Figure 2-13. Auscultation over the trachea.
g. Check for abnormal sounds. Check for sounds in the lungs that are not
modifications of breath or voice.
(1) Rhonchi. These are coarse, rattling sounds produced when the patient
exhales. The sounds are usually very clear but might change with coughing. Low-
pitched, these sounds occur when there is mucus in the bronchi.
(2) Rales (Crackles). Rales, also called crackles, are fine, rattling sounds.
These are noncontinuous, high-pitched, fine crackles, like the sound of carbonated
beverages. The sounds are usually heard when the patient breathes in and sometimes
when the patient begins to exhale. These sounds are usually caused by the presence
of fluid in the alveoli and the bronchioles. Sometimes the fluid is in these parts of the
respiratory system, and sometimes the fluid is not there. This is the reason that
sometimes the fine rattling can be heard, and sometimes it is not heard. Coughing
usually makes the sounds louder.
(3) Wheezes. Wheezes are musical sounds like the high-pitched notes on a
clarinet. Wheezes are produced by constricted or partially obstructed airways. The
sounds can be heard when the patient breathes in.
(4) Pleural friction rub. These are scratchy sounds like crinkling SaranTM
wrap. The sounds are produced by the movement of inflamed pleural surfaces rubbing