Breath sounds - Newbie

[stprdi_01]

I really having a hard time with breath sounds. Can someone please try to explain to me what I'm hearing. One patient has "gurgling?" on expiration throughout one lung with "crackles?" to the left lower lung. Some say it's fluid like in pneumonia. Someone else said if he were filling with fluid I'd hear nothing. I'm really confused as this is just a little important. Are there any tricks to the different sounds that you could let me in on. Thanks.

[hoolahan, ASN, RN]

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

[stprdi_01]

This is an elderly man who is failing. I am new to this and we have always been told to just describe the sounds as we hear them. eg: gurgles bubbles etc. Like you say, it's all fluid. Hearing the sounds on the link you sent I suppose they are just all crackles. You say end inspirations, I hear a fairly clear breath on inspiration and the crackles or maybe rubs on expiration. Someone had mentioned that if you hear no breath sounds, they are full of fluid. Maybe I didn't state that right. Lasix and O2 for interventions? I'm in an old folks home and these people are no transfers, so not looking at the technology that you may have in an ICU. I'm so confused. These are my weak spot.

[hoolahan, ASN, RN]

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.

[stprdi_01]

I mainly meant failing as in dying. Long battle. Yes, gurgly on exp. throughout right lung and clearing somewhat when turned. We did all what you mentioned. Guess we were right. Thanks