Interesting Kelly Grayson (AD) tip re: Tactile Fremitus

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medicdan

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Whatever you may think of him, he posts some interesting tips and tricks. After discussing his own hearing loss at length, he describes an aspect of the physican exam that can help you look for pleural effusions, pneumothorax, etc, all without your stethoscope.

http://www.ems1.com/medical-clinica...ction-Guaranteed-Field-Expedient-Stethoscope/

What do you think of this? A valuable tool for the ALS provider? BLS? Hogwash?
 
emt.dan said:
Whatever you may think of him, he posts some interesting tips and tricks. After discussing his own hearing loss at length, he describes an aspect of the physican exam that can help you look for pleural effusions, pneumothorax, etc, all without your stethoscope.

http://www.ems1.com/medical-clinica...ction-Guaranteed-Field-Expedient-Stethoscope/

What do you think of this? A valuable tool for the ALS provider? BLS? Hogwash?
Click to expand...

Thanks Dan. :) Even those of us who do know how to use it kinda forget to do so often enough. It's actually a skill I was taught as a mom, not as a Medic. I can remember being on a few very noisy scenes where feeling was more useful than hearing.
 
Sounds like a poor man's percussion.
 
It is a very old technique. It actually predates stethoscopes.
 
Veneficus said:
It is a very old technique. It actually predates stethoscopes.
Click to expand...
I'm sure it does. My sense is that while it's cool, on a BLS level, it isn't going to change the management of my patient. Does having the ability change anything ALS-wise?
I'm doing some research, but stowing it away with long bone percussion of rarely used, but potentially interesting skills.
 
emt.dan said:
I'm sure it does. My sense is that while it's cool, on a BLS level, it isn't going to change the management of my patient. Does having the ability change anything ALS-wise?
I'm doing some research, but stowing it away with long bone percussion of rarely used, but potentially interesting skills.
Click to expand...

The trouble is if you don't practice those skills, you will not be able to do them. The more you do them, the better you get. They are not "back ups" incase your stethoscope doesn't work or there is too much noise.

If he does this all the time, no doubt it works and his findings highly accurate. Some of these older techniques are quite applicable to EMS, austere environments, and disaster type scenarios where resources are in short supply.

It also helps to have somebody who is good at these skills teach them to you. Those practicioners are in very short supply as well. Not to mention it takes a great deal of theory to understand your findings.
 
It is actually a great technique and skill. Ive seen it used a couple of times in the hospital with percussion and auscultation to form a pnuemothorax diagnosis. One patient ended up crashing right in front of us.

What you have them say is still up to debate though. Traditionally ninety nine has been used a lot, but a couple of physicians have told me they use toy boat instead, because the English pronunciation of ninety nine is often not a true dip thong. I am not a linguist, nor a physician so I believe it, for now...
 
JPINFV said:
Sounds like a poor man's percussion.
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Absolutely not, they work in combination. Percussion is best used to differentiate air/not-air, fremitus or resonance is best used to differentiate that not-air into fluid/consolidation.
 
I've used it... once or twice... years ago. I remember noticing that there was a difference in what I felt between air and non-air locations, but unfortunately, never was exposed to that evaluation technique to be able to really differentiate between fluid and consolidation. I think I can honestly and confidently say... that I have about zero expertise in doing tactile fremitus.
 
Akulahawk said:
I've used it... once or twice... years ago. I remember noticing that there was a difference in what I felt between air and non-air locations, but unfortunately, never was exposed to that evaluation technique to be able to really differentiate between fluid and consolidation. I think I can honestly and confidently say... that I have about zero expertise in doing tactile fremitus.
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Unfortunately that's not uncommon in the developed world, even among chest medics - it's just much easier to get a chest film.
 
Wow! What an interesting technique. I've never heard of it, but frankly I am just out of EMT school so what I don't know about field EMS could fill a costco warehouse. I'm kinda surprised that they did not teach this to us. It is always good to have a backup tool in the kit, right?

I guess the real moral of the story here is to take care of your ears so that you'll be able to hear through your steth and not have to rely on a backup technique.
 
Danson said:
Wow! What an interesting technique. I've never heard of it, but frankly I am just out of EMT school so what I don't know about field EMS could fill a costco warehouse. I'm kinda surprised that they did not teach this to us. It is always good to have a backup tool in the kit, right?
Click to expand...
You're going to be asking why something wasn't taught a lot in EMS...
 
Not so hard to figure out why...
 
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