STUDY - Technical - New Dacian's Medicine
Crackles
(Classical / Allopathic Medicine)
A common finding
in certain cardiovascular and pulmonary disorders, crackles
are nonmusical clicking or rattling noises heard during
auscultation of breath sounds. Also known as rales or
crepitations, crackles usually occur during inspiration and
recur constantly from one respiratory cycle to the next. They
can be unilateral or bilateral, moist or dry. They're
characterized by their pitch, loudness, location, persistence,
and occurrence during the respiratory cycle.s
Pulmonary edema
causes fine crackles at the bases of the lungs, and
bronchiectasis produces moist crackles. Sickle cell anemia may
produce crackles when it causes pulmonary infarction or
infection.
Crackles indicate
abnormal movement of air through fluid-filled airways. They
can be irregularly dispersed, as in pneumonia, or localized,
as in bronchiectasis. (A few basilar crackles can be heard in
normal lungs after prolonged shallow breathing. These normal
crackles clear with a few deep breaths.) Usually, though,
crackles indicate the degree of an underlying illness. When
crackles result from a generalized disorder, they usually
occur in the less distended and more dependent areas of the
lungs, such as the lung bases when the patient is standing.
Crackles due to air passing through inflammatory exudate may
not be audible if the involved portion of the lung isn't being
ventilated because of shallow respirations.
ALERT:
If the patient with crackles shows signs of respiratory distress:
- quickly take the patient's vital signs, and examine him for airway obstruction
- check the depth and rhythm of respirations, for increased accessory muscle use and chest wall motion, retractions, stridor, or nasal flaring
- maintain a patent airway, administer oxygen, and institute emergency measures, if necessary.
If the patient doesn't present with signs of respiratory distress, perform a focused assessment.
If the patient with crackles shows signs of respiratory distress:
- quickly take the patient's vital signs, and examine him for airway obstruction
- check the depth and rhythm of respirations, for increased accessory muscle use and chest wall motion, retractions, stridor, or nasal flaring
- maintain a patent airway, administer oxygen, and institute emergency measures, if necessary.
If the patient doesn't present with signs of respiratory distress, perform a focused assessment.
HISTORY:
Review the patient's medical history for respiratory or cardiovascular problems or recent surgery, trauma, and illness.
Ask the patient whether he smokes or drinks alcohol.
If the patient also has a cough, ask him when it began and whether it's constant or intermittent. Find out what the cough sounds like and whether he's coughing up sputum or blood. If the cough is productive, determine the sputum's consistency, amount, odor, and color.
Ask the patient if he has pain. If so where is it located and does it radiate to other areas? Also ask the patient if movement, coughing, or breathing worsens or helps relieve his pain.
Ask the patient if he's experiencing hoarseness or difficulty swallowing.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about recent weight loss, anorexia, nausea, vomiting, fatigue, weakness, vertigo, and syncope.
Ask the patient if he has been exposed to irritants, such as vapors, fumes, or smoke.
Review the patient's medical history for respiratory or cardiovascular problems or recent surgery, trauma, and illness.
Ask the patient whether he smokes or drinks alcohol.
If the patient also has a cough, ask him when it began and whether it's constant or intermittent. Find out what the cough sounds like and whether he's coughing up sputum or blood. If the cough is productive, determine the sputum's consistency, amount, odor, and color.
Ask the patient if he has pain. If so where is it located and does it radiate to other areas? Also ask the patient if movement, coughing, or breathing worsens or helps relieve his pain.
Ask the patient if he's experiencing hoarseness or difficulty swallowing.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about recent weight loss, anorexia, nausea, vomiting, fatigue, weakness, vertigo, and syncope.
Ask the patient if he has been exposed to irritants, such as vapors, fumes, or smoke.
PHYSICAL
ASSESSMENT:
Note the patient's position: Is he lying still or moving about restlessly?
Examine the patient's nose and mouth for signs of infection, such as inflammation or increased secretions. Note his breath odor. Check his neck for masses, tenderness, swelling, lymphadenopathy, or venous distention.
Inspect the chest for abnormal configuration or uneven expansion. Percuss for dullness, tympany, or flatness.
Auscultate the lungs for other abnormal, diminished, or absent breath sounds.
Listen to the patient's heart for abnormal sounds, and check his hands and feet for edema or clubbing.
Note the patient's position: Is he lying still or moving about restlessly?
Examine the patient's nose and mouth for signs of infection, such as inflammation or increased secretions. Note his breath odor. Check his neck for masses, tenderness, swelling, lymphadenopathy, or venous distention.
Inspect the chest for abnormal configuration or uneven expansion. Percuss for dullness, tympany, or flatness.
Auscultate the lungs for other abnormal, diminished, or absent breath sounds.
Listen to the patient's heart for abnormal sounds, and check his hands and feet for edema or clubbing.
SPECIAL
CONSIDERATIONS:
Plan daily uninterrupted rest periods to help the patient relax and sleep. To keep the patient's airway patent and facilitate his breathing, elevate the head of his bed.
Plan daily uninterrupted rest periods to help the patient relax and sleep. To keep the patient's airway patent and facilitate his breathing, elevate the head of his bed.
PEDIATRIC
POINTERS:
Crackles in an infant or child may indicate a serious cardiovascular or respiratory disorder.
Pneumonia produces diffuse, sudden crackles in children.
Esophageal atresia and tracheoesophageal fistula can cause bubbling, moist crackles due to the aspiration of food or secretions into the lungs - especially in neonates.
Cystic fibrosis produces widespread, fine to coarse inspiratory crackles and wheezing in infants.
Crackles in an infant or child may indicate a serious cardiovascular or respiratory disorder.
Pneumonia produces diffuse, sudden crackles in children.
Esophageal atresia and tracheoesophageal fistula can cause bubbling, moist crackles due to the aspiration of food or secretions into the lungs - especially in neonates.
Cystic fibrosis produces widespread, fine to coarse inspiratory crackles and wheezing in infants.
AGING ISSUES:
Crackles that clear after deep breathing may indicate mild basilar atelectasis.
In older patients, auscultate lung bases before and after auscultating apices.
Crackles that clear after deep breathing may indicate mild basilar atelectasis.
In older patients, auscultate lung bases before and after auscultating apices.
PATIENT
COUNSELING:
Teach the patient how to deep-breathe and cough effectively. Encourage him to stop smoking or using aerosols, powders, or other products that might irritate his airways. If the patient needs to restrict fluid intake, teach him how to measure fluids accurately, and instruct him on fluids that he might consider solids such as gelatin.
Teach the patient how to deep-breathe and cough effectively. Encourage him to stop smoking or using aerosols, powders, or other products that might irritate his airways. If the patient needs to restrict fluid intake, teach him how to measure fluids accurately, and instruct him on fluids that he might consider solids such as gelatin.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)