Have you ever heard a lung sound with your stethoscope that just wasn’t quite right? One of the hardest things about the nursing head to toe assessment is being able to recognize lung and heart sounds that are not normal. Some of them sound similar, and some are easier to tell apart.

It is helpful to hear the different abnormal lung sounds back to back so that you can distinguish between them. This practice will also help you tell one sound from another at clinical (and not to mention, make you look like a nursing rockstar). 🙂

My goal is to make your life super easy-breezy and as simple as possible (you’ve got enough to worry about with school and all, am.I.right?). That’s why I searched high and low for the best audio recordings of the most common lung sounds.

Don’t worry about a thing, friend, I’ll do the hard work for you! You can just sit back, and let the sounds of sick lungs serenade you.

Let’s dive in.

Wheezing:

Wheezes are usually described as being musical and higher-pitched. Wheezes are usually heard on expiration, but can be heard on inspiration as the condition worsens.

Causes:
Reduced air flow through the lungs, possibly due to:
1. Foreign object
2. Asthma
3. Chronic bronchitis

Watch out: If you have a patient that is having an asthma attack and their wheezing suddenly stops (but they are obviously struggling for air), maintain a patent (clear) airway as best you can, give oxygen per facility policy and call for help. Their airway may have become severely blocked.

(Thanks to MedWorld for this video: https://www.youtube.com/watch?v=fKlH-kqc_tY)

Fine Crackles:

Fine crackles are a short, higher-pitched sound that is often compared to hair being rubbed between the fingers. They are usually heard on inspiration, but can be heard on expiration as well.

Causes:
Fluid in the alveoli or the alveoli are collapsed, possibly due to:
1. Pneumonia
2. Atelectasis (collapse of part or all of the lung)
3. Heart Failure

(Thanks to Johann Sulser for this video: https://www.youtube.com/watch?v=nE0dKCbveJ8)

Course Crackles:

Course crackles sound more like bubbling than popping. They are usually heard on inspiration, but can be heard on expiration as well.

Causes:
Fluid in the alveoli or the alveoli are collapsed, possibly due to:
1. Chronic Obstructive Pumonary Disease (COPD)
2. Pulmonary Edema
3. Heart Failure

(Thanks to MedWorld for this video: https://www.youtube.com/watch?v=TpPJZY-b8aI)

Pleural Friction Rub:

A pleural friction rub is a grating or rubbing sound during both inhalation and exhalation.

Causes:
There is not enough pleural fluid causing the pleural layers to rub together, leading to inflammation and pain. This can be due to:
1. Infection
2. Lupus
3. Rhumatoid Arthritis
4. Cancer

(Thanks to MedWorld for this video: https://www.youtube.com/watch?v=vlg80ZpxqpU)

Rhonchi:

Rhonchi is often related to a snoring sound, and usually goes away when the patient coughs.

Causes:

Fluid or another obstruction blocks the large airways of the lungs. This can be due to:
1. Chronic Obstructive Pulmonary Disease (COPD)
2. Pneumonia
3. Cystic Fibrosis

(Starts at 1:12)

(Thanks to www.egydoctors.net for this video: https://www.youtube.com/watch?v=5JA6D1Mguh0)

Stridor:

Stridor is higher-pitched and loud, and you can usually hear it without a stethoscope.

Causes:
Blockage in the upper airway, which can be caused by:
1. Foreign body
2. Croup
3. Epiglotitis


Watch out: Stridor may indicate a severely blocked airway. Maintain the patient’s airway as much as possible, administer oxygen per facility policy, and call for help.

(Starts at 0:13 and again at 0:44)

(Thanks to MedWorld for this video: https://www.youtube.com/watch?v=Z1X4Rz7vLdU)

I put crackles and the pleural rub next to each other because it may be hard to distinguish between the two sometimes. The pleural rub sounds more like a grating or a pulling rather than a popping sound.

Wheezes and stridor tend to be fairly obvious when you hear them because they don’t really sound like any of the others.

I really encourage you to ask your clinical instructor or nurse to listen with you to a patient’s abnormal lung sounds. They can verify if it’s the sound you thought it was, or they can help you figure out which one it is. Either way, it’s a great learning experience to talk through it with someone.

Go you for being a respiratory hero!

Comment below and tell me about a time when you totally rocked identifying a respiratory sound.