Breath Sounds

You are invited to check out a quick review of Breath Sounds to incorporate in the assessments you make as a professional.

Crackles

• Heard on inspiration and indicate fluid, atelectasis, or pneumonia
• In left sided heart failure and pulmonary edema, crackles will be persistent
• When heard in post-operative conditions and pulmonary or fat emboli, they are most often due to atelectasis and will clear with cough and deep breathing exercises
• Will be heard in bacterial pneumonia, along with bronchial (loud) breath sounds, but are often absent in viral pneumonia

Rhonchi

• Primarily heard on expiration and indicates movement of air through mucus
• Will be heard when the patient needs to be suctioned and should clear when suctioning is successful

Wheezing

• Indicates air movement through narrowed airways or a blockage in the vocal cords
• Expiratory wheezing indicates a mild obstruction
• Inspiratory wheezing is heard in chronic asthma
• Inspiratory and expiratory wheezing is heard in acute asthma and the inspiratory to expiratory (I:E) ratio will change
• Normal I:E ratio is 1:2. During an acute event, it changes to 1:1 due to hypoxia, and then becomes a 1:3 (or longer) ratio due to air trapping, indicating the patient is in trouble

Stridor

• Crowing sound indicating upper airway obstruction
• Quiet when the obstruction is above the glottis, such as in epiglottitis
• Loud and rasping when the obstruction is below the glottis, such as bronchiolitis
• Heard on inspiration with a mild obstruction
• With a severe obstruction, it is heard on inspiration and exhalation
• Silence is present with a complete obstruction

So, the next time you hear abnormal breath sounds, think about some of these important clinical scenarios.

If you have a post-op patient with crackles (and possibly) a low SpO₂, do not just increase their oxygen flow rate. Instead, have them cough and deep breath. If the crackles clear with coughing, good nursing care, incentive spirometry, and possibly a breathing treatment are needed. 

If you have a patient with chronic bronchitis and shortness of breath, make a valid assessment before you automatically move to suction them. If you hear bronchi, secretions are present. After suctioning, be sure to listen to see if the rhonchi have cleared.

If you have an asthmatic patient, look at the inspiratory to expiratory ratio. If exhalation is three (or more times) inhalation, your patient is in trouble and rapid interventions are needed.

If your patient has stridor, be especially concerned when it is heard on inspiration and exhalation. If they suddenly become “quiet”, the obstruction could have advanced and Rapid Response should be called.