I have a question about breath sounds. I work in ICU, and got a pt transferred up from the floor with resp failure, dr. wanted to try Bipap before we intubated to see if the pressure would help her without ETT, her resp on bipap were deep, non labored, 02 sat 98%, so she was fairly stable resp wise. I listened to her lung sounds, she had a few wheezes, sounded very loud and coarse to me. The nurse on the floor reported she had been clear and started developing wheezing/rhonchi. My charge nurse listened and immediately said she probably had pleural effusion, needed a thoracentesis. This was right at shift change, the doctor comes in and says the chest x-ray shows bilateral pleural effusion. My question is (I was too busy helping set up the the thoracentesis to ask my charge nurse or doctor) how do you describe the breath sounds normally heard with pleural effusion. I've done a little research and have found that breath sounds are usually diminished with effesion from air not being exchanged. The pt was not diminished. Just wondering what immediately tipped of my charge nurse about the breath sounds? I am new and still not 100% comfortable in assessing breath sounds and still have other nurses check with me sometimes, so maybe it's just that the other nurse has lots more experience than me.