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Sunday, January 11, 2015

What is a true bronchospasm wheeze?

A while back a fake buddy of mine made the observation that most people often confuse rhonchi for a wheeze.  He described it as "rhonchi-eeeeeeeeze."

Respiratory Therapists are often asked to give regularly scheduled breathing treatments that aren't needed because "the patient has a wheeze."  Sometimes the nurse says, "Can't you hear it?  I can hear it from here!"

My buddy also wrote a post about how what defines a wheeze is subjective, or that one person's wheeze is another person'a rhonchi or another person's coarse lung sounds.  Yet the bottom line is there is a lot of confusion regarding what a wheeze actually is.  This inspired the post "8 different types of wheezes."

My fake friend also wrote "Coarse lung sounds: the lazy clinician's lung sound." Here he wrote about how there is no such thing as a "coarse" lung sound, that what the clinician is actually hearing is rhonchi.  It's the sound of air moving through secretion filled air passages.  It was actually an NBRC test question once, proof that the experts who write the test were aware of the confusion long ago.

Sometimes rhonchi sounds bubbly on expiration.  A lazy clinician might confuse this as crackles or rhales, but it's actually rhonchi.  Coarse is rhonchi, and bubbly on expiration is rhonchi.  If you can hear it, it is rhonchi.  If you hear it over the throat, it's rhonchi.  Actually, if you place your stethoscope over the throat and you hear it, it's probably laryngospasm, but that's the subject of a future post.

Think of it this way.  If a person is having true bronchospasm, which is the true indication for bronchodilators such as Ventolin, Xopenex and Duoneb, the sound will not be coarse (i.e. rhonchi), and it will not be heard when you listen with the stethoscope over the neck where the vocal cords are, and it will definitely not be audible.

Think about it.  The air passages are tiny microscopic structures that can only be observed under the light of a microscope.  They are so tiny that there is no possible way that when they are obstructed the wheeze made will be heard unaided by a stethoscope.  It's simply not possible.

A wheeze is a high pitched sound, like eeeeeeeeeeeeeeee.  It even sounds like eeeeeeeeeeeeeee.  It can only be heard by auscultation.

A true wheeze (wheeeeeeze) is an indication for bronchodilator.  However, some people don't wheeze in the presence of bronchospasm, so another indication is no wheeze. So if you sit around waiting for a short of breath person to wheeze before you panic and order Ventolin, you may being your patient more harm than good.

So this is why it's important to know your lung sounds, as opposed to treating the patient with ventolin based on appearance and annoying audible noises coming from the patient.

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