ctab

Bretzel said:

What exactly does clear to auscultation imply? Does that simply mean you can hear lung sounds bilaterally? If you hear rales or wheezing is it no longer CLEAR to auscultation or are those separate observations?

Thanks in advance!

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CTAB means "I listened to the lungs. They were there. They were equal on both sides. All the sounds that are supposed to be there are there, and there were none of the sounds that weren't supposed to be there."

On the other hand, more specifically, and more along the lines of the answer you want, is that you hear vesicular lung sounds (quiet, inspiration longer then expiration) that are the same bilaterally at each of the points you listen to (8 on the back, 6 on the front, 1 on each side at a minimum) and each lung field was free of adventitious lung sounds (rales, ronchi, crackles, wheeze, stridor, however you want to name them).

REALLY what it means is "no one wants to read a ditribe on a normal physical exam finding, so I wrote CTAB to imply an exam was done, and I consider it normal"

Bretzel said:

If you hear rales or wheezing is it no longer CLEAR to auscultation or are those separate observations?

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If ever you have an abnormal finding, you wold not write CTAB. CTAB is a code for "normal lung exam." If you found a positive finding, you would instead describe the positive finding. When you describe a positive finding, it is presumed that all other findings on the lung were "normal."

The same is true for EOMI, RRR, No M/R/G, NT ND +BSx4 and the rest of the nonsense code. It conveys to the reader "i did the exam and I think its normal, scan for where I wrote real words to find the peritinent positives"

OveractiveBrain said:

CTAB means "I listened to the lungs. They were there. They were equal on both sides. All the sounds that are supposed to be there are there, and there were none of the sounds that weren't supposed to be there."

On the other hand, more specifically, and more along the lines of the answer you want, is that you hear vesicular lung sounds (quiet, inspiration longer then expiration) that are the same bilaterally at each of the points you listen to (8 on the back, 6 on the front, 1 on each side at a minimum) and each lung field was free of adventitious lung sounds (rales, ronchi, crackles, wheeze, stridor, however you want to name them).

REALLY what it means is "no one wants to read a ditribe on a normal physical exam finding, so I wrote CTAB to imply an exam was done, and I consider it normal"


If ever you have an abnormal finding, you wold not write CTAB. CTAB is a code for "normal lung exam." If you found a positive finding, you would instead describe the positive finding. When you describe a positive finding, it is presumed that all other findings on the lung were "normal."

The same is true for EOMI, RRR, No M/R/G, NT ND +BSx4 and the rest of the nonsense code. It conveys to the reader "i did the exam and I think its normal, scan for where I wrote real words to find the peritinent positives"

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I'm actually kinda curious about the naming of crackles/rales. In the beginning of the year we had a physical diagnosis professor lecture to us that crackles was the correct term to use because rales is supposed to actually describe râle de la mort (death rattle). Then later we had a pulm professor say in lecture that he doesn't want us to say crackles in third year because the proper term is rales. He went on to basically say that we'll sound like we know what we are doing if we say rales and we'll sound like newbs if we say crackles. Is there any kind of consensus?

richse said:

I'm actually kinda curious about the naming of crackles/rales. In the beginning of the year we had a physical diagnosis professor lecture to us that crackles was the correct term to use because rales is supposed to actually describe râle de la mort (death rattle). Then later we had a pulm professor say in lecture that he doesn't want us to say crackles in third year because the proper term is rales. He went on to basically say that we'll sound like we know what we are doing if we say rales and we'll sound like newbs if we say crackles. Is there any kind of consensus?

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I have been taught formally that rales is the correct term. However, only someone who is extremely anally retentive would flag you up for saying crackles instead of rales.

on my progress notes if everything is normal i just write in the physical exam section one line for the entire thing: "grossly intact"

ctab means "clear to auscultation, baby!"

VoiceofReason said:

on my progress notes if everything is normal i just write in the physical exam section one line for the entire thing: "grossly intact"

ctab means "clear to auscultation, baby!"

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Going into surgery?

I had been taught that the above terminology varies too much to mean anything. The 2-3 standard physical dx textbooks say different things. Some say Ronchi sounds like loud, wet Rales.... some say Ronchi sounds like wet stacattoed Wheezing.... so, I guess "Crackles" is a non-technical but more universal description.

http://chestjournal.chestpubs.org/content/85/4/523.abstract

I googled it and came up with a few articles like this one. the ATS stopped using "rales" in their articles in 1977....

