Rhonchi: recognizing low-pitched, snoring-like lung sounds that signal airway obstruction

What are lung sounds that resemble low-pitched snoring or rattling called?

• A. Wheezing
• B. Rhonchi
• C. Stridor
• D. Crackles

Answer: (B)

Lung sounds that resemble low-pitched snoring or rattling are known as rhonchi. These sounds typically occur when airflow is obstructed in the larger airways due to secretions or other blockages. Rhonchi are often described as a musical or moaning quality and are usually heard during expiration, although they may be present during inhalation as well. This characteristic helps differentiate rhonchi from other lung sounds. In practice, if an EMT hears rhonchi during a patient assessment, it may indicate that the patient has bronchospasm or an accumulation of mucus in the airways, which could be associated with conditions like bronchitis or chronic obstructive pulmonary disease (COPD). Recognizing these sounds is critical in forming a treatment plan, as they suggest the need for interventions such as suctioning or the administration of bronchodilators to help clear the airways.

On the move, with sirens in the background and a patient breathing through a crowded chest—that’s where you learn what the lungs are really telling you. In the world of EMTs, sound isn’t just noise. It’s information. And one sound you’ll recognize, if you listen carefully, is rhonchi—the low, snoring, rattling note that signals something isn’t moving as freely as it should in the big airways.

Rhonchi: what the sound is telling you

Let’s start with the basics. Rhonchi are lung sounds that patients make when air has to squeeze past secretions in the larger airways. Think of it like trying to blow air through a straw that’s got a speck of mucus in it. The result is a long, coarse, moaning or snoring quality. It’s not a tiny whisper; it’s a louder, more durable sound that you can often hear with the stethoscope pressed firmly on the chest, especially as the patient exhales.

A helpful rule of thumb: rhonchi are typically low-pitched. They may clear a bit when the patient coughs, which is a good clue. They’re often described as musical, moaning, or rattling. Unlike some other lung sounds, rhonchi tend to be more evident in the larger airways and can be present during expiration. In some cases they appear during inhalation as well, but the expiration-heavy pattern is a pretty reliable cue.

How rhonchi differ from other lung sounds

In the field, you’ll hear several different sounds, and they each tell a different story. Here’s a quick comparison so you can tell them apart in a busy room:

• Wheezing: a high-pitched whistling sound, usually due to narrowed airways from bronchospasm or swelling. It’s the “squeak” you hear when the air has to squeeze through tight passages.

• Stridor: a harsh, high-pitched sound heard primarily during inspiration, pointing to obstruction higher up in the airway (think larynx or trachea). It’s urgent and often louder than other lung sounds.

• Crackles (rales): fine or coarse popping sounds, usually tied to fluid in the alveoli or small airways. They can signal conditions like pneumonia or heart failure.

• Rhonchi: the low, snoring or moaning sound in the larger airways, from secretions or mucus plugging. It often clears with coughing.

Why rhonchi matter on the scene

If you hear rhonchi, you’re catching a clue about the airway’s condition. It suggests that mucus or secretions are hanging around in the bigger passages. That can come from bronchitis, a COPD flare, a respiratory infection, or even chronic mucus production in conditions like bronchiectasis. The presence of rhonchi tells you: airway clearance might be a priority, and bronchodilators or suctioning could play a role, depending on the situation.

Here’s the thing: rhonchi aren’t the whole story. They don’t tell you exactly what disease is present, but they nudge you toward a practical plan. If the patient is coughing up mucus, or if you’re found in a scenario with obstruction or bronchospasm, rhonchi help you weigh your next steps.

A practical approach for EMTs: what you can do about rhonchi

Let’s walk through how rhonchi shape what you do next, in a real-world sense.

• Clear the airway when you can. If there’s a visible or audible accumulation of secretions, suctioning may help. This isn’t about chasing a single sound—it’s about improving airflow so the patient can breathe more comfortably and get oxygen more effectively.

• Consider bronchodilators when indicated. If there’s a bronchodilator-responsive component (think COPD exacerbation or a reactive airway), a bronchodilator can reduce airway obstruction, which may lessen the rhonchi over time.

• Support oxygenation as needed. If the patient isn’t getting enough oxygen, or their work of breathing is rising, deliver supplemental oxygen to maintain adequate oxygen saturation. Rhonchi don’t replace the need to look at overall respiratory status, but they’re a part of the picture.

• Monitor the pattern. Listen again after interventions. Do the rhonchi soften or clear with coughing, bronchodilator use, or suctioning? If they persist and the patient isn’t improving, you know you’re facing a more complex scenario and should escalate care or transport sooner.

