Respiratory Therapy - Please stop charting "coarse" breath sounds!

[@leahlott1463]

As a nurse, and for the moment representing on behalf of RNs everywhere, I would like to formerly apologize to ALL RTs who are continuously frustrated with RNs mischarting breath sounds LOLOLOL! This tutorial needs to be mandatory as part of our nursing school training. Thx Coach!

[@mhairiboyd7712]

Hey Joe.....love your passion for your profession. In Scotland we don’t have RTs. The term “harsh” breath sounds is often used in our ICU. I favourably use the term bronchial breath sounds. Agreed, it’s a term which is often misunderstood. The term “crepes” is often used interchangeably to describe crackles in Scotland. When I was training to be an ACCP (Adavnced critical care practitioner) a Respiratory Consultant explained to me that the only time you should use this term, is when you are ordering a savoury pancake 🤣. Again awesome tutorial 👌🏻

[@RespiratoryCoach]

Hi Mhairi.... thank you for your awesome post!

[@ONEROCKMINISTRY]

I’m a nurse and am so grateful for this. I have NEVER heard “COURSE /CRACKLE “ explanation before. VERY INFORMATIVE.!

[@RespiratoryCoach]

Thanks so much for watching and commenting!! Always grateful to see nursing comments!! We appreciate y'all!

[@beyondreality8506]

JOE!!! Big time having us leveling up! Man I wish your videos had CEU credit. Lol Because not only are you educating us, your videos are really enjoyable! I can sit and binge watch this any day over Netflix! Real talk!

[@RespiratoryCoach]

I appreciate that! Thank you for watching and all the support. CEUs are in the works, hopefully sooner than later! Stay tuned.

[@beyondreality8506]

@@RespiratoryCoach Whaaaaaat?! I just threw that out there like wishing upon a star!! Oh wow Coach! I have my notification bell lit up for this channel. Can’t wait!

[@free2trvl]

Also why I think that crackles and rhonchi should be separately used , crackles as fluid overload and rhonchi as secretions. Keep them separate but use the adjectives fine and course to describe them both. Idk maybe that seems more complicated 🤷‍♀️

[@sapperpapi8249]

Hey Coach! Just passed my TMC today! I gotta include you in my thank you list. Your videos helped a ton!

[@CS-bh4ur]

Hey joe I’m a respiratory therapist in California. I’ve been a RT for 6 years, and I love your video. Thanks for educating me 👍

[@kinder7513]

Thank you for leading the charge for educating, at the click of a mouse, all future and current RT’s and healthcare professionals. You sir are Awesome!

[@Bellacat9]

Thanks so much for this clear explanation! I’m a Pediatric nurse and prior to this video have been describing breath sounds as “coarse” when in reality they are clear but perhaps just louder breathing.

[@joannsienkiewicz3488]

Bravo! Awesome explanation for this old goat! PS You really get worked up, but I won't forget this explanation!

[@henrythatrtguy6448]

Your videos are the best! I need a digital blackboard like that!

[@RespiratoryCoach]

Thanks Henry! I appreciate that! Thank you for watching and commenting!

[@wallytostado85]

As a new nurse in the ICU, I struggle with breathe sounds. This was extremely beneficial.

[@gretchentropy]

ICU RN here. When you were talking about bronchial breath sounds and how people chart diminished when they are actually hearing normal vesicular lung sounds, I literally said "YES!" out loud over my coffee and eggs. Nurses can be pretty terrible at auscultating breath sounds and we're having an influx of new nurses coming into our ICU (no experienced nurse wants to be in an ICU right now!)- I think I might design some education based on your video and some conversations I'll have with my RTs. Thanks!

[@chenkathy239]

Clear my long time confusion, thank you so much

[@Inyaking]

Thanks! I`m using some of your videos in my preparation to USMLE Step 1 as IMG, which I`ll have soon, and I have to say: I know what you`re talking about. We have very similar word to "coarse" in Russia (word "жесткое"), which I really don`t like, because it describes nothing in reality. On top of that, when physicians tell patients that their breath is "coarse" - they often think that there`s something bad and most of the times I have to explain that there`s nothing to worry about. So these undefined words create lots of problems not only for other physicians, but also for patients. I`ve felt a little bit stupid for a long period of time, because I didn`t understand what the heck it means, but, personally, I think that this option exists just because, when patient is sick and has some kind of flu, physicians feel kinda obligated to say that something is not okay, but I think that this is just unprofessional. It`s interesting, how similar medical issues arise in different countries and different languages

[@dolo9448]

Thank you so much !!! That was very helpful. Could you please make a video about flow trigger trigger vs pressure trigger.

