Basics of Lung Sounds GOAL:The goal of this basic course in lung sounds is to improve auscultation observational skills.

We focus on describing important breath sounds and in providing recordings of each. Many students find that waveform tracings aid in learning lung sounds; we have included dynamic (moving cursor) waveforms with each lesson. Lesson List: Vesicular breath sounds are soft and low pitched with a rustling quality during inspiration and are even softer during expiration. These are the most commonly auscultated breath sounds, normally heard over the most of the lung surface. In patients with pneumonia or chronic obstructive pulmonary disease, vesicular sounds can be diminished. They are also absent or diminished in conditions such as pneumothorax or misplaced endotracheal tubes. An example of diminished vesicular breath sounds can be found in the Intermediate Lung Sounds course and in the Lung Sounds Reference Guide. Fine crackles are brief, discontinuous, popping lung sounds that are highpitched. You can simulate this sound by rolling strands of hair between your fingers near your ear. Fine crackles are also similar to wood burning in a fireplace.Crackles, previously termed rales, are more commonly heard during inspiration. These crackles can be auscultated over a wide area of the chest. Coarse crackles are discontinuous, brief, popping lung sounds. Compared to fine crackles they are louder, lower in pitch and last longer. Coarse crackles have been described as similar to the sound of a hook and loop fastener being pulled apart. They have also been described as a bubbling sound. Crackles, sometimes called rales, are more often auscultated during breath inspiration than expiration. Coarse crackles are associated with congestive heart failure and pneumonia. Wheezes are adventitious lung sounds that are continuous with a musical quality. Wheezes can be high or low pitched. High pitched wheezes may have an auscultation sound similar to squeaking. Lower pitched wheezes have a snoring or moaning quality. Coughing may clear these lower pitched wheezes. Wheezing is typically more pronounced on breath expiration but is sometimes audible on inspiration as well. The proportion of the respiratory cycle occupied by the wheeze roughly corresponds to the degree of airway obstruction. They are caused by secretions or narrowing of the airways. Low pitched wheezes (rhonchi) are continuous, low pitched adventitious lung sounds that are similar to wheezes. They often have a snoring, gurgling or rattle-like quality. During auscultation, these are more common observed during expiration. Rhonchi usually clear after coughing.

Bronchial breath sounds are hollow, tubular sounds that are higher pitched. They can be auscultated over the trachea but are considered abnormal if heard over the peripheral lung fields. There is a distinct pause in the sound between inspiration and expiration. Pleural rubs are discontinuous or continuous, creaking or grating sounds. The sound has been described as similar to walking on fresh snow or a leather-on-leather type of sound. Coughing will not alter the sound. During auscultation, pleural rubs can usually be localized to a particular place on the chest wall. Because these sounds occur whenever the patient's chest wall moves, they appear on inspiration and expiration. Pleural rubs stop when the patient holds her breath. If the rubbing sound continues while the patient holds a breath, it may be a pericardial friction rub.

Intermediate Lung Sounds GOAL: The goal of this intermediate auscultation course is to expand your observational skills for breath sounds. The course lessons include voiced sounds: bronchophony, egophony and whispered pectoriloquy. We also provide lessons on several types of wheezes, crackles and stridor. Each of these lung sound lessons includes audio, text and dynamic waveform. Lesson List: Diminished vesicular sounds are of lower intensity and seem more distant. These sounds can occur in patients who move a lowered volume of air, such as in frail, elderly patients or shallow breathing patients. They are also heard with obese or highly muscular patients, where tissue mass impeds sound. They exhibit a normal inspiration to expiration ratio of 3 to 1, or 4 to 1. Stridor is caused by upper airway narrowing or obstruction. It is often heard without a stethoscope. It occurs in 10-20% of extubated patients. Stridor is a loud, high-pitched wheezing breath sound heard during inspiration but may also occur throughout the respiratory cycle most notably as a patient worsens. In children, stridor may become louder in the supine position.