Select all of the following that are considered discontinuous breath sounds:

Detection of adventitious sounds is an important part of the respiratory examination, often leading to diagnosis of cardiac and pulmonary conditions.

Crackles (or rales) are caused by fluid in the small airways or atelectasis. Crackles are referred to as discontinuous sounds; they are intermittent, nonmusical and brief. Crackles may be heard on inspiration or expiration. The popping sounds produced are created when air is forced through respiratory passages that are narrowed by fluid, mucus, or pus. Crackles are often associated with inflammation or infection of the small bronchi, bronchioles, and alveoli. Crackles that don't clear after a cough may indicate pulmonary edema or fluid in the alveoli due to heart failure or adult respiratory distress syndrome (ARDS).

• Crackles are often described as fine, medium, and coarse.
  
• Fine crackles are soft, high-pitched, and very brief. You can simulate this sound by rolling a strand of hair between your fingers near your ear, or by moistening your thumb and index finger and separating them near your ear. Visit EMTprep LungSoundSeries (Fine Crackles)
  
• Coarse crackles are somewhat louder, lower in pitch, and last longer than fine crackles. They have been described as sounding like opening a Velcro fastener. Visit EMTprep LungSoundSeries (Course Crackles) on Youtube.

Wheezes are sounds that are heard continuously during inspiration or expiration, or during both inspiration and expiration. They are caused by air moving through airways narrowed by constriction or swelling of airway or partial airway obstruction.
• Wheezes that are relatively high pitched and have a shrill or squeaking quality may be referred to as sibilant rhonchi. They are often heard continuously through both inspiration and expiration and have a musical quality. These wheezes occur when airways are narrowed, such as may occur during an acute asthmatic attack.
• Wheezes that are lower-pitched sounds with a snoring or moaning quality may be referred to as sonorous rhonchi. Secretions in large airways, such as occurs with bronchitis, may produce these sounds; they may clear somewhat with coughing.  Visit EMTprep LungSoundSeries (Wheezes)

Pleural friction rubs are low-pitched, grating, or creaking sounds that occur when inflamed pleural surfaces rub together during respiration. More often heard on inspiration than expiration, the pleural friction rub is easy to confuse with a pericardial friction rub. To determine whether the sound is a pleural friction rub or a pericardial friction rub, ask the patient to hold his breath briefly. If the rubbing sound continues, its a pericardial friction rub because the inflamed pericardial layers continue rubbing together with each heart beat - a pleural rub stops when breathing stops.  Visit EMTprep LungSoundSeries Pleural Rub Sounds

Stridor refers to a high-pitched harsh sound heard during inspiration.. Stridor is caused by obstruction of the upper airway, is a sign of respiratory distress and thus requires immediate attention.
If adventitious sounds are heard, it is important to assess:

• their loudness,
  
• timing in the respiratory cycle,
  
• location on the chest wall,
  
• persistence of the pattern from breath to breath, and
  
• whether or not the sounds clear after a cough or a few deep breaths.
  

Instant Feedback:

Rhonchi are discontinuous popping sounds heard during inspiration.

Visit the Youtube video Lung Auscultation Course from the University of Loyola includes self evaluation case studies. Explore this excellent resource!

Normal lung sounds occur in all parts of the chest area, including above the collarbones and at the bottom of the rib cage.

Using a stethoscope, the health care provider may hear normal breathing sounds, decreased or absent breath sounds, and abnormal breath sounds.

Absent or decreased sounds can mean:

• Air or fluid in or around the lungs (such as pneumonia, heart failure, and pleural effusion)
• Increased thickness of the chest wall
• Over-inflation of a part of the lungs (emphysema can cause this)
• Reduced airflow to part of the lungs

There are several types of abnormal breath sounds. The four most common are:

• Rales. Small clicking, bubbling, or rattling sounds in the lungs. They are heard when a person breathes in (inhales). They are believed to occur when air opens closed air spaces. Rales can be further described as moist, dry, fine, and course.
• Rhonchi. Sounds that resemble snoring. They occur when air is blocked or air flow becomes rough through the large airways.
• Stridor. Wheeze-like sound heard when a person breathes. Usually it is due to a blockage of airflow in the windpipe (trachea) or in the back of the throat.
• Wheezing. High-pitched sounds produced by narrowed airways. They are most often heard when a person breathes out (exhales). Wheezing and other abnormal sounds can sometimes be heard without a stethoscope.