Treatment including diuretics, positive inotropes ,oxygen therapy, and mechanical ventilation may be needed. Chronic fine crackles can also point to the development of ARDS, or acute respiratory distress syndrome. This can often be attributed to conditions like pulmonary edema and congestive heart failure. This may include postural or positional drainage, chest percussive therapy (VEST), vibration and PEP therapy,and cough insufflation/exsufflation therapy.įINE CRACKLES: also called moist crepitant rales may indicate fluid in the alveoli and small airways. MEDIUM CRACKLES: may indicate middle airway secretions (segmental to terminal bronchi) Bronchial hygiene may be required. This might be from an respiratory infection that produces large amounts of mucus. There are 3 types of crackles that may indicate specific disease states COARSE, MEDIUM, & FINE.ĬOARSE CRACKLES: also called RHONCHI may indicate large airway secretions (trachea, main bronchus) Patient may need to cough, or have th eir airway suctioned by the RT. In addition, normal BRONCHIAL sounds should ONLY be heard over the trachea and the bronchi.ĪBNORMAL BREATH SOUNDS, also known are ADVENTITIOUS and include the undesirable variations: CRACKLES WHEEZING STRIDOR SILENT CHEST PLEURAL FRICTION RUBĬRACKLES: (they sound like rice krispies) also known as RALES can indicate fluid or secretions (mucus) Often a clinician will say the patient sounds “wet”. The movement of the air should be low pitched quiet breathing, without any high pitched sounds or crackling. This should include all lung fields including the periphery or the lung borders.
NORMAL BREATH SOUNDS, also known as VESICULAR, should be equal or BILATERAL over both lung fields. In a normal air-filled lung, vesicular sounds are heard over most of the lung fields, bronchovesicular sounds are heard between the 1st and 2nd interspaces on the anterior chest, bronchial sounds are heard over the body of the sternum, and tracheal sounds are heard over the trachea.So what is the therapist hearing? First, let’s define the basics of Normal vs. Vesicular sounds are normally heard throughout inspiration, continue without pause through expiration, and then fade away about one third of the way through expiration. Vesicular sounds are soft, blowing, or rustling sounds normally heard throughout most of the lung fields. Bronchovesicular sounds are about equal during inspiration and expiration differences in pitch and intensity are often more easily detected during expiration. Bronchovesicular sounds are softer than bronchial sounds, but have a tubular quality. Bronchial sounds are loud and high in pitch with a short pause between inspiration and expiration expiratory sounds last longer than inspiratory sounds.Ĭlick here to view a brief and useful breath sounds video on YouTube presented by Bronchovesicular sounds are heard in the posterior chest between the scapulae and in the center part of the anterior chest. These sounds are harsh and sound like air is being blown through a pipe.īronchial sounds are present over the large airways in the anterior chest near the second and third intercostal spaces these sounds are more tubular and hollow-sounding than vesicular sounds, but not as harsh as tracheal breath sounds.
Tracheal breath sounds are heard over the trachea.