respiratory sounds question

leslie :-D · Oct 2, 2004

i have never auscultated lungs/fields/bronchi where there were no expiratory sounds....never.

now there can certainly be shortened expiratory sounds which means your lungs are not being completely emptied;

but when you're living, what goes in must come out, kwim?

leslie :-D · Oct 2, 2004

and might i suggest that if this 22 yo is unremarkable in presentation and her asthma is undercontrol, then after she inspires,

she's holding her damned breath and that's why you wouldn't hear any expiratory breath sounds. :rolleyes:

otherwise, there is no other medical explanation.

Still Riding · Oct 3, 2004

and might i suggest that if this 22 yo is unremarkable in presentation and her asthma is undercontrol, then after she inspires,
she's holding her damned breath and that's why you wouldn't hear any expiratory breath sounds.
otherwise, there is no other medical explanation.

Can I ask then how their would be room to continuously inspire? I thought that she would run out of room in her lungs, would she not? I heard her breath at least 5 times i know their is some reserve available in the lungs, but that much?

then is this a sign of her in denial that her asthma is uncontroled, and she want to beleive that all is good? and thats what i'm surposed to learn is that pt aren't always truthful? or honest?

thanx for the help,

allnurses Guide · Oct 3, 2004

I don't know for sure about your asthma patient but I have listened to lung sounds and not heard anything either insp or exp or both.

Recently listened to the lung sounds of a man with a large tumor in his right lung. There were no lung sounds on the right. None.

This is an interesting question . . .what would cause diminished or absent lung sounds. Consolidation (pneumonia?). Emphysema?

Have to do some research on this.

steph

Indy, LPN, LVN · Oct 3, 2004

The lung sounds I hear are skewed. I use an electronic stethoscope due to combination hearing loss. If the volume's down or the patient's really obese, I don't hear much. If I rub the head of the stethoscope, I hear fine crackles. (I am careful to keep my fingers still.) It took months for me to finally figure out what noise regular, normal inspiration with no fluid excess in there, sounds like to me. And yes, there's supposed to be a sound. Lack of lung sounds can indicate a collapsed lung. (I haven't seen / heard one of those yet but I'm sure it would drive me batty.)

My suggestion is, try a better stethoscope. Maybe there's some type of sound you just aren't hearing? Did anyone else hear a lack of expiration on this patient?

-Indy

CCU NRS · Oct 3, 2004

I don't know for sure about your asthma patient but I have listened to lung sounds and not heard anything either insp or exp or both.
Recently listened to the lung sounds of a man with a large tumor in his right lung. There were no lung sounds on the right. None.
This is an interesting question . . .what would cause diminished or absent lung sounds. Consolidation (pneumonia?). Emphysema?
Have to do some research on this.
steph

I was leaning toward emphysema too, they obviously do exhale but they have less expiratory flow than inspiratory flow and the sounds may just be missed due to less expiratory effort, it would be wise to listen close to the brochus in this instance to better hear the sounds

maturner · Oct 3, 2004

You guys are killing me! She is twenty-two not 72. Its not Emphysema! Lets use our critical thinking skills, wouldn't logic say her breath sounds are most likely related to her asthma. Afterall, this patient has no complaints but is having a follow-up appointment for her "controlled" asthma.

The problem with asthma is not getting air into the lungs it is getting the air out. Thus the E X P I R A T O R Y wheezes often heard during attacks or a prolonged expiratory phase as heard with chronic asthmatics. Could the expiratory phase be prolonged long enough that it is difficult to hear or faint enough to miss? A further evaluation of this pt would probably show an asthmatic cocktail of inhaled B-2 agonist and steroids. Additionally, the pt is most likely on a first name basis with her local Emergency Department, has been admitted multiple times for asthma, and possibly purchased a ventilator once or twice for really severe attacks.

michw2 · Oct 3, 2004

Here is a great web site to listen to respiratory sounds and other question

http://caring4you.net/tests.html

leslie :-D · Oct 3, 2004

Can I ask then how their would be room to continuously inspire? I thought that she would run out of room in her lungs, would she not? I heard her breath at least 5 times i know their is some reserve available in the lungs, but that much?
then is this a sign of her in denial that her asthma is uncontroled, and she want to beleive that all is good? and thats what i'm surposed to learn is that pt aren't always truthful? or honest?
thanx for the help,

no, you cannot continuously inspire w/o expiring.

for asthma, i would listen to the chest wall/bronchus area.

it is physically impossible to inspire w/o expiring.

and if her asthma wasn't under control, you'd be definitely hearing much more adventitious breath sounds; much more prominent.

but again, anterior chest wall, midline, is where i would listen; even close to the trachea would work well.

good luck.

leslie

Still Riding · Oct 3, 2004

thanx for all your help, i always learn alot from these boards.

ONe more question though, could it be that what she beleives is controlled asthma, or a good day is still asthmatic, but to her it's like breathing free and clear?

on the topic of medication i asked when i lisened and she is on advair and ventilin. though i'd add that.

thanx again

Home Health Columnist / Guide · Oct 7, 2004

respiratory failure is marked by decreased respiratory effort, poor or non- existent air movement which leads rapidly to air-hunger, hypoxia and respiratory arrest.

be ready to:

a silent chest on examination, pulsus paradoxus, heart rate >110 beats/min, inability to complete a sentence, a pco2 that is normal or rising or hypoxia are all grave signs indicating that ventilation should be considered

http://www.vh.org/adult/provider/internalmedicine/lungsounds/lungsounds.html

[/url]

lung sounds:journal,indian academy of clinical medicine

it is seen that the flow rate is very low to produce wheezing in cases of severe ventilatory failure. on the other hand, in severe asthma, wheezing results from either severe mucosal oedema or viscid mucous obstructing the small airways. this may sometimes be fatal, since during the terminal stages of severe asthma the peripheral flow resistance is very high. in these cases, the site of dynamic compression is displaced from the central bronchi towards the periphery of the bronchial tree and beyond a specific point the volume of air flowing through individual airways is so small that they cannot be set into oscillation. thus when the equal pressure point reaches these airways, the expiratory wheeze is silenced

do you hear what i hear?

http://www.wisconsinems.com/docs/lungs.htm

[color=maroon]treating the asthma patient

[color=maroon]http://www.mcfw.com/main/ems/ems_4.htm

asthma:

http://www.geocities.com/doctor_uae/pdx_chapter3.htm