Do you lot draw pretty pictures like this when describing systems?

richse said:

I'm actually kinda curious about the naming of crackles/rales. In the beginning of the year we had a physical diagnosis professor lecture to us that crackles was the correct term to use because rales is supposed to actually describe râle de la mort (death rattle). Then later we had a pulm professor say in lecture that he doesn't want us to say crackles in third year because the proper term is rales. He went on to basically say that we'll sound like we know what we are doing if we say rales and we'll sound like newbs if we say crackles. Is there any kind of consensus?

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Rales, teh french word for "lung sound" actually means nothing. I've found that it has been used to describe crackles, the sort of snap crackle pop sounds of atelectasis, simulated by rubbing two strands of hair together close to your ear. It is so commonly used that way that even though Rales is a poor word choice, it is understood to mean "an adventitious lung sound other than wheeze, ronchi, or stridor."

For information check out Sapira's Art and Science of Bedside Diagnosis which as a nauseatingly long explanation of the different lung sounds. You can check it out on Amazon here . The third edition is way cheaper and just as good.

Rales pronounced Rhal not Rails, and because its a French word, if you pronounce it in the french way, its not Rhalz, but Rhal. Almost universally referred to (including by myself because Im an ignorant white guy who speaks American English and doesn't try to pretend to speak french) as "Rails" as in the things that trains run on.

it's like RRR for the lungs

OveractiveBrain said:

Rales, teh french word for "lung sound" actually means nothing.

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It means something according to stedman's medical dictionary, bate's, and various other text.

OveractiveBrain said:

Rales, teh french word for "lung sound" actually means nothing. I've found that it has been used to describe crackles, the sort of snap crackle pop sounds of atelectasis, simulated by rubbing two strands of hair together close to your ear. It is so commonly used that way that even though Rales is a poor word choice, it is understood to mean "an adventitious lung sound other than wheeze, ronchi, or stridor."

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Rales is french for "rattle." It does not mean "lung sound." And it's synonymous with crackles in the modern usage. The trend is to use crackles rather than rales.

VoiceofReason said:

ctab means "clear to auscultation, baby!"

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I lol'd

b-real said:

Rales is french for "rattle." It does not mean "lung sound." And it's synonymous with crackles in the modern usage. The trend is to use crackles rather than rales.

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thechad said:

It means something according to stedman's medical dictionary, bate's, and various other text.

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You're right, I mispoke. Laennec used the term rales "to mean any ADVENTITIOUS chest sounds that he could identify in the first 3 yars after he invented the stethoscope. This would be equivalent to the English word 'rattle" with its connotations of 'death rattle.'" (Sapira, Page 313). In the previous post I was trying to indicate that one should not use Rales without a modifier, that it actually means nothing on its own. Its better to say "I heard something not normal, but I don't know how to describe it" than to put "rales," which is diagnostically insignificant and conveying a different meaning than what you want it to.

Its not any lung sounds, its any bad lung sound. Because Rales meant "death rattle" it was poor form to say the word "rale" in front of a patient, so he used "rhoncus," the latin form. Translating from french to latin to english has rales lose its connotation. Isnt that a kick in the pants. Rales (French) = Rhoncus (Latin), which was then both translated back into English, RESTRICTING the use of rales.

There are wet rales, the crackling rales, the things Hippocrates described as boiling water, referring to inspiratory crackles of atelectasis.

There are gurgling rales, probably ronchi.

There are Low-Pitched Wheezes (Rale sec sonore ou ronflement), or a musical ronchus, which is really just a wheeze, maybe stridor

There are High-pitched Wheezes (Rale sibilant sec ou sifflement), or hissing, that also constitutes wheeze

Current Dogma has said "rales = crackles" because people learn "rales = adventitious lungs sounds, but since its a different word from rhoncus, it must mean something else." ANd to people who point out "its in a book" there were plenty of books that said the earth was flat, that the world will end in 2012, and that the Rapture has come / will come in October.

For most people, who do not care to learn the true meaning or history of a word, which constitutes most physicians, rales = crackles, and can be used as such. (Rales is "better" because its french, crackles sounds like Rice Krispies... people are so vulnerable to the guiles of emotional manipulation). Since it was a thread on physical diagnosis, I thought I'd go ahead and shed some light on the truth. Take what you will from it.

OveractiveBrain said:

You're right, I mispoke. Laennec used the term rales "to mean any ADVENTITIOUS chest sounds that he could identify in the first 3 yars after he invented the stethoscope. This would be equivalent to the English word 'rattle" with its connotations of 'death rattle.'" (Sapira, Page 313). In the previous post I was trying to indicate that one should not use Rales without a modifier, that it actually means nothing on its own. Its better to say "I heard something not normal, but I don't know how to describe it" than to put "rales," which is diagnostically insignificant and conveying a different meaning than what you want it to.

