Bronchovesicular: Medium pitch, heard over major bronchi (1st-2nd intercostal spaces). Inspiration = expiration
Bronchial/Tracheal: Loud, high-pitched, heard over trachea. Expiration > inspiration
Adventitious (Abnormal) Breath Sounds
Crackles (Rales)
Fine crackles: Velcro-like, end of inspiration
Coarse crackles: Bubbling, throughout inspiration
Causes: Pulmonary edema, pneumonia, atelectasis
Don't clear with coughing
Wheezes
High-pitched, musical
Inspiratory and/or expiratory
Causes: Asthma, COPD, bronchospasm
May improve with bronchodilators
Rhonchi
Low-pitched, rumbling, snoring sounds
Causes: Secretions in large airways
Often clears with coughing
Stridor
High-pitched, inspiratory sound
Indicates upper airway obstruction
MEDICAL EMERGENCY
Pleural Friction Rub
Grating, creaking sound
Heard during both inspiration and expiration
Causes: Pleuritis, pleural inflammation
Oxygen Delivery Devices
Nasal cannula: 1-6 L/min → 24-44% FiO2
Simple face mask: 5-8 L/min → 40-60% FiO2
Non-rebreather mask: 10-15 L/min → 80-95% FiO2
Venturi mask: Precise FiO2 delivery (24-50%)
High-flow nasal cannula: Up to 60 L/min, precise FiO2
Key Assessment Documentation
Respiratory: RR 18, regular rhythm, adequate depth. Chest symmetric, no accessory muscle use. Lungs clear to auscultation bilaterally. SpO2 98% on room air. No cough, dyspnea, or cyanosis.