Heart Sounds by Paramedics

18G

18G

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Question. Who routinely listens to heart sounds in the field? More specifically, does anyone try to pick up on S3 in the older patients to incorporate into their assessment when treating or suspecting heart failure and respiratory distress patients?

Heart sounds were not taught as part of my Paramedic program so not sure if other programs teach them or not. And I don't believe heart sounds are apart of the NSC. With that said, are there any risks involved with documenting heart sounds once a level of proficiency is obtained by a Paramedic?

Thoughts?
 
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Listen to them regularly for the above reason. They were taught in my curriculum.

What possible risk could come of documenting them as long as it's in support of other findings?
 
usalsfyre said:
Listen to them regularly for the above reason. They were taught in my curriculum.

What possible risk could come of documenting them as long as it's in support of other findings?
Click to expand...

When I mention risk I was mainly referring to documenting an exam finding that may not be within a Paramedic's scope of practice for some areas. For example, a call get's to court and an attorney starts drilling about heart sounds and where did the Medic learn them, who evaluated the Medic to make sure they can accurately determine heart sounds, etc, etc... in other words trying to discredit the Medic because of something not within a scope of practice. I searched the Paramedic NSC and could not find heart sounds as being apart of it.

I'm not saying a risk is necessarily present, just wanted to get feedback and other's thoughts.
 
Don't be wrong in your treatment regimen and it's not an issue ;).

I think we get way too spun up over legal risk sometimes. I doubt "heart tones" are the deciding factor in your treatment pathway. I'm not really sure non-invasive testing can really be "out-of-scope" anyway.
 
They were taught in my class and I listen to them regularly as part of my assessment.
 
Every patient, every time. It's part of a thorough assessment.
 
Heart tones were taught and I used to listen to them fairly regularly. Unfortunately, very few of my patients had an S3 or an S4 sound to really get used to hearing those sounds. Right now, I'm on the hunt for patients with an S3 or S4 sound so that I can really begin to appreciate those sounds when I hear them.
 
It wasn't part of my curriculum.

I've been trying to learn a bit about them because I like the idea of incorporating it into my assessment. The more info the better I feel, and in any case, its interesting.

I'm having a bunch of trouble with them though. Mostly in that they're barely audible. Maybe its my scope, my ears, my positioning or the environment we're in. I sat down with a doc for about an hour and he gave me a crash course. I still can't hear s**t.
 
I agree that cardiac auscultation can be very difficult, especially with the background noise present in an EMS environment. Many of the changes are very subtle. Many are also relatively non-specific / in-sensitive, or provide information that doesn't alter prehospital treatment.

This would be a good thing to do in a chest pain patient, especially if acute MI is expected. Both tamponade (more in the days after an MI), and papillary muscle rupture are common complications, particularly in STEMI. If you were to listen and hear a loud systolic murmur, it might be a good time to be at a facility with thoracic surgery, and might be a good idea to avoid thrombolytics (if they're an option), and do some rapid transport.
 
Even as an EMT I try to listen to heart sounds. Though I may not be skilled enough to discern specific faint sounds, It's always good too listen for any PAC/PVC or AFIB which is pretty discernable.
 
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