to go on a ventilator. So Kaplan mentions Cheney Stokes respirations. We have a gradual increase in depth of respiration followed by a gradual decrease in the depth then a period of apnea. Okay, that wraps it up. Thank you so much for watching. 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