Lung Sounds- Normal & Abnormal (crackles, wheeze, stridor) | Use headphones

Summary

In this video, Dr. Chirag Madaan, an Intensivist at Apollo Hospital, New Delhi, discusses the auscultation part of the respiratory system, emphasizing the importance of physical examination over reliance on investigations like X-rays or CT scans. He explains both normal (vesicular, bronchial, bronchovesicular) and adventitious breath sounds (crackles, wheezes, rhonchi, stridor, pleural rub), describing their characteristics, causes, and what they indicate about the patient's condition. Viewers are encouraged to listen closely to the breath sounds for better understanding, and the video aims to educate medical professionals on effective auscultation.

Takeaways

• 😀 Auscultation is a crucial part of respiratory system examination, despite the growing reliance on diagnostic tools like ABG, X-rays, and HRCT.
• 🩺 Physical examination, especially auscultation, should be prioritized as the first step before investigations for accurate diagnosis.
• 🎧 For better understanding, the doctor recommends using headphones to hear the breath sounds more clearly.
• 🔊 Normal breath sounds include vesicular, bronchovesicular, and bronchial breath sounds.
• 🫁 Vesicular breath sounds are soft, low-pitched, with a longer inspiratory phase than expiratory, and no gap between them.
• 🔉 Bronchial breath sounds are loud, high-pitched, with a longer expiratory phase and a gap between inspiratory and expiratory phases.
• 🎯 Bronchovesicular sounds, heard mainly at the manubrium, have intermediate pitch and equal inspiratory and expiratory durations. When heard in other lung areas, they indicate pathologies like collapse, consolidation, carcinoma, or cavities.
• 📄 Adventitious or abnormal breath sounds include crackles, wheezes, rhonchi, stridor, and pleural rub.
• 🫧 Crackles, similar to the sound of crumpling paper, can be fine or coarse, often caused by secretions or the explosive opening of collapsed airways.
• 🎶 Wheezing is a high-pitched musical sound due to airway constriction, commonly caused by conditions like COPD or asthma.

Q & A

What are the four steps involved in the respiratory system examination?

The four steps involved are: 1. Inspection, 2. Palpation, 3. Percussion, and 4. Auscultation.

Why is auscultation considered important by Dr. Chirag Madaan?

Auscultation is considered important because many clinicians rely on investigations like ABG's, X-rays, or HRCT, but Dr. Madaan believes that a good physical examination, especially auscultation, is more important in diagnosing conditions.

What are the two main categories of breath sounds?

The two main categories are: 1. Normal breath sounds, and 2. Adventitious or abnormal breath sounds.

What are the three types of normal breath sounds?

The three types of normal breath sounds are: 1. Vesicular, 2. Bronchovesicular, and 3. Bronchial.

What are the characteristics of vesicular breath sounds?

Vesicular breath sounds are: 1. Soft, 2. Low-pitched, 3. The inspiratory phase is longer than the expiratory phase, 4. There is no gap between the inspiratory and expiratory phases.

What differentiates bronchial breath sounds from vesicular breath sounds?

Bronchial breath sounds are: 1. Loud, 2. High-pitched, 3. The expiratory phase is longer than the inspiratory phase, 4. There is a gap between the inspiratory and expiratory phases, unlike in vesicular breath sounds.

Where are bronchovesicular breath sounds typically heard, and what does it signify if they are heard elsewhere?

Bronchovesicular breath sounds are typically heard at the manubrium. If heard in other lung fields, it suggests a pathology such as collapse, consolidation (pneumonia), cancer (bronchogenic carcinoma), or a cavity.

What are the causes of crackles, and how are they categorized?

Crackles can be caused by conditions like pulmonary edema, congestive heart failure (CHF), consolidation, or COPD. They are categorized as fine or coarse crackles based on pitch, intensity, duration, and whether they change with position or coughing.

What is the primary cause of wheezing sounds, and when are they typically heard?

Wheezing is caused by the passage of air through a narrowed airway due to constriction, commonly seen in COPD and asthma. It is usually heard in the expiratory phase but can also occur during inspiration.

What is a pleural rub, and what causes it?

A pleural rub is a non-musical, leathery sound heard during both inspiration and expiration. It is caused by inflamed pleura rubbing against each other, often associated with pleuritic chest pain or local tenderness.