I
Basic
Respirations
Overview
• Intended to review and familiarize you with
commonly heard breath sounds encountered
in the field.
• How many of you were taught breath
sounds, but never had an audio or clinical
opportunity to validate cognitive
objectives?
Respiratory Review
Mouth
Epiglottis
Nasopharynx
Oropharynx
Larynx
Trachea
Lung
Bronchi
Diaphragm
Characteristics of Normal Breathing
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Normal rate and depth
Regular inhalation and exhalation pattern
Audible on each side of chest
Equal rise and fall of each side
Movement of the abdomen
Normal Respirations Rates
• Adult – Over 8 Years Old
– 12 to 20 rpm
• Child – 1 to 8 Years Old
– 15 to 30 rpm
• Infant – Birth to 1 Year Old
– 25 to 50 rpm
Sign of Abnormal Breathing
• Rate slower than 8 per minute or faster than 24 per
minute
• Muscle retractions above clavicles, between ribs
and below rib cage (especially in children)
• Pale or cyanotic skin
• Shallow or irregular
• Pursed lips
• Nasal flaring
Auscultation Points
• Anterior and Posterior of Patient
– Apices– under the clavicular line midpoint
– Mid-axillary lines (armpit at nipple line)
– Bases – lower border of rib cage
Breath Sounds
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Practice run!
How many can you identify?
Take out a pen and paper …
Make a list numbered 1 to 9 …
Are you ready?
Breath Sound # 1
Listen Carefully &
Write Down What You Think It Is
Breath Sound # 2
Listen Carefully &
Write Down What You Think It Is
Breath Sound # 3
Listen Carefully &
Write Down What You Think It Is
Breath Sound # 4
Listen Carefully &
Write Down What You Think It Is
Breath Sound # 5
Listen Carefully &
Write Down What You Think It Is
Breath Sound # 6
Listen Carefully &
Write Down What You Think It Is
Breath Sound # 7
Listen Carefully &
Write Down What You Think It Is
Breath Sound # 8
Listen Carefully &
Write Down What You Think It Is
Breath Sound # 9
Listen Very Carefully &
Write Down What You Think It Is
Answer Key
Number 1 is….
• Normal. (soft and low pitched)
• Regular inhalation and exhalation
• Rate is 20-24
• If we could see this patient, there would be equal
rise and fall and movement of the abdomen
Number 2 is…
• Expiratory wheezing
• Wheezing is described as a whistling or
sighing sound during exhalation
Wheezing Pathology
• Lower partial airway obstructions
– Asthma
– COPD
– Edema
• Upper partial airway obstruction
– Croup (progresses to stridor)
– Foreign body
– Edema
Number 3 is…
• Expiratory wheezing with
inspiratory crackles (Coarse
Rales)
Number 4 is….
• Rales (medium with no
expiratory wheeze)
• Due to presence of fluid in smaller airways
– Bronchioles
• Rales can be heard on inspiration and exhalation
• Rales are also referred to as “crackles”
• Rales are coarse,medium or fine
Rales Pathology
• Initially occurs in the lower lobes, but can advance
to upper areas (in the alveoli, but below
bronchioles)
• Pulmonary Edema
• CHF
• Near drowning
• Toxic inhalation
• Advanced COPD
• Others
Number 5 is….
• Subcutaneous emphysema
• SCE is the presence of air in soft tissues around
upper chest and neck
• It is often felt and heard during examination of the
upper chest and lower neck while palpating and
auscultating.
• It is often described as “rice crispies”
Subcutaneous Emphysema
Pathology
• SCE is usually seen in chest trauma
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–
–
–
Flail chest
Tracheal tears
Penetrating chest and neck trauma
Others (spontaneous pneumo, missed ET and
crichs)
Number 6 is…
• Rhonci
• Coarse breath sounds heard in patients with
chronic mucus in the upper airway (bronchi)
• Rhonci is most pronounced during expiration
• Low pitched rhonci occur in the larger bronchi and
occur early in expiration, while high pitched occur
in the terminal bronchi and are late in expiration
Rhonci Pathology
• Rhonci commonly occur in both acute and
chronic bronchitis and bronchiolitis
• Can occur in bronchial asthma patients
Number 7 is…
• Stridor
• On inspiration is a high pitched brassy
sound
• ..and a forceful expiration creates a barking
cough
• Often referred to as a “seal like” bark
Stridor Pathology
• Laryngeal edema from croup or epiglottitis
– Croup is laryngealtracheobronchitis
– Epiglottitis is inflammation of the epiglottis
• Stridor is more pronounced in children because of
smaller airways
• Others
– Toxic inhalation
– Cancer
– Foreign body obstruction
Number 8 is…
• Pediatric Grunting
• Grunting is a sound that occurs primarily in
neonates when the infant exhales air against a
partially closed epiglottis.
• Grunting is a natural function which generates
back pressure to keep smaller airways open.
Grunting Pathology
• Occurs because of underdeveloped
accessory muscles
• Grunting occurs in all infant with
respiratory distress, flu or infections
Number 9 is…
• A Bonus…..
• It is Crepitus from rib fracture
• Grating of the bone ends as they move back
and forth against each other on inspiration
and expiration
Crepitus Pathology
• Trauma
Summary
Laryngeal-tracheal
Stridor,Grunting,SubQ,Wheezing
Tracheal-bronchiole
Rhonci,Wheezing
Bronchiol-alveoli
Rales
• Use history along with pulmonary
assessment to advise your Medical Control
and treat patient.
• Most on-line docs want to know if patient is
wet or dry and where.