• Communicate the findings. Your assessment notes should include what you heard, not just what you suspect. “Rhonchi heard on expiration in the lower to mid lung fields; mucus production noted; partial improvement with suctioning,” that kind of clear, concrete line helps the receiving team know what to expect.

Technique matters: listening like a pro

The way you listen makes a big difference. Here’s a straightforward method you can use on any call:

• Position matters. Have the patient seated or semi-upright if possible. A relaxed airway allows air to flow and sound to travel clearly.

• Use the diaphragm of your stethoscope. It picks up the lower, longer sounds better than the bell for rhonchi.

• Test multiple sites. Check both lungs, moving in a methodical pattern (anterior and posterior if you can, and lateral views if needed). Compare sides and note whether the sound is more pronounced in a particular region.

• Ask about what helps. If the patient can cough, listen before and after coughing. Rhonchi that clear with a cough point toward secretions in the larger airways.

• Note associated signs. Are they coughing up mucus? Is there wheezing, shortness of breath, chest tightness, or fever? All of these details sharpen your sense of the likely cause.

A real-world moment to connect

Think of an afternoon call in a small town where a middle-aged patient with a history of smoking sits on the curb, breathing hard, chest rising and falling with effort. You listen with your stethoscope and hear a low, lingering, snoring note—rhonchi—especially as they exhale. The patient has a productive cough, bringing up thick mucus. It could be bronchitis, a COPD flare, or a viral infection with secondary mucus production. You don’t know yet what’s driving it, but you know two things: the airway needs help moving air, and the mucus is part of the problem.

In that moment, you implement a practical plan: position the patient to optimize breathing, suction if secretions are pooling, consider a bronchodilator if you have the protocol and the patient’s history allows, and monitor oxygenation. You coordinate with the team and prepare for transport. The rhonchi you heard aren’t just a sound; they’re a doorway to understanding the patient’s airway status and guiding care.

A quick bedside checklist to keep in mind

• Confirm the core finding: low-pitched, snoring or moaning sounds in the larger airways, often on expiration.

• Check for mucus production and coughing. Note whether coughing clears the sound.

• Assess overall respiratory status: rate, depth, effort of breathing, oxygen saturation.

• Decide on airway care: suctioning if secretions are present and interfering with airflow.

• Consider medications within scope and protocol: bronchodilators if indicated and approved.

• Reassess after interventions: do the rhonchi lessen or disappear? If not, escalate as needed.

• Document clearly: location, timing, whether it changes with coughing, and how the patient’s condition evolves.

A few caveats to keep in mind

Rhonchi aren’t a universal sign of a single disease. They are a helpful clue that secretions are present in the larger airways. They can be heard in a range of scenarios—from bronchitis in a younger adult to a COPD flare in an older patient. And yes, in some cases, you won’t hear rhonchi at all, or you’ll hear other sounds that demand a different plan. The skill is in listening carefully, recognizing patterns, and tying what you hear to how the patient feels and what you observe.

The bigger picture: why this matters beyond one sound

Lung sounds are part of a larger art—assessing a patient’s respiratory system. Rhonchi are a signal that there’s something in the way of clean, free air movement. They help you decide if airway clearance is a priority, if meds might help, or if the patient needs rapid transport for advanced care. It’s not just about identifying a single sound; it’s about reading the lungs as a living clue sheet that guides your actions.

A small sidebar: tools you might rely on

• Stethoscope brands you’ll see in the field. A dependable Littmann model is a common pick for clear acoustic quality. The better you can hear, the more precise your assessment becomes.

• Suction equipment. Portable suction units and catheters let you clear secretions quickly, reducing airway resistance and improving oxygenation.

• Oxygen delivery gear. Simple nasal cannulas, simple face masks, or non-rebreather setups—whatever fits the scene and keeps the patient comfortable while you manage the airway.

Bringing it together

Rhonchi are a concrete, real-world cue in the EMT toolkit. They aren’t the whole story, but they’re a meaningful piece of the puzzle—one that helps you shape a practical, compassionate response on scene. When you hear that low-pitched, snoring sound, you’re not just listening to a nuisance. You’re catching a vital piece of the patient’s breath story, and that story often points to a path toward relief: clear the airway, support breathing, monitor closely, and transport when needed.

So next time you’re at a patient’s side with a stethoscope pressed to the chest, tune in to those deeper notes. Rhonchi aren’t just a sound; they’re a clue, a signal, and a reminder that every breath matters. And in the world of emergency care, paying attention to those sounds can make the difference between a rough night and a smoother, safer recovery for someone who needs you right now.