![]() Listen to rales here on the Medzcool YouTube channel. Rales are usually broken up into more specific types, based on the way they sound. When these tiny sacs are damaged or weighed down with fluid or mucus, they can make a crackling sound as they attempt to fill with air. These are tiny sacs of air and inflate and deflate with each breath. This usually occurs in the smaller parts of the lungs, like the alveoli. These sounds are formed when air moves into closed spaces. The terms rales or crackles have been used interchangeably and are usually a matter of preference, not a difference in the condition. Rales are a higher-pitched sound sometimes called crackles or bibasilar crackles. Listen to rhonchi here on the Medzcool YouTube channel. The sound you hear is the the sound the air makes as it moves around the blockage. These sounds are produced when there is something blocking the airway, like fluid. Rhonchi can either come and go on and inhale or exhale or be heard continuously. It can be heard on an inhale or exhale, and it’s often compared to the sound of snoring. This low-pitched sound that usually starts in the larger airways in the lungs. The difference between the two is in the pitch and the exact cause of the sound. Tympanic sounds heard over the chest indicate excessive air in the chest, such as may occur with pneumothorax.Rales and rhonchi can both be coarse, even crackling sounds. Tympany is normally heard over the stomach, but is not a normal chest sound. Tympanic sounds are hollow, high, drumlike sounds. Either vocal resonance or tactile fremitus in a patient with asymmetric chest expansion would strongly support the diagnosis of pneumonia. An area of hyperresonance on one side of the chest may indicate a pneumothorax. Diminished breath sounds may be noted in both conditions, but vocal resonance (egophony or bronchophony) and tactile fremitus should not be present directly over a pleural effusion. Hyperresonant sounds may also be heard when percussing lungs hyperinflated with air, such as may occur in patients with COPD, or patients having an acute asthmatic attack. Hyperresonant sounds that are louder and lower pitched than resonant sounds are normally heard when percussing the chests of children and very thin adults. Dullness replaces resonance when fluid or solid tissue replaces air-containing lung tissues, such as occurs with pneumonia, pleural effusions, or tumors. Dull or thudlike sounds are normally heard over dense areas such as the heart or liver. Flat or extremely dull sounds are normally heard over solid areas such as bones. Look at the following diagram that shows percussion notes on the posterior chest: Resonant sounds are low pitched, hollow sounds heard over normal lung tissue. Visualize the structures underneath as you proceed. Work from the top part of the chest downward, comparing sounds heard on both the right and left sides of the chest. ![]() Watch a video segment of percussion technique. Then, strike the finger placed on the patient's skin with the end of the middle finger of your dominant hand. ![]() Place the first part of the middle finger of your nondominant hand firmly on the patient's skin. Percussing the anterior chest is most easily done with the patient lying supine the patient should sit when percussing the posterior chest. Percussion helps to determine whether the underlying tissues are filled with air, fluid, or solid material. Percussion sets the chest wall and underlying tissues into motion, producing audible sounds and palpable vibrations. Just as lightly tapping on a container with your hands produces various sounds, so tapping on the chest wall produces sounds based on the amount of air in the lungs. Percussion is an assessment technique which produces sounds by the examiner tapping on the patient's chest wall. A pneumothorax orĮffusion provide space or a boundary that sound must cross, reducing it greatly. A consolidated lung transmits the sounds more faithfully, giving bronchial sounds on auscultation. In the healthy lung the air spaces attenuate this to give the softer vesicular sounds. Normal breathing causes vibration of the lung tissue. Consolidated lung lacks the gas-filled space to resonate, and the liquid/gas boundary at an effusion prevents the impulse transmitting to the lung effectively. The normal lung is less resonant than a pneumothorax as the lung tissue dampens the resonance slightly. So for percussion, any air filled cavity will sound resonant (pneumothorax, normal lung). Sounds hitting a gas/liquid boundary tend to be reflected Solids and liquids transmit sounds better than gases 3. An air-filled space acts as a resonant cavity 2. It is possible to memorise these, but the reason for the pattern can also be understood, and this may be easier to remember for some people.ġ. Lung Sounds on Percussion and Auscultation Condition Normal lungĪusculatation Vesicular Bronchial Diminished Diminished
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