Lung sounds

[zacarias, ASN, RN]

Hey all,

So I work on a tele/stepdown unit and while I feel I'm OK at listening to lung sounds and distinguishing them, I also get situations that make me feel like fresh newbie again.

Last night I had a new admit, smoker guy (44 years) with chest pain r/o MI and HTN. His lungs had crackles when I first listened, I told him to cough and they still had them. I pretty much knew he didn't have any significant pulmonary history. His admit CXR had been negative, and just before I was going to talk to the doctor, I listened again and his lungs sounded beautiful.

My question is, could what I have been hearing was just he hadn't cleared his throat enough and I was hearing pharyngeal sounds? Or possibly, he had a small bronchial plug that he got rid of? But why would I hear crackles throughout? It's these things that make me lose my confidence. His sats were fine on RA, but normally I would trust my assessment, but when all of the other objective data says he has no lung problems, I hear crackles!! Anyway, thanks for reading.

[GingerSue]

could it have been atelectatic crackles (not pathologic)? - when sections of alveoli are not fully aerated, they deflate slightly and accumulate secretions, then crackles are heard when these sections are expanded, they are heard in the periphery, and disappear after a few breaths or after a cough.

[RN92]

I know this may sound "basic", but i have to ask: Were you listening over any clothing? In a hurry, sometimes, i have put the stethoscope over a thin t-shirt or gown and heard what I thought were crackles (of course, I would then go under under the shirt). Also, Ive heard stuff when listening over a very hairy chest.

On the other hand, maybe instead of the pt having chest congestion, you had earwax. (just kidding) :rotfl:

[RN92]

could it have been atelectatic crackles (not pathologic)? - when sections of alveoli are not fully aerated, they deflate slightly and accumulate secretions, then crackles are heard when these sections are expanded, they are heard in the periphery, and disappear after a few breaths or after a cough.

Yeah, what she said!! (it sounds better).

[GingerSue]

I know this may sound "basic", but i have to ask: Were you listening over any clothing? In a hurry, sometimes, i have put the stethoscope over a thin t-shirt or gown and heard what I thought were crackles (of course, I would then go under under the shirt). Also, Ive heard stuff when listening over a very hairy chest.

On the other hand, maybe instead of the pt having chest congestion, you had earwax. (just kidding) :rotfl:

A patient's hairy chest (the movement of those hairs under the stethoscope can sound like crackles) and this can be avoided by wetting the hairs with a damp cloth, or by pressing harder.

[zacarias, ASN, RN]

could it have been atelectatic crackles (not pathologic)? - when sections of alveoli are not fully aerated, they deflate slightly and accumulate secretions, then crackles are heard when these sections are expanded, they are heard in the periphery, and disappear after a few breaths or after a cough.

That's what it most likely was but I had him cough a couple times and it wasn't until I came back that he had them cleared. Now he IS a heavy smoker which could delay the atelectatic crackles clearing.

Thanks so much for your responses all! :)