Wheezing
Narrowed lower airways. Common contexts include asthma, COPD, allergic reactions, respiratory infection, or irritant exposure.
Main rule
Breath sounds suggest a process—they do not prove a diagnosis
The same sound can appear in different conditions. Use history, respiratory effort, SpO₂, ETCO₂, chest symmetry, fever, trauma, edema, medication history, and response to care.
Crackles
Brief popping sounds associated with small airways opening, fluid, infection, edema, atelectasis, or chronic interstitial disease.
Stridor
Upper-airway narrowing. Consider croup, foreign body, swelling, anaphylaxis, burns, infection, or airway trauma.
Rhonchi
Coarse, lower-pitched continuous sound often associated with secretions or turbulent airflow in larger airways.
Diminished
Reduced air movement or sound transmission. Consider shallow breathing, obesity, obstruction, effusion, pneumothorax, or poor technique.
Absent / silent
May reflect severe airflow limitation or a unilateral process. In a distressed patient, this is a high-priority finding.
Treatment categories
Treatment follows the cause and the patient—not the sound label
Follow local protocol and scope. These categories are for learning, not a patient-specific treatment plan.
Support airway and ventilation
Position, suction when indicated, airway maneuvers or adjuncts, oxygen when needed, and assisted ventilation when breathing is inadequate.
Bronchospasm treatment
Bronchodilator therapy may be appropriate for wheezing from lower-airway bronchospasm when allowed by protocol or prescription. Reassess air movement—not just wheeze loudness.
Allergic upper/lower airway disease
Anaphylaxis can cause wheezing, stridor, swelling, and shock. Epinephrine and airway support may be time-critical under protocol.
Fluid or infection processes
Crackles require cause-focused evaluation. Pneumonia, pulmonary edema, atelectasis, and chronic lung disease are managed differently.
Trauma or unilateral absence
Unequal or absent sounds after trauma can signal a life threat. Rapid reassessment and trauma-specific care are required.
Reassess response
Repeat lung sounds, respiratory rate, effort, SpO₂, ETCO₂, mental status, and patient-reported breathing after intervention.
Emergency warning signs
Findings that should raise your concern
Silent chest with severe distressVery little air movement can produce less wheezing even as the patient worsens.
Stridor with swelling, drooling, or altered mental statusMay indicate a rapidly threatened upper airway.
Unilateral absent sounds after traumaConsider a serious pleural or airway problem and treat the situation urgently.
Cyanosis, exhaustion, or decreasing mental statusThese suggest failing oxygenation or ventilation regardless of the sound heard.
Can only speak a few wordsSpeech limitation can reflect significant respiratory compromise.
Rapid deterioration after treatmentReassess the airway, ventilation, and diagnosis rather than assuming the first treatment worked.
Scenario practice
Choose the best interpretation
Scenario 1
A patient with asthma was loudly wheezing. They are now drowsy, barely moving air, and the wheeze is much quieter.
Scenario 2
A febrile patient has focal crackles in the right lower posterior field and a productive cough.
Scenario 3
After blunt chest trauma, the patient is hypotensive, severely dyspneic, and has absent sounds on one side.
Trusted references
Learn more from medical references
Emergency reminder: Severe breathing difficulty, cyanosis, altered mental status, exhaustion, stridor with distress, rapidly worsening swelling, unilateral absent sounds after trauma, or a silent chest requires urgent action.