Dsitinguishing Breath Sounds

  1. 0
    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.
  2. 10 Comments so far...

  3. 0
    Breath sounds for pleural effusions usually sound like a coarse rubbing together of leather as well as diminished.
  4. 0
    I agree with Air'n about the sound coarse crackle ..in the lower lobe of the lung .
  5. 0
    This file contains coarse crackle sound.
    http://chatqtr.com/uploader/uploads/coarse.zip
  6. 1
    Quote from TennRN2004
    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.
    Pleural effusion(s), depending how bad they are can sound anywhere from crackles, to rubs, to absent. It depends on how much fluid has collected.
    dmc_rrt likes this.
  7. 0
    Quote from beauty nurse
    This file contains coarse crackle sound.
    http://chatqtr.com/uploader/uploads/coarse.zip
    Wow, do you know of other files so that we can listen to all the breath sounds?
  8. 0
    I am a 2nd semester nursing student. I had a patient today with a dx of Pleural Effusion and could not figure out what lung sounds I was hearing. All the doc progressive notes in the chart described them as coarse but I took that to mean coarse crackles. After reading the description of "dry leather," I am almost positive that is what I heard in the R/L lower lobes. I have heard a pleural friction rub described as dry leather. It almost sounded like bowel sounds weirdly enough.

    So, when lung sounds are described as coarse, is that the same thing as a friction rub? Meaning there can be coarse crackles, or coarse lung sounds (aka friction rub)?
  9. 0
    Coarse crackles on expiration are usually due to secretions. I find that most pleural effusions present as diminished breath sounds. Remember the fluid is gravity dependant and will usually collect at the bases when the pt is sitting upright and along the back when lying supine. I find that pleural rubs are not that common.
  10. 0
    Here are examples and discussion of course crackles and pleural rub (and other breath sounds) ...
    http://www.easyauscultation.com/cour...x?CourseID=201.
  11. 0
    I would try asking the nurse that told you the patient probably had a pleural effusion what she heard and how she knew/suspected a pleural effusion.


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