[@stacyculbert2878]

I had an older therapist one time tell me I was wrong for calling rales crackles he said they are not the same..... it made me confused so I think it’s important that older therapists and newer therapists are using the same terms the same way.

[@RespiratoryCoach]

100% It really is about ALL therapists speaking the same lingo.

[@cheftommy]

OMG i love the new board and the lighting ! big ups my man ! thank you for everything you have done

[@robgooner]

Thank you so much you are such a gift to the profession. Who is educating all these “coarse” breath sound people?

[@RespiratoryCoach]

I'm not sure, but thank you for your kind comment!!!

[@brandybowden400]

Week 4 semester one student here.. we are learning the breath sounds and I’ve never heard them called coarse solely on their own. I guess I should be lucky I have good instructors.

[@tgaskill]

Awesome video! In my small community hospital, the terminology of adventitious breath sounds (right or wrong) get past down from one generation to another. Plus I think you have non-clinical personnel writing in the descriptions in the EMR!

[@geminigirl68]

I use bronchial all day every day! I find students struggle the most learning the difference between "wet" fluid overload crackles vs Rhonci clearable secretions.

[@RespiratoryCoach]

I love it! And I agree! Not all crackles are created equal.

[@ValentinanSantinamommy]

I can recognize fluid overload outside the patients room.Till these days the Doctor and the nurse insist to give patient albuterol for CHF fluid overload.

[@geminigirl68]

@@ValentinanSantinamommy Al-betterall! 🤣😂🤣😂 Every year we have to educate a new group of residents what Lasix vs Albuterol means!

[@jakesmith789]

Dude this absolutely drives me nuts!! I use the term Ronchi and now that I can define it to be the same as coarse cackles this actually makes more sense. I’m still a student and everyone charts coarse and it drives me crazy just like you’re saying. I ask them the same questions as you’re stating in minutes 9-16. I ask them to explain it to me and they just say coarse and I’m like alright whatever dude..... then I ask them well what’s Ronchi then? And they can’t explain it to me. They say Ronchi isn’t the same as being coarse. But then you ask them well they have secretion build up in their lungs so if we suction it out that would make their breath sounds more clear. They agree but then we get back into this dispute with coarse and Ronchi..... 🙄then if you pop open 2020 version of Kettering they refer to these as Stertor. There’s no option for that and I’ve never heard that before. But I can play the little games with terminology but I agree, continuity needs to be there throughout. Or you have therapists who chart diminished without even listening to their lungs. Why even do that? It literally takes 10 seconds to listen. Bad practice. And this is why I listen to the coach. Thanks man.

[@RespiratoryCoach]

Thanks again Jake for another insightful comment. I too recently came across stertor. Seems like this refers to loud, sonorous breath sounds. And YES...use your stethoscope!!!

[@fishingsouls4christceoofgi614]

From shadowing my good share of professionals in the field, this is my take perspective on breath sounds as to the picture that I got from veteran RT’s. I was literally told time after time “if you are ever called in to court and one of your patients (ex patients is under investigation) you want to make sure you are charting in a way that won’t get you in trouble (😮as a student I was like “ok”) veterans and working RT’s (the average which is a boat full) are playing it safe and not charting accordingly! Your right! I don’t recall seeing Bronchial BS on patients report…. Lol, if it was an option… I want to say I brought it up to the RRT I was shadowed and response was “ohh nobody charts that” I can understand why wrongful BS charting would give you a twitch🤣😂I agree with you 250%. Bottom line, a great RT does not need to document in a gray line to protect their license

[@RespiratoryCoach]

"nobody charts that" Wish you could've seen my eye roll!!

[@clarewhite3004]

At clinicals, we document ronchi or rales, and therapists use the term ronchi frequently. At my student job, we document fine crackles or coarse crackles.

[@RespiratoryCoach]

Perfect! Thanks for watching and sharing your experience!

[@sergioiramgonzalez6112]

Hahaha. You stole my rant!! “Course is an adjective!”

[@RespiratoryCoach]

Sorry I stole your rant! Lol. Someone had to say it. Thanks for watching!

[@D1G1TALSYNAPS3]

They chose to put coarse on the chart just like they chose not to use rhonchi. LONG LIVE RHONCHI!!!!!!

