Vesicular (aka normal) breath sounds can sound kinda-crackley if you listen close enough. I learned that you could have crackles in your lungs, and set about listening to the lungs on all my patients very closely. rales, rhonchi, egophony, stridor, tactile fremitus. I remember when we first were instructed on the lung exam. Tim also has active experience as a columnist and content developer with over 200 published works and over 100 hours of education content available online, and is a social media influencer on LinkedIn within the EMS industry.One of the difficult things about learning the art of the physical exam early in medical school is learning to differentiate pathology from normal. He is experienced in EMS operations, community paramedicine, quality assurance, data management, training, special operations and administration disciplines, and holds credentials as both a supervising and managing paramedic officer. His background includes nearly a decade of company officer and chief officer level experience, in addition to training content delivery and program development spanning his entire career. He has nearly two decades of experience in the emergency services industry, having worked as a career firefighter, paramedic and critical care paramedic in a variety of urban, suburban, rural and in-hospital environments. Tim is the founder and CEO of Emergency Medical Solutions, LLC, an EMS training and consulting company that he developed in 2010. With the ability to record lung sounds throughout the year, replay them to the class, save them in an archive and then revisit them in a testing environment, your test bank of opportunities as an instructor just expanded tenfold as the year progresses (and with the ability to throw in a trick question bowel or heart sound for good measure). ![]() How about an interactive hearing exam to go along with it? Spice up your classroom and your students’ exams with some “live” lung sounds! We’re accustomed to testing students in a “dynamic cardiology” environment (with a “live” rhythm strip scrolling across a cardiac monitor’s screen showing one of the 12 often-repeated rhythms clearly displayed). Question 1: “Which expiratory lung sound is characterized by. ![]() Now, it’s time to verify and validate what you’ve been learning. Being able to recap on what you heard as a student, or as an instructor to recap on what your student heard, is a valuable teaching tool for a field preceptor.Ĭome examination day, everything you’ve been studying for in your respiratory chapter has come to its peak. Hearing rales or crackles for the first time on a “live” patient – outside of the sterile hospital clinical setting – sounds “different” than in a patient’s home or in the back of an ambulance. This sound – which didn’t seem the same as traditional rales or rhonchi – was unique and intermittent, and your device’s digital recording function caught the sound in action. This lung sound – although a result of irritation of the upper airway that resonated into the lungs – was recorded and can now be played back to the attending physician and the rest of the class. Keeping a close eye on the patient, with your digital stethoscope in place on his chest, you’re able to experience the patient’s cough return and hear a rough, “seal-like,” resonant lung sound in result. Listening to his lung sounds after this resulted in seemingly clear sounds, but still a bit more resonant than what we would all come to expect as compared to “normal.” ![]() Shortly thereafter, the patient lets out his “rough cough” in a coughing fit that lasted a few seconds. The child doesn’t complain of any pain, and a cooperative physical exam of his throat doesn’t reveal any swelling or irritation. ![]() His parents reported that their child had begun to get this “rough cough” overnight, which led to him having a hard time sleeping. Last week’s clinical group heard something interesting while assessing a 3-year-old male who came to the emergency department with a “rough cough.” He presented as active in appearance, breathing with normal rates and effort, and otherwise seemed hemodynamically stable – but he did have a slightly elevated temperature.
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