inside this video right here we're gonna talk about patient assessment when i hear a certain lung sound what might be going on we're gonna go through it all here we go [Music] hey everyone it's the paramedic coach here i'm so excited to deliver this video to you do me a solid smash that like button down below somebody out there hit the like button for you to see this video so give back and do it for somebody else and make sure to hit subscribe so you can see more of this great ems content now today's a big topic we got the mannequin out we're talking about patient assessment when i see a certain lung sound what might be going on with your patient now this is so important if somebody complains of difficulty breathing i can't breathe they're tripine they're short of breath we need to be able it's so important we need to be able to get a good set of lung sounds that will put us in the right direction yes with the respiratory rate yes with pulse oximetry yes with vital signs yes with history but this is one of the most important things in lung sounds so let's break these down and we're going to go through all this now here we go first we have wheezing let's say i assess this patient's lung sounds okay and i hear wheezing the mnemonic for wheezing is a a c so aac i'll put right here on the side ac asthma anaphylaxis and copd those are the three culprits when we hear wheezing now for my more advanced folks watching this video you're always going to do an ekg on a patient if you hear wheezing yes there are something called cardiac wheezes if someone's having a cardiac event they can wheeze do you're doing ekg on any patient that typically breathing i just want to mention that briefly now let's move in to the next what's going to be rockeye here we go well hold on just before we move into roncai let's quickly just briefly talk about two big pearls with aac if we have an asthma or a copd patient and they're having an attack a flare up there's gonna be tightness in their chest so chest tightness a buzzword the other buzz word is that they're gonna have a productive cough so tight chest productive cough that's gonna be your aac don't forget with anaphylaxis strider that upper airway sound hives two or more body systems being affected makes you an anaphylaxis okay we're gonna start seeing blood pressure changes going down anaphylactic shock we want to treat them right if he's an anaphylaxis we want to treat him as soon as possible we don't wait when we get aggressive we treat early okay now rhonchi means junk in the lungs so what that means is we have a hyper secretion of like i said junk infection inflammation going on in the lungs where wheezing is a tightness of the bronchial tree bronchi is well i have an infection in my bronchial tree right so we think of pneumonia now if this patient has had pneumonia maybe for a few days maybe even a week wrong guy right now here's a question check me out here super important i want to talk about unilateral versus bilateral lung sounds unilateral means one side bilateral means both sides okay so we can have an ammonia on both sides or one side now i'll tell you pneumonia is most common on one side but it could be both so we have to look at other sign symptoms the big one fever hot skin give you one more that productive cough but this time it's greener yellow sputum okay that infection pathway now here's rails okay now if this patient right here i listen i hear rails if i hear rails bilaterally i'm thinking more chf because more common but we don't stop there chf flare up if it was starting in the beginning of that process i might have jvd i might have edema in my legs well i can hear pulmonary edema which be blood coming into my my lung fields right and chf chf means the heart is failing as a pump we know blood backs up in the system okay chf now the thing is an early onset pneumonia could have rails so the question is is it on one side or the other but remember big key here chf and ammonia both cough up correct but one's coughing up pink frothy sputum chf and the other one's coughing up green or yellow speed ammonia there's a big differentiator and chf is not gonna have a fever that got hot skin it'd be quite the opposite actually if they're going towards cardiogenic shock with me okay now let's go we're going to talk about diminish in absence and we'll continue on you may hear out in the field on an exam about diminished lung sounds right diminished lung sounds means really that you can't hear the lung sounds good enough right it's diminished the patient is either so tight in the bronchial tree or there's so much fluid that you cannot hear what's going on this diminished lung sounds and absent lung sounds are the most sinister signs you can see now here's the deal if i have diminished lung sounds okay let's say it was bilateral diminished lung sounds this could be a whole host of things okay whole host but when we talk about exams or what's happening on the field this is what we gotta look at our other signs and symptoms if he has diminished lung sounds bilaterally that could be almost anything so what are the other signs symptoms i want to talk about pulmonary embolism and pneumothorax okay if this goes back to my unilateral was bilateral a pneumothorax would have diminished lung sound on one side right versus the other so let's say it was the right side right that was diminished there's a pneumothorax on this side there would be jvd a late sign tracheal deviation as the pressure moves over in the heart over here and that puts pressure on the heart trachea shifts mediastinals shifts we have jvd because the hearts failing as a pump so blood backs up okay a pulmonary embolism remember a pulmonary embolism has nothing to do with the bronchial tree you could have clear lung sounds in a pulmonary embolism but the reason that they could be diminished in uh pulmonary embolism is well the lungs are dying it's a lung attack so a bad pulmonary embolism there's no blood supply going to the lung tissue right it's a blockage of the pulmonary artery tracts so it's not impossible for that to happen okay key point okay now remember the big thing here we're talking about unilateral or bilateral pneumothorax i'll say it again is going to be one side or the other diminished lung sounds on one side is the most common way of pneumothorax now let's talk about absence now absent lung sounds two things come to mind if i hear absence man the first thing i'm thinking about is a pneumothorax again if it's unilateral okay right on one side i'm thinking tension pneumothorax okay with my other sign symptoms when mentioned earlier i'll mention now is going to be hypotension okay tachycardia hypotension right now here's an interesting one think about this okay hang with me if i am wheezing okay with asthma or anaphylaxis or copd what's happening is my bronchial tree is getting tighter and tighter and tighter and tighter what if the bronchial tree gets so tight that there's not even any air exchange wouldn't you have absent lung sounds like there's no air movement because what you're hearing with the wheezing is a tightening of the air movement so an absent chest in the presence of someone having an aac event and asthma and phylaxis copd events they could have absent long sounds would it be unilateral or bilateral it would be bilateral in aac everything in aec is bilateral okay you're with me my friends this was your lung sound assessment i got one more message for you hey i'm so happy you made it and watched this entire video you're going to see the first link in the description down below it is my video study course that includes over 400 videos of content prep for all the schools emt advanced emt paramedic national registry prep for emt advanced emt paramedic full-length drug cards i go through the white board and we go through all that if you want to get this stuff down cold and understand your ems class and national registry at the highest level possible click the link down below just for watching this video i will give you a lifetime access to the course my friends thank you so much for watching this channel i'll see you around take care please don't waste any time don't don't be hesitant and just do it because i know this program works and i know it's it got me to where i was where it's been a year without school from emt to hey i passed my test and 70 questions like go for it you could do it like do not hesitate and don't waste any time people that don't know you they need to they need this program this program is not a choice to me this program is a happy to take uh thousands and thousands of pages in the books and you just narrow it down and just make everything simple past the registry so uh this is great content man i promise you it's worth it took this with three weeks left to go in my class and i just i'm not sure if i would have been able to pass my course or the nremt first try without this course the fact like when i was taking the the national and i would read the question and i would be like whoa evan literally just went over this in the car so it's it really it helps i got to the point where i was just ready to spill all my knowledge onto this freaking test so i'm like you know what man just go ahead go for it open it up boom congratulations you passed it was um outside of having my children that's probably not for like the happiest day of my life you