Before I start this week, I want to apologize. As much as I want to produce a weekly article for Medical Monday, life sometimes gets in the way. I have been working on my Senior status for the Ski Patrol while simultaneously managing the patrol and updating my classes to incorporate the new AHA standards.
Truth be told, I’m also running out of ideas of topics to cover. I’m VERY open to suggestion of any topic in medicine that you find difficult to understand or are looking to learn. Please send the comments and help me help you.
We all carry stethoscopes to use for assessing patients, but how many of us really know the sounds that we’re hearing. For most pre-hospital care simply knowing that there’s air moving into the lobes of the lungs is sufficient. But are we listening in the right place to assess all 5 lobes? I had found this photo series to show the proper place to assess lung sounds in each lobe. (I’m sorry I don’t know the proper photo credit, I found it uncredited. If someone know the proper source, I’ll be happy to update).
It’s also important to remove anything that may impede a clear sound. We have to place our stethoscope diaphragm (or bell) directly to the skin. Movement of clothing can greatly affect our ability to hear the subtle sounds of the lungs. In addition a good quality stethoscope can help you better hear the sounds. I personally do not find sprague-rapport stethoscopes useful at all because of the sounds of the tubes interacting. I also wouldn’t even consider one of the cheaper stethoscopes useful even as a toy.
So what are the sounds created by the lungs? You will only learn them by listening to a lot of lungs (in a quiet space). Please listen to the following video to begin to learn the sounds and then listen to as many lungs as possible. Just as all other things in the human body, everyone is individual and will sound slightly different. It’s only through a very large sample that we begin to become proficient.
Heart sounds are an entirely different matter. Just as lungs the sounds very subtle, but with practice you can diagnose various abnormalities in the heart. Things like murmurs, rubs and valves can all be assesses by a trained ear. This is a very informative video for assessing heart sounds.
The stethoscope is a very important tool to any pre-hospital provider, but without practice becomes inefficient to our patient’s care. Take the time to really learn the sounds and put add more sense (hearing) to your care.