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

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

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

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.