[@RespiratoryCoach]

LOL..."LONG LIVE RHONCHI!!!!!!!!"

[@free2trvl]

Yesssss rhonchi! Always! Lol

[@harveyball7246]

I am a beginning RT student, and I do have a real question. I have a hearing loss and am trying to learn what breath sounds actually sound like. Is there a recorded library of breath sounds that are available with labels, not just wordy descriptions. I want to hear a sound and have someone tell me what type of sound it is. This is normal breath sounds like, play tape. I am also looking for a auscultation device that will allow me to hear breath sounds. I was looking for something more sensitive or maybe amplified. Any thoughts? The continuity of care issue you were talking about above, course breath sounds, does depend on a shared vocabulary, which is common to a community, like health care. It sounds like the RTs don't have a shared vocabulary.

[@harveyball7246]

I love your stuff. You must let me know why you talk so funny, it seems adventitious. Are you from the USA?😀

[@toufikbeni336]

Thank you so much doctor My dad has infected by covid19 he was in hospital for three months anf one months at home her ct scan showed more than 90% damaged in her lungs, now he still oxygen machine 4 little, and VNI machine, The doctor said may he will stay use oxygen for ever. My question is when i put him on 3 litter of oxygen his saturation doing good 95% but when he eat or did some effort his saturation get dow fast sometimes 65% and it's take a few minutes to get better, You prefer to keep the level of oxygen 3 litter and his saturation get better slowly or you prefer augment the level of oxygen and his saturation get better faster?

[@sailipednekar8189]

This was much needed sir. Thank you so much for giving more clarity on this topic. Sir can you also please explain what is meant by crepts? Many of the therapists document crepts as the auscultatory findings. Is it even the correct term ? Is so then what is it? Is it just coarse crackle?

[@RespiratoryCoach]

Hi! Not sure what "crepts" is. Maybe crepitus? Associated with sub q emphysema. I'm not sure why "crepts" is being routinely charted. Maybe it's listed in another text? Great question and thank you for watching and commenting!

[@ManmeetKourAustralia]

i think u r talking abt crepes

[@sailipednekar8189]

@@ManmeetKourAustralia crepts specifically.. as in b/l crepts +ve What is crepe? Can you please explain..

[@ManmeetKourAustralia]

@@sailipednekar8189 in some places they refer to the crepitations as crepes

[@razchhhhh]

hey coah...just really curious...PFT is a really complicated and hard topic...what book can you recommend to understand PFT easier...I know PFT by Vincent madama but are there other books much easier to understand? oh and by the way, I like the new board 👍

[@RespiratoryCoach]

Have you seen my PFT series?

[@razchhhhh]

@@RespiratoryCoach not yet coach...tbh, I want to have a little background first in PFT before I start watching that video.

[@peterdoyle8571]

Could u give us a respiratory overview of epic charting as u understand it.

[@henriquelopes9596]

Thank you.

[@RespiratoryCoach]

You are very welcome! Thank you for watching and commenting.

[@inspiredx3866]

Crackles/Rales is like popping bubble wrap on inspiration

[@الاءحسين-د2ش]

Why we have alarm for PIP and we haven't for P plat? Please can you answer the question

[@jennaramirez6283]

Facts thank u!

[@juegy_poogy]

Man, I feel old. I use the term rhonchorous! Haha

[@RespiratoryCoach]

Not "old"...."OLDER" LOL

[@sinclair657]

Thank you

[@rexshylamariefelipe788]

Hi coach, can you make a video about the air compressor in the mechanical ventilator? and what will happen if you don't plug the mechvent, is there any oxygen flows to the patient and is it okay also if there is no air compressor?

[@najmushshakireen1594]

A very useful vlog

[@RespiratoryCoach]

Thanks a lot. I appreciate you watching and commenting!

[@free2trvl]

I also can't stand when people use coarse as a breath sound!!!!! Its a descriptor of a sound, not a sound by itself!

[@RespiratoryCoach]

Say it louder for the people in the back!

[@keristeen2065]

My pet peeve is when someone charts coarse/rhonchi. The term is synonymous.

[@kD-xu1sq]

So when the crackle is rough is it still coarse crackles? Ex on a vent

[@RespiratoryCoach]

I'm not sure if your description of rough is the same as my description of rough. Hence the struggle with the continuity of breath sounds. If there is a loud, discontinuous sound then we call it course crackles....even on the vent.

[@F22_Raptors]

nice board!

