![]() Important factors in the history of the patient include accompanying symptoms, history of infection, and occupational history. The sound does not change after a bout of coughing.Īdditional findings on history and physical exam will be suggestive of the underlying pathology. A typical description of the sound is that it “sounds like walking on fresh snow.” The pleural friction rub is biphasic (heard on inspiration and expiration), usually localized to a small area of the chest, and may be accentuated by increasing the pressure on the stethoscope. ![]() On auscultation, pleural friction rub is a non-musical, short explosive sound, described as creaking or grating and likened to walking on fresh snow. The sound may be intermittent or continuous. The patient may complain of local tenderness with palpation, depending on the underlying etiology. This sensation is suggestive of a pleural rub. Upon palpation of the chest, the clinician may note a sandpaper-rubbing type of sensation. If the underlying cause of the pleural rub is pleural effusion, patients may experience some relief from leaning forward and supporting their upper body with hands placed on the knees or another surface. Patients will often complain of pleuritic chest pain, which is sudden, intense, and worse with movement, such as respiration. The visceral pleura lacks somatic innervation and nociceptors. Somatic nerves innervating the parietal pleura are responsible for this pattern of pain. While the visceral pleura lacks somatic innervation and nociceptors, somatic nerves innervating the parietal pleura relay the sensation of pain. If the site of inflammation is near the diaphragm, pain can refer to the neck or shoulder. Often, pleural friction rub is accompanied by pleuritic chest pain, which is characterized by sudden, intense, and sharp pain that is worse with inspiration. The characteristic grating sound of the pleural rub is believed to result from the release of energy when the inflamed pleural surfaces overcome the increased friction and slide past one another. Pediatric Pulmonology published by Wiley Periodicals LLC.Pleural friction rub occurs when inflammation roughens the surfaces of the visceral and parietal pleura. In this setting, friction between the pleura further increases due to decreased production of lubricating fluid (pleural fluid) by the pleura. Less experienced physicians perform better on lung auscultation, indicating that continuing education with critical feedback should be offered.Ĭrackles pleural friction rub respiratory sounds squawks wheezes. Gaps remain in both terminology and recognition of lung sounds among a wide population of Greek physicians. Years of experience were negatively correlated with the number of correct answers (OR: 0.73 CI:0.62-0.84 p = 0.001). The medical specialty was correlated with the correct answers and both pediatricians and physicians of general/internal medicine and subspecialties recognized fewer sounds compared with respiratory physicians (odds ratio : 0.37 confidence interval : 0.22-0.62 p < 0.001 and, OR: 0.47 CI: 0.22-0.99, p = 0.048, respectively). The rates of correct answers were 55.2% for fine crackles, 74.5% for coarse crackles, 72.2% for wheezes, 18.75% for squawks, and 11.25% for pleural friction rub. They listened to five audio-recorded respiratory sounds and described them in free-form answers. The present study aimed to assess the auscultatory skills of healthcare professionals and medical students.Ī total of 295 physicians (185 pediatricians, 69 pulmonologists, and 41 physicians of general/internal medicine and subspecialties), 55 residents, and 50 medical students participated in the survey. However, the ability of observers to recognize respiratory sounds varies considerably and depends on the sound. Lung auscultation is an important tool for diagnosing respiratory diseases.
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