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Wednesday, April 17, 2013

Lungsounds for dunderheads

I have decided to use dunderheads here because dummies is already patented.  The following is lung sounds for dunderheads, and how you can use these "adventitious" lung sounds to the benefit of your patient.  Note:  Adventitious means abnormal lung sound. 

So your patient presents with dyspnea, now what?  Place your stethoscope to the patient's chest.
What you hearWhat it isPossible CausePossible Diagnosis
CoarseRhonchi.   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 wheezeStridor, 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*
Adult: Wet

Child:  Croup

Child/Adult: Asthma
Sibilant wheeze (only heard by auscultation)Wheeze. This is a high-pitched continuous sound heard on inspiration, expiration, or both.BronchospasmAsthma, 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 lungsPulmonary edema, bilateral pneumonia

May also be excessive secretions patient is unable to cough up
Inspiratory/ end inspiratory cracklesFine CracklesAlveoli popping open with each breathPneumonia, COPD
DiminishedDiminishedPoor air movementAcute asthma, Emphysema

The following is the scientifically proven treatment for said lung sound:

Pulmonary toilet if patient not expectorating on own.  If expectorating, you monitor
Adult:  Have patient cough, search for signs of heart failure (fluid overload, I&Os, etc.)
Child:  Cool mist, racemic epinephrine
Child/Adult:  Bronchodilator therapy 
WheezeBronchodilator therapy, systemic corticosteroids
Coarse Crackles
Pulmonary Edema:  Diuretics
Bilateral Pneumonia:  Antibiotics
Fine Crackles (may be isolated to one lobe, or one segment of one lobe)
Pneumonia: Antibiotics
COPD:  May be normal for patient
Acute Asthma:  Bronchodilator therapy, systemic steroids
Emphysema:  May be normal for patient

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.

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