Heart sounds

[Keith]

I love pulse ox as a guide, but I agree with the people in here that stated that its not a "sure fire" thing. For the most part, its awsome, and with my previous training I used to live by it, but I was taught otherwise by a medic that I highly reguard, as well as a few other well educated clinicians. Granted I am still just an ambulance driver (he he). I have been taught the wonderful word of capnography, and I will tell you... holy crap, it makes life some much easier (and more accurate).

BUT... the "unnamed" company that I work for doesn't believe that basics need access to pulse oximeters, so I purchased my own.

And as for the reference to a "bad emt" previously, thats a load of crap, think if your in this field, your in it for a reason. Your pretty much gonna have to go out of your way to be a bad emt, or else you just need to be educated in a different way. It takes a lot to be a "bad emt".

...cause everyone knows we're all in it for the money, right? hahaha

 

[BruceD]

.. his pressure was a little low 110/66 with hx of hypertension. Lung sounds where mostly clear. I decided to listen to his heart sounds for a gallop, s3, s4 extra sound. I didnt hear any. But never the less, this is technically not something I was taught as a basic, but I have been taught before and very much practised in. Would this be out of my scope of practise? Would I be better off letting the nurse know of my suspicion of heart failure and leave the advanced assessment up to the doc?
Is it unethical for me to be doing this?

I know that Grady_emt already covered this, but just a little further information on this:

Over the longer term (please don't use this to treat an acute patient!) patients in heart failure (or DM or renal failure) are often treated to lower BPs than what an otherwise healthy person with hypertension would be treated to.

This reduces cardiac workload (oxygen demand), increase coronary blood flow, and help prevent cardiac remodeling and (sometimes, hopefully) reverse some of the damage already done. (ref. below)

It does not seem to me to be unethical to practice non-invasive, patient monitoring skills as long as that person is in no immediate danger, the practice is not uncomfortable, does not cause harm, does not prevent you from monitoring their condition(s), the patient doesn't mind it, and all your other required checks have been completed.

Good luck
-B

Ref: Mayo Clinic: http://www.mayoclinic.com/health/high-blood-pressure/DS00100/DSECTION=8
Ref: WebMD: http://www.webmd.com/hypertension-h...lood-pressure-hypertension-treatment-overview
Ref: Lippincott's Pharmacology 3rd edition, chapter 19 pp213-225

 

[BossyCow]

I'm a firm believer that what other people think of me is none of my business. So, I would not allow a potential reaction from someone else to determine what I'm going to learn from a call.

A lot of that is going to be in the presentation though. Often I will ask the nurse, medic or doc.. "Hey.. I saw this, which to me looked like this..... is that right?" I generally get more of an education than I bargained for and the accompanying evil stare and rolling eyes from my partner on the rig who really wants to get back home.

 

[paramedix]

If you know what you are listening to and listening for... go ahead. You can never learn too much.

It is not an invasive procedure and you cannot harm the patient by listening to the heart sounds. I was in a similar position before and fully understand that people would rather think you are arrogant than turning around and thinking, wow this medic's got potential... let's help him!

Fortunately we have a lot of medics that are very eager to teach you or share knowledge.

 

[Ops Paramedic]

With regards to your original post, you were not unethical. There is distinct difference between being unethical and ignorance (You weren't). It would be unwise to not raise the alarm, should you think to do so. The worst that can happen is that someone can help you along or say that it not the case, either way no harm done.

Abnormal heart sounds is easy to learn but could be hard to ausciltate. As mentioned in other posts, you will only what is wrong if you know what is right. Thus by you ausciltating for heart sounds (the different types and there locations) will not be to the detrement of the patient (Provided it does not interfere with the emergency care of the patient), it will only increase your database for future reference.

As for the scope of practice: " does it mention any where that you are not allowed to ausciltate heart sounds??" I don't know your scope, but i will bet it doesn't. But be carefull of falling into the the trap, of "someone once told me about a this or that". Ensure thet you know what you are talking about and that you can back it up, even to the cardiologist.

Some posts refered to their training and that it may not have been included. Alot of times I get "I was not taught that". Your training and knowledge does NOT depend on your lectures, it depends only on YOU.

 

[FFMedic1911]

Rid, do you know of some good sites for info on pt assessment.Such as things to look for and what they are telling us.

 

[skyemt]

I in no way want to answer for Rid...

i do think Clinical Clues, by Paul Werfel is an excellent book...

 

[Ridryder911]

Here is a site that is written by a Paramedic with examples, you listen to with a stethoscope on you computer speakers ( be sure to turn it down first :wacko

http://www.co.gaston.nc.us/gemshp/training/HeartTones.htm

R/r 911

 

[rhan101277]

Went over heart sounds today, just at a fundamental level for detailed cardiac exam on physical assessment. We won't hit cardiology until next month. I learned S1 and S2 are normal and that S3 or S4 or not. However S3 or S4 may be normal in babies. There is much more to learn.