Normal Breath Sounds Vesicular Bronchovesicular Bronchial Tracheal

Duration Insp > exp Insp = exp Insp < exp Insp = exp

Intensity/Pitch of Expiratory Sound Soft/low Med/med Loud/high Very loud/high

Locations Most of lungs 1 & 2 interspaces; interscapular Manubrium; in lobar pneumonia Over trachea
st nd

Adventitious Breath Sounds Crackles/Rales Discontinuous Intermittent, non-musical, brief Like dots in time Fine crackles: soft, high-pitched, brief Coarse crackles: louder, lower in pitch Wheezes/Rhonchi Continuous More than 250 msec, prolonged, musical Like dashes in time Rhonchi: low-pitched w/snoring quality

Condition Chronic bronchitis

Trachea Midline

Percussion Resonant

Breath sounds Normal

Transmitted sounds Normal

Early LHF

Midline

Resonant

Normal

Normal

Consolidation (lobar pneumonia, pulm edema, pulm hemorrhage) Atelectasis (lobar) Large pleural effusion Pneumothorax COPD

Midline

Dull

Bronchial

Increased

Adventitious sounds None or wheezes, rhonchi, crackles Late inspiratory crackles on lower lungs, wheezes Late inspiratory crackles

TOWARD side AWAY AWAY Midline

Dull Dull Hyperresonant or tympanic Hyperresonant

Absent Decreased or absent Decreased or absent Decreased or absent Can be obscured by wheezes

Absent Decreased or absent Decreased or absent Decreased

None None or pleural rub Pleural rub None unless bronchitis is also present Wheezes, crackles

Asthma

Midline

Resonant to hyperresonant

Decreased