Breath sounds - Newbie

Crackles, or rales, (and some debate the difference, but don't sweat it, it all equals fluid) sounds just like it you took your hair and rubbed it between your fingers next to the diaphragm of your stethoscope. Usually heard at end-inspiration. I don't know why anyone would say that you wouldn't hear it until they are filled with fluid, afterall, that is the entire point of critical care assessment, to prevent problems before they occur by more frequent and careful assessment.

"Gurgling". Hhhmm, is this on a vented pt? Usually if you heard very loud gurgling it may be because you need to empty the tubings of water condensation, which will be refferred and sound like gurgling in the chest. If you hear gurgling in an extubated pt, I call that the death rattle, not a good sign!

Try this, hope my link works Breath Sounds Tutorial

Failing as in death rattle? If if is very gurgly sounding on expiration, it is probably rhonchi, which indicates secretions in the larger airways. You fix it with turning q 2, chest PT, and suctioning as needed, O2 probably is a good idea too, and defintely before and after suctioning.

If they want to know if lasix is needed, maybe a chest xray would be the place to start. If he is bedbound and failing, it is probably pnemonia, and secretions though. Who knows, hard to advise w/o examining the pt myself.

If no breath sounds are heard, it is probably atelectasis, or pnemothorax (collapsed lung.) Sometimes very large people, or weak people who are not able to take a deep breath have diminished breath sounds, and some COPDer's you can't hear good breath sounds. But it is unusual to have absence of BS unless it is a pnemothorax, or they had previous lung surgery like lobectomy or pnemonectomy.

The best way to learn BS is practice, practice, practice, and have someone who knows BS listen and tell you if what you think you heard is correct.