Knowing what you hear, and what it means, is one of the most useful skills in a respiratory assessment.
Normal breath sounds
| Sound | Where you hear it | What it sounds like |
|---|---|---|
| Vesicular | Most of the lung fields | Soft, low, longer on breathing in |
| Bronchovesicular | Near the sternum and between the shoulder blades | Medium, equal in and out |
| Bronchial | Over the trachea | Loud, high, harsh |
Abnormal (adventitious) sounds
| Sound | What it sounds like | Common causes |
|---|---|---|
| Fine crackles | Short popping, like hair rubbed by your ear, usually on breathing in | Fluid in the alveoli: heart failure, pneumonia |
| Coarse crackles | Lower, louder bubbling | Secretions: pneumonia, pulmonary edema |
| Wheezes | High-pitched whistling, often on breathing out | Narrowed airways: asthma, COPD |
| Rhonchi | Low snoring or rattling that may clear with a cough | Mucus in the large airways: bronchitis |
| Stridor | Loud, high-pitched sound on breathing in, heard without a stethoscope | Upper airway blockage: swelling, foreign body. Emergency. |
| Pleural friction rub | Grating, like leather rubbing | Inflamed pleura: pleurisy |
| Diminished or absent | Quiet or no sound | Pneumothorax, collapsed lung, fluid around the lung |
What to do
- Stridor: call for help right away. It is an airway emergency.
- New crackles in heart failure: check oxygen, raise the head of the bed, and notify the provider about possible fluid overload.
- Wheezing: check oxygen and breathing effort, and give ordered bronchodilators.
- Rhonchi: have the patient cough and deep breathe, then listen again.
Practice this in Head-to-Toe
Put the stethoscope on and hear the difference for yourself.
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Quick answers
What is the difference between crackles and rhonchi?
Crackles are short popping sounds from fluid in the small airways and do not clear with coughing. Rhonchi are low rattling sounds from mucus in larger airways and may clear with a cough.
Is stridor an emergency?
Yes. Stridor means the upper airway is narrowed or blocked. Call for help right away.
Evidence & Clinical Sources
- Jarvis, Physical Examination & Health Assessment, Elsevier
- Hinkle & Cheever, Brunner & Suddarth's Textbook of Medical-Surgical Nursing, Wolters Kluwer
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