Crackles on auscultation

zacarias, ASN, RN · Dec 16, 2004

Sorry I posted this twice, I thought the first one didn't take!

kids · Dec 16, 2004

Sorry I posted this twice, I thought the first one didn't take!

I fixed that for you :)

Toby's mum · Dec 16, 2004

Hey all,
This is a question for all you experienced nurses out there. I'm a nurse with about 1 and 1/2 years experience and feel like I'm OK at listening to lungs and assessing for adventitious sounds.
Well last night I had a new admit with long-term diabetes, being worked up for an MI/ACS event. I listened to his lungs and heard wheezing and some early to mid inspiratory crackles in mid lung fields. His sats were OK. The admitting doctor had written that his lungs sounds were normal.
I listened again this early morning and the wheezing was gone but the crackles were still there. I asked him to cough and then the crackles were mostly gone. Good for him, bad for me. The reason is, I don't always ask people to cough when they have crackles. Something made me ask him to though. Should I just trust my judgment? Also, I thought true crackles weren't cleared with coughing.
Maybe it's good practice to ask everyone with crackles to cough when auscultating their lungs? It just makes me wonder about all those crackles I've heard thus far in my career, and if they were true crackles or not depending on if I made the pt cough. Do you always have patients cough with crackles or do you sometimes only based on your judgment of the situation?
Can any experienced nurses out there give me advice on this? By the way, he's a smoker so the wheezing makes sense, and the crackles might symbol chronic bronchitis but who knows. Thanks so much!

zacarias,

I think it probably is good practice to ask someone to cough first before assessing lung sounds, especially if they have been lying flat for a while. I had a similar experience when I thought I heard crackles. Luckily I was there when the primary doctor examined the patient. I asked the doctor about the lung sounds and he recommended that I ask the patient to cough to help clear the airway prior to auscultation. Crackles may clear up if the patient coughs. I think crackles are secretions in the airway and if you are able to clear the airway via coughing, then they may disappear. I would only record them if they remained despite the cough/change in position. Good question though and I look forward to reading/learning from additional comments. Steph

Toby's mum · Dec 16, 2004

Hey all,
This is a question for all you experienced nurses out there. I'm a nurse with about 1 and 1/2 years experience and feel like I'm OK at listening to lungs and assessing for adventitious sounds.
Well last night I had a new admit with long-term diabetes, being worked up for an MI/ACS event. I listened to his lungs and heard wheezing and some early to mid inspiratory crackles in mid lung fields. His sats were OK. The admitting doctor had written that his lungs sounds were normal.
I listened again this early morning and the wheezing was gone but the crackles were still there. I asked him to cough and then the crackles were mostly gone. Good for him, bad for me. The reason is, I don't always ask people to cough when they have crackles. Something made me ask him to though. Should I just trust my judgment? Also, I thought true crackles weren't cleared with coughing.
Maybe it's good practice to ask everyone with crackles to cough when auscultating their lungs? It just makes me wonder about all those crackles I've heard thus far in my career, and if they were true crackles or not depending on if I made the pt cough. Do you always have patients cough with crackles or do you sometimes only based on your judgment of the situation?
Can any experienced nurses out there give me advice on this? By the way, he's a smoker so the wheezing makes sense, and the crackles might symbol chronic bronchitis but who knows. Thanks so much!

zacarias,

I think it probably is good practice to ask someone to cough first before assessing lung sounds, especially if they have been lying flat for a while. I had a similar experience when I thought I heard crackles. Luckily I was there when the primary doctor examined the patient. I asked the doctor about the lung sounds and he recommended that I ask the patient to cough to help clear the airway prior to auscultation. Crackles may clear up if the patient coughs. I think crackles are secretions in the airway and if you are able to clear the airway via coughing, then they may disappear. I would only record them if they remained despite the cough/change in position. Good question though and I look forward to reading/learning from additional comments. Steph

USA987, MSN, RN, NP · Dec 17, 2004

When I worked in the ICU if I heard crackles I always asked them to cough. If they clear after a few deep breaths or coughing they were atlectatic crackles and I always charted "crackles auscultated at bases bilaterally--cleared with C&DB....."

USA987, MSN, RN, NP · Dec 17, 2004

When I worked in the ICU if I heard crackles I always asked them to cough. If they clear after a few deep breaths or coughing they were atlectatic crackles and I always charted "crackles auscultated at bases bilaterally--cleared with C&DB....."