Cardiac Auscultation

[TheLocalMedic]

I don't listen pre-hospital, in no way affects anything I'm going to do. In the hospital I generally listen in one area. The valve region is largely crap. There is so much transfer of sound waves in the chest that you can't reliably say where the murmur is just by auscultation (even adding in the radiation garbage). Secondly, I hear a murmur. If the patient doesn't know they have one I'm ordering an echo, end of story, if they know its there and they are asymptomatic it probably doesn't matter anyways.

Bingo. Even if I was listening to enough hearts to be able to definitively say that I was hearing something that wasn't right, it still isn't going to affect anything I'm going to do.

Besides, why would you stop everything else that you should be doing on a call to listen to a patient's heart for a few minutes? Yes, please delay care of a STEMI patient for a few minutes while you play with your stethescope and pretend that you're some cool whiz kid that who will have some kind of "aha!" moment after intently listening to your patient's chest. I know for a fact that nobody I work with actually listens to heart sounds, and if I met a medic on the street who professed to actually include them in his assessment I'd either believe him to be either very new or very naive for thinking that they could diagnose anything or use what they heard to help them make a diagnosis.

 

[Handsome Robb]

I listen to heart tones on the majority of patients, but I don't believe I'm competent enough to recognize most abnormal variations. I can hear S1 S2, and then "things that are different." I've heard a few murmurs this way. Most of the time, I ask my patient more about their heart history after I hear something odd and they do have a murmur or PFO.

I'm in the same boat. If it is pertinent (ie cardiac and trauma...sometimes breathers just because I'm already right there listening anyways) I'll listen but beyond s1-s2 it's usually limited to "abnormal heart tones" in my report to the RN/Physician in my face to face report, I don't include them in my radio report. I've had physicians ask me about them when I haven't listened and I've had physicians surprised when I did and reported an abnormal finding. Never had one tell me not to listen to them. Still working on this whole education thing and furthering it.

I don't think you can argue it's detrimental to the patient due to delaying definitive care, it's a down and dirty quick listen and like someone, Halothane maybe, said, it only takes a couple seconds to do.

I don't understand how people harp on how EMS education focuses too much on rapid transport and that "seconds matter" then the same people do a 180 and argue against a full and thorough assessment because you're delaying definitive care but that's just my opinion.

I can think of three conditions where seconds really count. Those being cardiac arrest, complete FBAO and anaphylaxis.

 

[Aprz]

Well, since we are talking about it. I actually did watch videos on it a long time ago, and I just kinda chickened out and never did practice it on patients.

s3 is like lub-dub-pause-another sound here.

s4 is another sound here-pause-lub-dub?

I never really understood whether s3, s4, or both are associated with congestive heart failure, and I don't get why the sounds exist.

I am gonna go watch that heart murmor revised video right now. I probably won't be able to respond until tomorrow morning.

Edit Wow, this video makes it seem easy so far.

Edit Very informative video.

Edit Prehospital 12-lead ECG on Facebook just asked a question that had S3 as one of the possible answers. It was pretty much in congestive heart failure (CHF), what sign would be most likely found in left sided failure? A) JVD B) Rales C) Pedal edema D) S3.

Edit Been listening to myself. I am kinda hesitant to try on patients since I am usually not managing patient care (I don't work BLS). If I do happen to do BLS, I might start listening to heart tones to see if I can pick up anything different. Seems to be really hard just trying to listen to the videos. The video describes it easily, but actually listening to the tone (when, shape, pitch) is hard. I'll be sure to check heart sounds on the patient's chart as a way to see if I can hear what they are describing.