So your patient presents with dyspnea, now what? Place your stethoscope to the patient's chest.
What you hear What it is Possible Cause Possible Diagnosis Coarse Rhonchi. It is a low-pitched, continuous sound that is best heard on expiration. Air moving through secretions in upper airway. May radiate through lung fields and be confused as a wheeze. COPD, pneumonia Audible wheeze Stridor, rhonchi Adult: Secretions up airway, secretions near vocal cords, dehydration
Child: Inflammation upper airway
Child/ Adult: Secretions may pool in upper airway due to bronchospasm*
Sibilant wheeze (only heard by auscultation) Wheeze. This is a high-pitched continuous sound heard on inspiration, expiration, or both. Bronchospasm Asthma, COPD Inspiratory and expiratory crackles (usually follow the path of gravity, if sitting or standing, will be in bases.** Coarse Crackles or rhales. This is when crackles are heard on inspiration and expiration, and is the sound of air moving through fluid. Fluid in lungs Pulmonary edema, bilateral pneumonia
May also be excessive secretions patient is unable to cough up
Inspiratory/ end inspiratory crackles Fine Crackles Alveoli popping open with each breath Pneumonia, COPD Diminished Diminished Poor air movement Acute asthma, Emphysema
The following is the scientifically proven treatment for said lung sound:
Child/Adult: Bronchodilator therapy
Wheeze Bronchodilator therapy, systemic corticosteroids Coarse Crackles Fine Crackles (may be isolated to one lobe, or one segment of one lobe) Diminished
Please note: I did not put bronchodilator down for the treatment of all the above adventitious lung sounds, only diminished and silent wheeze.
*Due to inability of patient to generate enough flow to expectorate.
** By the path of gravity, I mean if the patient is sitting, the fluid will be at the bottom of the lungs (the bases), and if lying on left side, the fluid will travel to the left side.