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Rhonchi or Rales? Important Lung Sounds Made Easy: A Practical Guide (With Full Audio)

CPD
5m

Published: 05 February 2019

Cover image for article: Rhonchi or Rales? Important Lung Sounds Made Easy: A Practical Guide (With Full Audio)

Lung Sounds Made Easy

From the general practice nurse to the ICU nurse, lung sounds tell you a great deal about a patient and their relative health. However, knowing the difference between rales, a crackle, and a wheeze is sometimes still a confusing proposition for many nurses, especially new nurses.

Part of the reason for that is that some of the language is interchangeable. For instance, crackles actually are rales, and the large amount of words can leave anyone’s head spinning. Knowing what to call what you hear on the other end of the stethoscope can tell you – and the doctor – quite a bit about a patient’s condition.

Rhonchi

What was once called rhonchi are now called a sonorous wheeze, and this is because they have a snoring, gurgling quality to them. Rhonchi are often a low-pitched moan that is more prominent on exhalation. It differs from wheezes in that wheezes are high and squeaky while these are low and dull. Rhonchi are caused by blockages to the main airways by mucous, lesions, or foreign bodies. Pneumonia, chronic bronchitis, and cystic fibrosis are patient populations that commonly present with rhonchi. Coughing can sometimes clear this breath sound and make it change to a different sound.

Crackles (Rales)

Crackles are the sounds you will hear in a lung field that has fluid in the small airways. As stated before, crackles and rales are the same thing, and this can often lead to confusion among health care providers. Crackles come in two flavours: fine and coarse. Fine crackles sound like salt heated on a frying pan or the sound of rolling your hair between your fingers next to your ear. Coarse crackles sound like pouring water out of a bottle or like ripping open Velcro. This lung sound is often a sign of adult respiratory distress syndrome, early congestive heart failure, asthma, and pulmonary oedema.

Rhonchi rales, stridor, sibilant wheezes sonorous wheezes, crackles lung sounds patient

Rhonchi, rales, wheezes, rubbing or stridor? – Listening for lung sounds.

Wheezes

Wheezes and rhonchi are actually very closely related. They are so closely related that the terminology for them has changed, too. Wheezes are now known as sibilant wheezes to distinguish them from rhonchi. Sibilant wheezes are high-pitched and shrill sounding breath sounds that occur when the airway becomes narrowed. They often have a musical quality to them. These are the typical wheezes heard when listening to an asthmatic patient. Sibilant wheezes are caused by asthma, congestive heart failure, chronic bronchitis, and COPD (see ‘Understanding COPD and the Hypoxic Drive to Breathe‘).

Stridor

Stridor is an unusual sound that not many adult patients will have, but it bears mentioning. It is a high-pitched, musical sound that is heard over the upper airway. It usually indicated a foreign body obstruction of the larger airways, such as the trachea or a main bronchus, and requires immediate attention. It is also the most common type of breath sound heard in children with croup, though it is important to differentiate between croup and a foreign body airway obstruction.

Rub

A pleural friction rub is caused by the inflammation of the visceral and parietal pleurae. These membranes are usually coated in a protective fluid, but when inflamed, they stick together and make a sound like leather creaking against itself. It often causes a great deal of pain, and the patient will splint their chest and resist breathing deeply to help mitigate the pain. A pericardial rub and a pleural rub will often sound similar, and the best way to distinguish between the two is to make the patient hold their breath. If you still hear the rubbing sound, then the patient has a pericardial rub and requires different treatment. Pleural effusion and pneumothorax are two diagnoses that can cause a pleural friction rub.

Author

Portrait of Lynda Lampert
Lynda Lampert Visit

Lynda is a registered nurse with three years experience on a busy surgical floor in a city hospital. She graduated with an Associates degree in Nursing from Mercyhurst College Northeast in 2007 and lives in Erie, Pennsylvania in the United States. In her work, she took care of patients post operatively from open heart surgery, immediately post-operatively from gastric bypass, gastric banding surgery and post abdominal surgery. She also dealt with patient populations that experienced active chest pain, congestive heart failure, end stage renal disease, uncontrolled diabetes and a variety of other chronic, mental and surgical conditions.

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Learner Reviews

4.6

12 Total Rating(s)

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Nina Kraskov
14 Oct 2019

Having recordings available was really great in helping to identify the lung sounds. The article also provided great written descriptions that will help you to remember the differences.

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Erin howard
14 Oct 2019

It is short, but effective the pleural rub vs pericardial rub tip was good

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Margaret Jean (JEANNIE) Minnis
11 Sep 2019

This is a very simple yet powerful demonstration of lung sounds.

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Suzanne Cook
07 Sep 2019

Brief insight to abnormal lung sounds. Great to actually be able to hear them.

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Chris Wilson
05 Sep 2019

Good but limited resource, covers basics well.

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Tracy Taylor
05 Sep 2019

excellent resource. Short, easy to follow with practical examples of breath sounds

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Helee Park
01 Sep 2019

Handy

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Margaret Wayland-Peck
01 Sep 2019

Hearing the breath sounds and reading the description reinforces my confidence in my ability to recognise abnormal chest sounds in my patients

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Stephen Allan
31 Aug 2019

Quiet good and clear

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Nicole Bondfield
14 Jul 2019

Had handy and practical tips such as differentiating pleural vs pericardial rub