6 - Breath Sounds

Breath
sounds
Noura AlNaimi Msc.
Outline:
• Auscultation.
• Normal breath sounds.
• Abnormal breath sounds.
• Voice sounds.
• How to document auscultation findings.
Definition of
breath sounds
• Breath sounds originate in airways where
air velocity and turbulence induce vibrations in
the airway walls. These vibrations are
then transmitted through the lung tissue and
thoracic wall to the surface.
Before the stethoscope
stethoscope
Auscultation technique
Cont.
• Use the diaphragm of the stethoscope
• Posterior Chest
• Auscultate from side to side and top to bottom. Omit the areas covered by the
scapulae.
• Compare one side to the other looking for asymmetry.
• Note the location and quality of the sounds you hear.
• Anterior Chest
• Auscultate from side to side and top to bottom
• Compare one side to the other looking for asymmetry.
• Note the location and quality of the sounds you hear.
Rules of Auscultation
1.Patient should be sitting up.

2.The areas required for examination should be exposed.
3.It is not a good idea to listen to breath sounds when the patient is
uncomfortable, uncooperative, or in pain. WHY?
4.When listening, press directly and gently on the patient’s chest.
5.When listening to the patient's chest, it is always a good idea to do it in a
symmetrical manner.
Normal breath sounds
• The patterns of normal breath sounds are created by the effect of body structures
on air moving through airways.
• In addition to their location, breath sounds are described by:
• Duration (How long the sound lasts),
• Intensity (How loud the sound is),
• Pitch (How high or low the sound is),
• Timing (When the sound occurs in the respiratory cycle).
Classification of normal breath
sounds
• Normal breath sounds are classified as:

1- Tracheal
2- Bronchovesicular
3-Vesicular
Normal breath sounds

Cont.
• Breath sounds are decreased when:

• Normal lung is displaced by air (emphysema or pneumothorax) or fluid (pleural
effusion).
• Airflow is decreased as in obstructive lung disease or muscle weakness.
• Breath sounds shift from vesicular to bronchial when there is fluid in the lung itself
(pneumonia). WHY?
• Extra sounds that originate in the lungs and airways are referred to as "adventitious"
and are always abnormal.

Adventitous breath sounds
1. crackles
2. Wheeze
3. Rhonchi
4. Stridor
5. Pleural Rub
6. Death rattle
Adventitious breath sounds
• Come in two varieties: Continuous & Discontinuous.

• Continuous sounds are called “wheezes”
• A continuous sound heard over the upper airway is called “stridor”
• Discontinuous sounds are called “crackles”.
1. Crackles (rales, crepitations)
• Crackles are discontinuous, nonmusical, brief sounds heard more commonly

on inspiration.
• They can be classified as:
• Fine (high pitched, soft, very brief)
• Coarse (low pitched, louder, less brief)
• Fine crackles are produced by the sudden opening of small airways in the lung with
deep breathing; they are heard with pulmonary fibrosis and atelectasis
• Conditions: ARDS, Bronchiectasis, Chronic Bronchitis, Interstitial Lung Disease,
Pulmonary Edema
Cont.
Cont.
• Coarse crackles are more related to the movement of excessive secretions in

the airways as air passes through.
• Heard on inspiration and expiration.
• Usually clears when the patient coughs.
2. Wheeze
• Wheezes are consistent with airways obstruction; monophonic wheezing

indicates one airway is affected, and polyphonic wheezing indicates
multiple airways are involved.
• Conditions:
Asthma
CHFHow?? ( Blackboard)
Chronic bronchitis
COPD
3. Rhonchi
• They usually imply obstruction of a larger airway by secretions.

• Coarse crackles that are continuous and low-pitched is referred to as Rhonchi.
4. Stridor
• Loud continuous and high-pitched sound that may be heard without a stethoscope.
• Stridor suggests an obstructed trachea or larynx and therefore constitutes a
medical emergency that requires immediate attention.
5. Pleural rub
• Pleural rubs are creaking or brushing sounds produced when the pleural surfaces
are inflamed or roughened and rub against each other.
• Conditions:
Pleural Effusion
Cont.
6. Death rattle
• A rattling sound
• Often audible without a stethoscope
• A gurgling sound sometimes heard in a dying person's throat
Absent and deminished breath
sounds
• Causes: If the flow rate of inspired air slows, less air movement occurs.
Conditions that limit airflow into the lung include?
Shallow breathing, Diaphragmatic paralysis, Severe airway obstruction, Pneumothorax,

Hemothorax, Pleural effusion, Hyperinflated lung and obesity.
Voice transmission tests.
• These tests are only used in special situations.
• This part of the physical exam has largely been replaced by the chest x-
ray.
• All these tests become abnormal when the lungs become filled with fluid
(referred to as consolidation).
Bronchophony
• Ask the patient to say "ninety-nine" or “one-two-three” several times in a

normal voice.
• Auscultate several symmetrical areas over each lung.
• The normal sounds you hear should be muffled and indistinct.
• Louder, clearer sounds heard over consolidation are called bronchophony

Egophony
• Ask the patient to say "ee" continuously.
• You should hear a muffled "ee" sound. If you hear an "ay" sound this is
referred to as "E > A" or egophony.
• The area where it is heard may indicate a compressed lung above a pleural
effusion.
Whispered Pectoriloquy
• Ask the patient to whisper "ninety-nine" or “one-two-three” several times.

• You should hear only faint sounds or nothing at all. If you hear the sounds clearly this
is referred to as whispered pectoriloquy.
• Normally, whispers are heard as muffled, low-pitched sounds through the
stethoscope.
• If the clinician hears high-pitched sounds, this is evidence that consolidation is
present in the lung.
• Sounds are heard more clearly over consolidation
Documentation of Auscultation
• Comment on air entry for both lungs and the presence of adventitious sounds.
• If present, identify the type, location and timing of the adventitious sound.
• Example “ Upon auscultation, equal bilateral air entry (EBAE) were noted
with fine inspiratory crackles in the right lower lobe “
• “ EBAE with diminished breath sounds in the lower lobes bilaterally in
addition to diffuse inspiratory crackles all over the lung fields “
Questions?
Reading
• Refer to chapter 5 “ Fundamentals of physical

examination “

6 - Breath Sounds

Uploaded by

Copyright:

Available Formats

6 - Breath Sounds

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

6 - Breath Sounds

Uploaded by

Copyright:

Available Formats

Breath

1.Patient should be sitting up.​

• Normal breath sounds are classified as:​

• Breath sounds are decreased when: ​

• Come in two varieties: Continuous & Discontinuous​.

• Crackles are discontinuous, nonmusical, brief sounds heard more commonly

• Coarse crackles are more related to the movement of excessive secretions in

• Wheezes are consistent with airways obstruction; monophonic wheezing

• They usually imply obstruction of a larger airway by secretions.

Shallow breathing, Diaphragmatic paralysis, Severe airway obstruction, Pneumothorax,

• These tests are only used in special situations.

• Ask the patient to say "ninety-nine" or “one-two-three” several times in a

• Auscultate several symmetrical areas over each lung.

• The normal sounds you hear should be muffled and indistinct.

• Louder, clearer sounds heard over consolidation are called bronchophony

• Ask the patient to say "ee" continuously.

• Auscultate several symmetrical areas over each lung.

• Ask the patient to whisper "ninety-nine" or “one-two-three” several times.

• Refer to chapter 5 “ Fundamentals of physical

You might also like

1.Patient should be sitting up.

• Normal breath sounds are classified as:

• Breath sounds are decreased when:

• Come in two varieties: Continuous & Discontinuous.