First time writing this blog, and I hope this blog will be helpful to those are who are still learning the tips and bits of becoming a doctor ( like me )
Yesterday I was revising about lung sounds. And oh my god i have to say when i came cross these three words ' Crepitation, Rales and Crackles'
How do they differ from each other?
Well i went up for some literature search :
So as you can see the founder of stethoscope was René-Théophile-Hyacinthe Laënnec. He was also the first one to classify adventitious sounds into 5 primary types
As you see, he used the term 'rale' which was translated into 'crepitation' by Forbes - hence the confusion !!!
And if you notice, there are dry vs moist rales - what are those?
Well theoretically speaking, moist rales happens when there are secretions inside your alveoli, and dry rales happen when there is obstruction without secretion. However, at least for me, they sound like the same !! In my opinion, it'll be very good of you to notice that patient has rales and he needs further workup !! Moist vs dry does not matter so much; you will know it's either moist or dry after you know the diagnosis
Recently NEJM has an excellent article discussing about the fundamentals of lung auscultation. According to the author, the term rale has been replaced by crackle
So no more dry vs moist confusion, there is only coarse vs fine crackle ( which in my opinion is appropriate as we can know the level i.e upper vs lower of lung pathology )
Finally, this is my attempted table for the adventitious lung sounds
PS please correct if there's any mistake !!
And if you notice, there are dry vs moist rales - what are those?
Well theoretically speaking, moist rales happens when there are secretions inside your alveoli, and dry rales happen when there is obstruction without secretion. However, at least for me, they sound like the same !! In my opinion, it'll be very good of you to notice that patient has rales and he needs further workup !! Moist vs dry does not matter so much; you will know it's either moist or dry after you know the diagnosis
Recently NEJM has an excellent article discussing about the fundamentals of lung auscultation. According to the author, the term rale has been replaced by crackle
So no more dry vs moist confusion, there is only coarse vs fine crackle ( which in my opinion is appropriate as we can know the level i.e upper vs lower of lung pathology )
Finally, this is my attempted table for the adventitious lung sounds
PS please correct if there's any mistake !!
Hopefully this clears up some of your doubts
References
Fundamentals of Lung Auscultation Abraham Bohadana, M.D., Gabriel Izbicki, M.D., and Steve S. Kraman, M.D. N Engl J Med 2014; 370:744-751
http://www.nejm.org/doi/full/10.1056/NEJMra1302901
Laennec and Auscultation Milli Gupta
http://www.uwomj.com/wp-content/uploads/2013/06/v78n1.61-65.pdf
Classification of Adventitious Sounds The British Medical Journal April 16 1938
http://europepmc.org/articles/PMC2086242/pdf/brmedj04272-0043a.pdf
References
Fundamentals of Lung Auscultation Abraham Bohadana, M.D., Gabriel Izbicki, M.D., and Steve S. Kraman, M.D. N Engl J Med 2014; 370:744-751
http://www.nejm.org/doi/full/10.1056/NEJMra1302901
Laennec and Auscultation Milli Gupta
http://www.uwomj.com/wp-content/uploads/2013/06/v78n1.61-65.pdf
Classification of Adventitious Sounds The British Medical Journal April 16 1938
http://europepmc.org/articles/PMC2086242/pdf/brmedj04272-0043a.pdf
Thank you, needed this explanation!
ReplyDelete