We had this discussion the other morning at work. Intubated gentleman with difficult time vent weaning post abdominal surgery. He has bad COPD so his lungs are not exactly in the best shape. I gave report to an agency nurse and stated that his lungs were "clear and diminished" (which I have been saying for years with no issue), to which he replied that lungs are not clear if they are diminished. According to him, they cannot be both clear and diminished at the same time. I told him I disagree, because to me if they are absent of adventitious lung sounds (i.e. rhonchi, wheezes, etc) then they are clear, but certain pathophysiologies, poor lung compliance, body habitus, etc may make them sound diminished but clear with a good stethoscope. I told him that with bowel sounds, they can be present and hypoactive. Just because they are hypoactive doesn't mean they sound any different, so they are still present. He seemed annoyed that I was disagreeing with him, but I think he has a complex for wanting to always be right.
Anyway, what are your thoughts on this? I was always under the impression that lung sounds could be both clear and diminished, but his reaction got me thinking!