[@mh1290]

I have been saying this for years!!! Nobody seems to understand why it annoys me so much. 😂😂 Also, I use rhonchi, not coarse crackles, to describe secretions in the airway. Another thing that I feel like needs to be touched on is that diminished is a quality of a breath sound, not a breath sound in and of itself. I see people chart diminished, which only tells me that they were softer than usual, but doesn’t tell me anything else.

[@yeaaredz14]

Hey Coach can you do a video on CF and bronchiectasis

[@MarahJane]

Can you make a video about ABG sticks? I can’t seem to be successful on my ABG draws. 😢

[@jakesmith789]

What I have learned with ABG draws is to kind of map out the artery going backwards starting from the wrist. Use your middle and ring fingers to find the pulse because you can actually discover your own pulse if you use your pointer finger. Extend the hand down like they teach you in school and what I do is I try to find the edge of both sides of the artery with my other hand while the needle is ready to go but not inserted. This way I have a general idea on how the artery is running and about how thick it is. I go at a 45 degree angle and try to get a close estimate to where the artery is. Most of the time you don’t get it on your first try so pull out a little bit and aim it back in to the direction of the artery and insert once more. If you still miss do it again and again making little adjustments. If you still can’t get it, maybe pull out completely and try the other hand. Look for the most bounding pulse. Take your time and be patient. You honestly don’t even need to insert the needle very deep to get a successful blood gas. If I see the needle starting to go more than halfway I get a little nervous and pull out and redirect. Really watch for the flash of blood and once you get it you either have to insert a little deeper or pull out a little. Maybe this will help a little bit. I missed a few times before being successful. I try to make it least painful as possible for the patient so I don’t try to be too aggressive and just take my time.

[@RespiratoryCoach]

Great response! Thank you Jake!

[@RespiratoryCoach]

Yes Marah. I'll try to make a video demonstrating the procedure.

[@MarahJane]

@@jakesmith789 Sgt Smith is this you? I finally got successful ABGs. I’m such a visual person so it was hard at first but now I just palpate for that pulse and stick. I still do have a hard time with patients with low BP.. that’s when I try to visualize the anatomy of the arm. Sometimes it works, sometimes it doesnt. Thank you for your response!!

[@MarahJane]

@@RespiratoryCoach Yes thank you sir!

[@kD-xu1sq]

If it is a rough sound is it still crackles?? I hear it a lot on the vent . Please advise

[@RespiratoryCoach]

Probably should have read this comment before replying to your other. Tell me what you mean by rough. Is it clear, just louder, like you can hear the vent delivering the breath, or is an abnormal discontinuous sound?

[@kD-xu1sq]

@@RespiratoryCoach when I say it Sounds rough, it’s louder than a normal coarse . It’s deep and sometimes dry and definitely not a wheeze. One preceptor told me it’s coarse and another preceptor said that’s rhonci.

[@RespiratoryCoach]

@@kD-xu1sq Got it! Based off of your preceptors' feedback, I'm going to say that you're hearing coarse crackles, aka rhonchi. Your one preceptor who defined it as "coarse" is the prime example of what the hell does that mean? Case in point for why the video was made. Coarse isn't a breath sound. So it sounds like you're hearing coarse crackles amplified by the positive pressure ventilation. Does that help?

[@kD-xu1sq]

@@RespiratoryCoach ok thank you so coarse is rhonchi ultimately, thank you so much. I wish you were my teacher. I have my final Monday your videos are helpful I sincerely appreciate you

[@RespiratoryCoach]

@@kD-xu1sq GO BE GREAT!

[@JustBreathe30]

You have made a great point with using the word coarse. During my clinical's, the RT's would have me just chart, in Epic, coarse. Would you chart coarse crackles in the chart instead? Thank you for all the videos you do. It helps a lot with my studies.

[@RespiratoryCoach]

Awesome! Glad you find the channel helpful. Thanks for watching and commenting!

[@srk341717]

Hello sir... Sir can you help by teaching Critical care medicine used in ICU ?

[@rohithshetty7821]

Crepes used for??

[@RespiratoryCoach]

I'm assuming fine crackles, but really not sure.

[@itsssmenil7287]

Hi coach , can you pls discussed prvc simv and prvc ac🙏

[@RespiratoryCoach]

I'll see what I can do soon! Thank you for watching and asking your question!

[@itsssmenil7287]

@@RespiratoryCoach thanks coach!🙏😀