Overview
This lecture explains the identification and treatment of key lung sounds, including crackles (rales), wheezing, diminished/absent sounds, rhonchi, and stridor, with focus on diagnosis and EMS interventions.
Crackles (Rales)
- Crackles (rales) indicate fluid in the lungs and are heard as abnormal lung sounds.
- Bilateral crackles suggest congestive heart failure (CHF); unilateral suggests pneumonia.
- CHF signs: pink frothy sputum, hypertension, jugular vein distension (JVD), peripheral edema.
- Pneumonia signs: fever, chills, body aches, green/yellow sputum, often unilateral.
- EMS treatment for CHF: CPAP, nitroglycerin, EKG; for pneumonia: oxygen administration.
Wheezing
- Wheezing is caused by bronchoconstriction (tightening of airways).
- Common in asthma, anaphylaxis, and COPD (AAC mnemonic).
- Symptoms: difficulty breathing, tripod position, short sentences.
- Treatments: albuterol (bronchodilator), ipratropium (dries secretions), epinephrine (for severe cases), steroids (anti-inflammatory), magnesium (smooth muscle relaxant for severe cases).
Diminished or Absent Lung Sounds
- Diminished or absent sounds bilaterally suggest severe airway constriction or obstruction.
- Unilateral absent sounds may indicate pneumothorax, especially after trauma.
- Pneumothorax signs: JVD, tracheal deviation, tachycardia, hypotension.
- EMS treatment: high-flow oxygen, rapid transport; needle decompression at paramedic level.
Rhonchi
- Rhonchi indicate airway infection and "junk" (mucus) in the lungs.
- Commonly found in cases of pneumonia with symptoms like productive cough and possible pain.
- Treatment includes oxygen and assessing need for airway support.
Stridor
- Stridor is a loud upper airway sound caused by upper airway narrowing or obstruction.
- Causes: croup (gradual, barking cough, mainly in children), epiglottitis (rapid onset, drooling, painful), inhalation burns, foreign body obstruction, anaphylaxis.
- Immediate airway management may be needed, including removal of obstruction or epinephrine for anaphylaxis.
Key Terms & Definitions
- Crackles (Rales) — Fine, crackling sounds from fluid in the lungs.
- Wheezing — High-pitched sound from narrowed airways due to bronchoconstriction.
- Diminished/Absent Sounds — Reduced or absent breath sounds, often from severe obstruction or pneumothorax.
- Rhonchi — Coarse, low-pitched sounds from mucus in airways.
- Stridor — Harsh, high-pitched upper airway sound from obstruction.
- Jugular Vein Distension (JVD) — Visible neck vein swelling, often indicates heart failure.
- CPAP — Continuous Positive Airway Pressure used to treat CHF.
- Albuterol — Medication that relaxes bronchial muscles.
- Ipratropium — Medication that dries airway secretions.
- Magnesium — Smooth muscle relaxant for severe airway constriction.
Action Items / Next Steps
- Review lung sound characteristics and associated conditions.
- Practice identifying lung sounds using audio examples.
- Study airway management protocols and medications for each scenario.