When you don't hear what the docs hear?

[tsm007]

How often does this happen to you? It is messing with my confidence. I finally felt like I was starting to get lung sounds. I can consistently get wheezing and diminished, but crackles I'm hit and miss. I do hear them, but not always. I feel like I must be missing something. This is a really bad example, but my poor little man (my 1 year old) has pneumonia. I do not do pediatrics. I took the kid in and I had listened to his lungs yesterday and honestly was more concerned about his ears than his lungs. I was shocked when the doc said he heard crackles in the bases and had pneumonia (RSV came back on his swab test too). Of course I go home and listen to my little bug and still can't hear it. I finally left the boy alone because I think my husband was going to strangle me if I listened to his lungs any longer. Is there another example of what crackles sound like besides bubbles, popping, or rice krispies? I have listened to many of the websites with crackles and I am definitely not hearing those sounds when I listen to his lungs. I feel a little bit better that my sister in law who is an experienced nurse took care of him all day yesterday and was also shocked that the kid had pneumonia. (I am not looking for medical advice in case somebody thinks I am, just lung sound advice which I have asked for before, but I'd welcome prayers or positive thoughts for my little guy.)

[VANurse2010]

Coorifice - the most overused word in charting

[Julius Seizure]

Coorifice - the most overused word in charting

Can't disagree with you

[VANurse2010]

Can't disagree with you

My favorite - coorifice in uppers, diminished at the bases. Yeah, whatever.

[Wile E Coyote, ASN, RN]

Until i went to a place with EMR, the most overused lung sound assessment i saw charted was"scattered rhonchi".

[SHGR, MSN, RN, CNS]

Does your electronic stethoscope offer the option to record and slow down the recording? that might help. Glad you have the tenacity to get this skill down. You are correct, it is not easy!!

[jenin]

Fine crackles can sound like hair rolled between your fingers next to your ear. This is how I have always described them.

[Been there,done that, ASN, RN]

How often does this happen to you? It is messing with my confidence. I finally felt like I was starting to get lung sounds. I can consistently get wheezing and diminished, but crackles I'm hit and miss. I do hear them, but not always. I feel like I must be missing something. This is a really bad example, but my poor little man (my 1 year old) has pneumonia. I do not do pediatrics. I took the kid in and I had listened to his lungs yesterday and honestly was more concerned about his ears than his lungs. I was shocked when the doc said he heard crackles in the bases and had pneumonia (RSV came back on his swab test too). Of course I go home and listen to my little bug and still can't hear it. I finally left the boy alone because I think my husband was going to strangle me if I listened to his lungs any longer. Is there another example of what crackles sound like besides bubbles, popping, or rice krispies? I have listened to many of the websites with crackles and I am definitely not hearing those sounds when I listen to his lungs. I feel a little bit better that my sister in law who is an experienced nurse took care of him all day yesterday and was also shocked that the kid had pneumonia. (I am not looking for medical advice in case somebody thinks I am, just lung sound advice which I have asked for before, but I'd welcome prayers or positive thoughts for my little guy.)

Don't always believe what the doctor's say.. about what they hear.

In this case was it a pediatrician and was an xray done? Easy to " hear" things when you have just looked at an xray. Rales do not sound like bubbles or popping.. that is rhonchi.

I could best hear rales in the bases.. upon deep inspiration through the mouth. Don't think your little guy would cooperate enough for that exam. Wishes for his speedy recovery .. and rest for mom.

[Brandidrn]

Well stethoscopes are all different and maybe they have one that is stronger and easier to hear. So I got a recording of the sounds and just listened over and over til I got it. Good luck?

[Julius Seizure]

Don't always believe what the doctor's say.. about what they hear.

In this case was it a pediatrician and was an xray done? Easy to " hear" things when you have just looked at an xray. Rales do not sound like bubbles or popping.. that is rhonchi.

I agree that its easy to have your "hearing" be influenced by the CXR report! I've seen that.

I'm pretty sure that rales is just a rarely-used-anymore synonym for crackles. Rhonchi is different. I found some links that agree with that, just to support my statement:

"Crackles are caused by the "popping open" of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during expiration. The word "rales" derives from the French word râle meaning "rattle"."

"Part of the reason for that is that some of the language is interchangeable. For instance, crackles actually are rales"

This website shows crackles and rales as being the same thing. (and also has audio samples!)

This website also contains good descriptions of rales vs. rhonchi.

[Been there,done that, ASN, RN]

I agree that its easy to have your "hearing" be influenced by the CXR report! I've seen that.

I'm pretty sure that rales is just a rarely-used-anymore synonym for crackles. Rhonchi is different. I found some links that agree with that, just to support my statement:

"Crackles are caused by the "popping open" of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during expiration. The word "rales" derives from the French word râle meaning "rattle"."

"Part of the reason for that is that some of the language is interchangeable. For instance, crackles actually are rales"

This website shows crackles and rales as being the same thing. (and also has audio samples!)

This website also contains good descriptions of rales vs. rhonchi.

Oldy moldy here. They will ALWAYS be rales. Crackles are a new-fangled description for rales.

By the way.. I have heard them without any new fangled stethoscope. Have actually put my ear to the chest and auscultated them.

Rales are present with either atelectasis or pulmonary edema. That's when your findings need to be differentiated by an x-ray.[h=2][/h]

[Julius Seizure]

Rales are present with either atelectasis or pulmonary edema. That's when your findings need to be differentiated by an x-ray.

And then the x-ray report will read "Atelectasis vs. infiltrates. Suggest clinical correlation."

(P.S. BTDT - I am also from Michigan...around the "pinkie" area of the mitten. I'm always excited to see other people from my state :) )