BREATH SOUNDS- Stages of Fluid Overload. Pneumonia

breath sounds with the stages of fluid overload on inspiration, starting here when the patient begins to retain fluid you will hear early, inspiratory crackles in other words, at the start of inhalation you will hear crackles. (like the sound of velcro) then as the fluid overload progresses the crackles will be audible for a longer duration on inspiration the the crackles will start progressing over in the exhalation phase as the lower lobes become filled with fluid, the crackles on early inspiration will disappear as the fluid retention progresses, more of the inspiratory crackles disappear until the whole inspiratory phase is clear and crackles are only heard upon exhalation at this point the patient should be complaining of dyspnea and most likely orthopneic its typical for the caregiver to overlook these early signs and administer a bronchodialator in the final stages of fluid overload, the crackles disappear on exhalation also the patient’s health is at a critical point, if appropriate medications are not given soon, respiratory failure is impending when you hear bronchial breath sounds and no crackles, this is a sign of fluid overload or other consolidation in the lung tissue if you are not sure that is what you are hearing there is a way to verify it its called bronchophony positive bronchophony is when you can understand words the patient speaks while auscultating the chest negative bronchophony is when you can not understand words spoken by the patient while auscultating the chest i typically have them count from 1 to 10, out loud, slowly and i listen to a different part of the lungs with each word positive bronchophony is an indication of fluid overload or other consolidation if a “waaa” is heard as they are speaking, this is negative bronchophony, and an indication that no consolidation is present if you are able to clearly hear the spoken word from the patient in the lower lobes and a “waa” in the upper lobes, you can pinpoint the level of consolidation in this case, i know they are in fluid overload up to this point. you might even say, for example, “this patient is full of fluid up to the third intercostal level” and they are in trouble another technique, usually used for locating a plueral effusion is egophony if you auscultate over the suspected plueral effusion, and have the patient say outloud “eeee” and you hear “aaaa” then that is a sign of consolidation, usually a plueral effusion typically the plueral effusion has to be 75mls before this technique can be used

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