When you don't hear what the docs hear?

OscarTheOwl · Mar 5, 2016

To me it also sounds like pulling apart velcro. Its not always a loud crackle. Many times I hear a faint sound at the very end of inspiration.

chare · Mar 5, 2016

Don't get discouraged, learning lung, and heart, sounds takes time. Listen to everyone. First, you need to learn normal sounds. Thn, you will start hearing abnormal sounds. When you hear these abnormal sounds, and are unable to identify them, ask one of your coworkers if they can listen.

You might find the Auscultation Assistant helpful.

Kitiger, RN · Mar 6, 2016

Do you have a very good stethoscope?

Lev, MSN, RN, NP · Mar 6, 2016

Well it's definitely not clear, it's not diminished, it's not a wheeze, but it's something that is not right and it's not a rub -- it's a crackle (fine, course, rhonchi) you name it.

Julius Seizure · Mar 6, 2016

There is more than one noise that can be called a "crackle" - which makes it tricky. Additionally, sometimes crackles can also have other names: rales, coorifice, fine crackles, wet crackles, dry crackles. It's a little bit subjective, too. It will take time and experience to get comfortable with it.

tsm007 · Mar 6, 2016

Do you have a very good stethoscope?

Yes. I have 2 a Kila and an electronic Littman. I thought the electronic would help and it does, but my problem is not hearing it's distinguishing.

tsm007 · Mar 6, 2016

There is more than one noise that can be called a "crackle" - which makes it tricky. Additionally, sometimes crackles can also have other names: rales, coorifice, fine crackles, wet crackles, dry crackles. It's a little bit subjective, too. It will take time and experience to get comfortable with it.

Okay, I listened to him again this morning. It's hard to get him to cooperate for me to listen to him. He wants me to hold him so it's easier for the doc to get him in a good position. Anyway, I *think* I heard them now and actually this was a good experience as far as learning new sounds. (You wouldn't know he had RSV by the way he's playing.) I want to listen to him again for comparison when he's all better. He sounded sort of like a blender, but quieter and much faster and the sound all blended together. Not a popping or bubbling or velcro sound. I have heard the velcro sounding crackles. One of my patients it almost sounded like a cat purring. I would not have recognized it as crackles though because it was more of a continuous sound and it was softer than what expected. I am not sure if it's because he's a baby though and his lungs are moving faster than adults. I definitely need to work more on this.

tsm007 · Mar 6, 2016

Eureka! I heard it. Really silly to feel so successful. Poor kid. His mom is more preoccupied as using him as a guinea pig... Okay, I got it for real though. I listened one more time. It IS during inspiration, not expiration, but his expiration is so much shorter than an adult I didn't catch it. And the "crackling" sounded softer like a purring or blender and faster than an adult. I don't think I'll be diagnosing pneumonia in children any time soon, but feel accomplished that I think I have finally got the missing piece. I'll have to put this in the kids baby book. Maybe I should go add this to the other thread going on "Your nurse brain sill at work....".

LadyFree28, BSN, LPN, RN · Mar 6, 2016

Most RSV and pneumonia kids that I take care of and assess I hear "crackles", it isn't crackly, but when you hear fluid moving up and down harshly-a lot of times if I can't hear crackles but I rub, I document "coorifice" and "rhonchi" to cover my bases.

Crackles can be very broad, hence I like the description of coorifice and rhonchi better than "crackles".

tsm007 · Mar 6, 2016

Most RSV and pneumonia kids that I take care of and assess I hear "crackles", it isn't crackly, but when you hear fluid moving up and down harshly-a lot of times if I can't hear crackles but I rub, I document "coorifice" and "rhonchi" to cover my bases.
Crackles can be very broad, hence I like the description of coorifice and rhonchi better than "crackles".

YES! Exactly what it sounded like coorifice and louder, but not exactly crackly. I wouldn't have thought of that as crackles and honestly because I don't listen to babies very often I didn't realize at first that this was a different sound than normal.

Julius Seizure · Mar 6, 2016

I, too, use the word "coorifice" much more than "crackles".

For lack of a better explanation, coorificeness just sounds...noisy - not that sound of clear, unobstructed air exchange that it should be. Sometimes it is so loud and "wet" sounding that it can sound like a washing machine!

The velcro sound? That, specifically, is fine crackles. And if it is louder and rougher sounding, I might call it coorifice crackles. I almost never chart "coorifice crackles"...I will just say "coorifice" in that instance. But if it sounded particularly like rice krispies, I might :)

Now, you might hear rhonchi described as a low-pitched wheeze, but I never really "got" that. To me, I think of rhonchi as a very dry sound, not one where I hear fluid moving around. In reality, rhonchi often means there are thick secretions in the lungs there aren't loosened up (and you can't cough them up if they aren't loose).

Wheezing can be EITHER inspiratory OR expiratory...but expiratory is far more common.

Stridor can often be heard without a stethoscope at all. If you are needing a stethoscope to hear it, then at first it can be confusing to differentiate between stridor and wheezing. But stridor is specifically upper airway noise, so if you put your stethoscope high up near their throat, it is going to be louder. That might help until you get the hand out it, and then it will get pretty obvious one you've heard it a few times.