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AnthonyM83

"Tight" Lung Sounds

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I hear a term all the time that I didn't learn in school, but it makes perfect sense when trying to describe lung sounds..."tight". How would you document that?

It's not just decreased, like with a pneumothorax. It's not actual wheezing. It's much less crackly than wheezing, rales, or normal lung sounds. The medics usually relay it as "wheezing" to base, so that they'll be allowed to give albuterol and it usually offers immediate relief.

Guess it sounds like constriction of airway, but no stridor or other sounds...just tighter.

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I'll usually use "tight" to describe minimal tidal volume with end expiratory wheezes. Kind of what it would sound like to breathe through a swizzle stick, I guess.

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"Tight" breath sounds is not official. Basically what it is bilateral wheeze with decreased air exchange up to and including not being able to hear any wheeze at all. If you hear no wheeze, minimal air exchange (sometimes none), and see gross assessory muscle use with tracheal tugging, tripoding, nasal flaring, and apprehension, I'd say that pt is "tight".

It could be argued that the pt is still wheezing, but there is such little air exchange that there is not enough air to make the wheeze audible, or they are wheezing but at such a high pitch that it is beyond our auditory range that we just can't hear it.

Just my thoughts.

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Sometimes you might have a patient with chronic COPD and or long hx. of asthma that will describe it "tight" themselves if they have experienced in the past. In that case you can state that the patient described it as "tight", which you can verify by the decreased air flow as the others have stated.

I myself having asthma, what Delta and AZCEP described are right on.

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Good point firedoc.

I guess the term would be a bit subjective, and if the patient describes it that way I'd use it to relay the information.

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As AZCEP said, the term is largely subjective. I think that it is more appropriate for the patient to describe the feeling of a tight chest, as opposed to describe a sound on auscultation. Tight, as in the feeling that the patient gets..that they cannot expand their chest to accommodate enough air..

Wheezes are wheezes, rhonchi is rhonchi, rales are rales..'tight' is not an airway sound, nor should it be used to describe one..In my opinion that is.. :?

I do understand that intense wheezing or lack of sounds all together is commonly called tight chest referring to the bronchoconstriction..Similar to using the term 'junky' to describe a wet, rhoncus chest..common, but incorrect..

I think a physician would appreciate a more descriptive term..as would I if I were trying to treat or prepare for a patient..

my $.02...give or take :D

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I guess I will continue stating the obvious, that if the patient is so "tight" that wheezing is inaudible, keep an eye on them, as they are probably going to be so tired, due to the resperatory effort, that they are going to "crash".

I'll presume the word, while not official, sure describes what might happen next.

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..common, but incorrect..

That is a term that needs to be burned onto the forehead of every new EMSer. (Or, as some whiners might consider that poor management technique, perhaps just explained better in school.)

Great point.

Dwayne

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The vernacular / terminology used when describing what one is auscultating to a ER doc can be very clear and besides the development of 'slang' in Emergency Medicine is not a new concept at all.

Tight = Wheeze / Asthma / COPD

Wet = Bibasilar fine creps or crackles = CHF

Rhonch (coarse) = +++ secretions = Pneumonia

Leathery crackling sounds (and not easy to pick up) = Plural rubs

The silent chest is the most serious consideration to my way of thinking, so why make it so complex with old terminology from the dark ages of time, if you have to patch for advice or orders .... the KISS theorem is quite applicable in most cases and far more easily understood.

BUT if the C/C of a "tight feeling in the chest" this is a entirely whole different concept.

Personally I use the term "your quite musical sir/madam" when speaking with patients .... somehow this term is far less "stressing" to the patients .... IMHO.

cheers

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probably going to be so tired, due to the resperatory effort, that they are going to "crash".

I'll presume the word, while not official, sure describes what might happen next.

Nice . . .

As far as the term, it's commonly used here, though I suppose someone new to the area could be confused...though first time I heard that lung sound as a new EMT, I knew exactly what everyone meant when they said "tight".

It's hard to use a different term, because you're not actually hearing a wheezing sound...and you're not hearing absence of sound. You're hearing air having trouble pushing through passages, it seems...and if it is wheezing it's so compressed that you don't hear actual wheezes anymore...(though they might both be from same cause)

It's a pretty common sound, btw....I'd say almost half of our asthma patients have tight sounds rather than the sound of wheezing...most are pretty stable and get enough relief to hold off inbutation from an albuterol nebulizer.

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