Its not any lung sounds, its any bad lung sound. Because Rales meant "death rattle" it was poor form to say the word "rale" in front of a patient, so he used "rhoncus," the latin form. Translating from french to latin to english has rales lose its connotation. Isnt that a kick in the pants. Rales (French) = Rhoncus (Latin), which was then both translated back into English, RESTRICTING the use of rales.

There are wet rales, the crackling rales, the things Hippocrates described as boiling water, referring to inspiratory crackles of atelectasis.

There are gurgling rales, probably ronchi.

There are Low-Pitched Wheezes (Rale sec sonore ou ronflement), or a musical ronchus, which is really just a wheeze, maybe stridor

There are High-pitched Wheezes (Rale sibilant sec ou sifflement), or hissing, that also constitutes wheeze

Current Dogma has said "rales = crackles" because people learn "rales = adventitious lungs sounds, but since its a different word from rhoncus, it must mean something else." ANd to people who point out "its in a book" there were plenty of books that said the earth was flat, that the world will end in 2012, and that the Rapture has come / will come in October.

For most people, who do not care to learn the true meaning or history of a word, which constitutes most physicians, rales = crackles, and can be used as such. (Rales is "better" because its french, crackles sounds like Rice Krispies... people are so vulnerable to the guiles of emotional manipulation). Since it was a thread on physical diagnosis, I thought I'd go ahead and shed some light on the truth. Take what you will from it.

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I like this. Im going to start using it.

OveractiveBrain said:

You're right, I mispoke. Laennec used the term rales "to mean any ADVENTITIOUS chest sounds that he could identify in the first 3 yars after he invented the stethoscope. This would be equivalent to the English word 'rattle" with its connotations of 'death rattle.'" (Sapira, Page 313). In the previous post I was trying to indicate that one should not use Rales without a modifier, that it actually means nothing on its own. Its better to say "I heard something not normal, but I don't know how to describe it" than to put "rales," which is diagnostically insignificant and conveying a different meaning than what you want it to.

Its not any lung sounds, its any bad lung sound. Because Rales meant "death rattle" it was poor form to say the word "rale" in front of a patient, so he used "rhoncus," the latin form. Translating from french to latin to english has rales lose its connotation. Isnt that a kick in the pants. Rales (French) = Rhoncus (Latin), which was then both translated back into English, RESTRICTING the use of rales.

There are wet rales, the crackling rales, the things Hippocrates described as boiling water, referring to inspiratory crackles of atelectasis.

There are gurgling rales, probably ronchi.

There are Low-Pitched Wheezes (Rale sec sonore ou ronflement), or a musical ronchus, which is really just a wheeze, maybe stridor

There are High-pitched Wheezes (Rale sibilant sec ou sifflement), or hissing, that also constitutes wheeze

Current Dogma has said "rales = crackles" because people learn "rales = adventitious lungs sounds, but since its a different word from rhoncus, it must mean something else." ANd to people who point out "its in a book" there were plenty of books that said the earth was flat, that the world will end in 2012, and that the Rapture has come / will come in October.

For most people, who do not care to learn the true meaning or history of a word, which constitutes most physicians, rales = crackles, and can be used as such. (Rales is "better" because its french, crackles sounds like Rice Krispies... people are so vulnerable to the guiles of emotional manipulation). Since it was a thread on physical diagnosis, I thought I'd go ahead and shed some light on the truth. Take what you will from it.

Click to expand...

If I correctly understood your post. Then I think the answer to my question is that my phsyical diagnosis prof. was right to say rales refers to the death rattle and we should use other terms (e.g. crackles). This really makes me wonder about the pulm attending that told us we would sound stupid if we said crackles instead of rales. Hopefully I wont end up rotating with him because I'm going to be saying crackles.

richse said:

If I correctly understood your post. Then I think the answer to my question is that my phsyical diagnosis prof. was right to say rales refers to the death rattle and we should use other terms (e.g. crackles). This really makes me wonder about the pulm attending that told us we would sound stupid if we said crackles instead of rales. Hopefully I wont end up rotating with him because I'm going to be saying crackles.

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I wouldnt wonder too much.... if it worries you about that particular attending, just adapt to his terminology for the rotation. Some medical terms simply don't have fixed definitions, or the common usage differs from the "official"

Eg - laceration is a jagged-edged wound from blunt trauma, while an incision is smooth-edged due to penetrating trauma. -OR- laceration is any linear open wound, and an incision is made by a surgeon

Eg - that whole sedative - hypnotic - anxiolytic confusion...

I dont think you can go wrong if you describe the rales or crackles each time - fine, coarse, wet, gurgling + rales or crackles. The description would mean more than the named sound to whoever's reading.