Nursing Student Chronicles: Week 4: Inhale...Exhale...Repeat. What's that Sound?

I know, I missed writing last week...Last weekend was CRAZY and I didn't even have time to fully finish all my readings before class. Anyway, my test was last Monday and I did very well. I was extremely happy with my results. :-D

Last week, the main focus was oxygenation and breathing. One of the big subcategories was lung sounds. I decided to write about abnormal lung sounds since I find them hard to keep straight.

First up for abnormal lung sounds is wheezing. Wheezing comes from the airways contracting or narrowing and air still trying to be forced through. It can be caused by bronchoconstriction, pneumonia, and inflammation, to name a few.

According to my textbooks, wheezing sounds like music. I had a patient two weeks ago with pneumonia and I eagerly listened to his lungs (since I knew we were studying oxygenation and lung sounds the next week) and he had obvious wheezing but it did NOT sound musical. At least, I wouldn't describe it as musical. It sounds really coarse. Personally, I would describe it as a half-strangled, breathy owl trying to say "Whooo!"

Just imagine him trying to hoot. Photo credit goes to the photographer.

This video has wheezing lung sounds. Listen to it and let me know if my description of the strangled owl is correct. :-D

The next adventitious (ooh! I used a big, medical word! Basically, it just means "abnormal" with regard to the lungs) lung sound I'll highlight is crackles. Crackles come from the alveoli (the air sacs in the lungs) suddenly inflating when the person inhales. It can be caused from bronchitis, pneumonia, and pulmonary edema from left-sided heart failure, to name a few. For some of you "old school" people, crackles used to be known as rales.

I'm disappointed to say that crackles don't sound like Rice Crispies (you know, snap! crackle! pop!), but it does sound a lot like wind being blown into a camera while you're filming. You know, that sound that always makes you cringe while watching the video clips later.

Ok, so maybe this wind is a bit extreme for the noise, but it gives you a good mental image. Once again, photo credit goes to the photographer.

Here's a video clip where you can here crackles. Doesn't it sound like wind in the camera?

Next up to the plate is rhonci. Rhonchi are also called "sonorous wheezes" and are caused from secretions in the airway. It's hard to describe a sonorous wheeze... Maybe an automatic hand dryer starting up but not getting too loud?

Listen and you decide:

And last, but not least, is the pleural friction rub. This is when the pleura of the lungs are infected and are rubbing. It is extremely painful to the patient but it makes a cool sound, like an old creaky ship rocking back and forth on the high seas. Sometimes, it's hard to tell between a pleural friction rub and a pericardial fricion rub. The way to tell between them is to have the patient hold their breath for several seconds. If the noise stops, then it's pleural. If it continues, then it's pericardial (because you can't just make your heart stop. At least, I hope you can't!)