Stethoscope hacking.

ChaseZ33 said:
they did a study with medical students, residents, and various MD specialties on recognition of heart sounds and it was overwhelmingly poor. It is one of those skills that takes a lot of practice and experience.
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That is the key.

Of course if you ask people who hardly ever or never do something to do it the results will be poor.
 
Veneficus said:
That is the key.

Of course if you ask people who hardly ever or never do something to do it the results will be poor.
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I had a patient with dementia who had an artificial valve that no one knew about until I brought it up. If you did not hear that then you are just blatantly lying about listening.
 
I don't care if basics can differentiate between heart tones, but I think they should know how to asses whether they exist or not. If you are a BLS crew and "aren't sure" if there is a pulse, please for the love of the flying spaghetti monster listen for heart sounds before starting CPR.
 
fast65 said:
How do you expect to treat patients then?

Anyways, couldn't agree more with what Vene said. My Littmann is the best $120 I ever spent, it's probably one of the best tools I have. Granted, I can hear lung sounds well enough with the crappy stethoscopes provided by my company, but they kill my ears, and quite honestly, they gross me out.

I could never take a provider seriously if I saw them with the kind of stethoscope described above. It's unprofessional, an it only serves to make you look like a hack to your patient, and to fellow healthcare staff. It's not horribly difficult to keep track of your stethoscopes, granted there are times when things get hectic and it may get misplaced temporarily, but that seems rather rare. Buy a decent scope, get your name engraved on it, and take care of your things so you can take care of others.
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I don't use my stethoscope to "treat" patients. I am a Basic and as a basic my "treatments" are bandaging, splinting and rapid transport to put it simply.

My stethoscope is used for BP's and lung sounds. While both can be very important and have and impact on patient outcome, there is nothing I can do at the Basic level for them.

Probably the most important thing I do with my stethoscope that can have a negative effect is obtaining a BP when I am going to assist a patient with their Nitro.

My decisions are sick or not sick, ALS or straight to the ER. I don't diagnose (though I do try to narrow it down as much as I can). Therefore I am not making "clinical" decisions. I am not ordering treatments or procedures to be done.
 
Aidey said:
I don't care if basics can differentiate between heart tones, but I think they should know how to asses whether they exist or not. If you are a BLS crew and "aren't sure" if there is a pulse, please for the love of the flying spaghetti monster listen for heart sounds before starting CPR.
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Is there a website or a source where we can listen to the heart sounds? I would like to learn these but don't know where to start. I've been going to a website that lets me listen to lung sounds so I am getting pretty good at those.
 
leoemt said:
Is there a website or a source where we can listen to the heart sounds? I would like to learn these but don't know where to start. I've been going to a website that lets me listen to lung sounds so I am getting pretty good at those.
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It is not as simple as listening to them ad identifying the sound.

You must first understand the physiology and pathophysiology of it.

There is a really good explanation in Guyton's medical physiology.

Many of the Study guides for medicine also have this information.

Once you know what is going on and what you are listening for, then you can start practicing.

As for not diagnosing or ordering treatments, if you have a suspected fracture (a differential diagnosis) do you not splint ( a treatment) it?

If you have no pulse or respiration do you not diagnose cardiopulmonary arrest and begin treatment with CPR?

Do you not diagnose uncontrolled external hemorrhage and treat by controling bleeding according to the clinical presentation and escalate treatment modalities as needed?

Do you observe a cool, clammy, and diaphoretic patient with hypotension and not diagnose "shock?" Do you not treat for shock when you find it?

I am not sure who told you that you do not dagnose or treat, but they are either a fool or a liar.
 
leoemt said:
I don't use my stethoscope to "treat" patients. I am a Basic and as a basic my "treatments" are bandaging, splinting and rapid transport to put it simply.

My stethoscope is used for BP's and lung sounds. While both can be very important and have and impact on patient outcome, there is nothing I can do at the Basic level for them.

Probably the most important thing I do with my stethoscope that can have a negative effect is obtaining a BP when I am going to assist a patient with their Nitro.

My decisions are sick or not sick, ALS or straight to the ER. I don't diagnose (though I do try to narrow it down as much as I can). Therefore I am not making "clinical" decisions. I am not ordering treatments or procedures to be done.
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My point is not "treating" patients with a stethoscope, my point is that it can be a key point in making clinical decisions in the patients course of treatment. Your assessment is just as important as anyone else's, at least in my opinion.
 
leoemt said:
My stethoscope is used for BP's and lung sounds. While both can be very important and have and impact on patient outcome, there is nothing I can do at the Basic level for them.
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You don't carry albuterol?
 
n7lxi said:
Basics in WA don't carry albuterol.
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Coming from NM I have a hard time wrapping my head around that. Our EMT-Bs can give Atrovent, Albuterol, Narcan, Epi 1:1000 SQ w/ MCEP, charcoal, glutose paste, and ASA, along with assisting with pt NTG and MDIs (which never happens since we carry at least Albuterol they give on the truck)... So weird.
 
TransportJockey said:
Coming from NM I have a hard time wrapping my head around that. Our EMT-Bs can give Atrovent, Albuterol, Narcan, Epi 1:1000 SQ w/ MCEP, charcoal, glutose paste, and ASA, along with assisting with pt NTG and MDIs (which never happens since we carry at least Albuterol they give on the truck)... So weird.
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It's because EMS is not nationally standardized and probably never will be.

If I'm an RN in NY, I can do the same thing as an RN in California.

EMT/Paramedic could be vastly different. It's moronic.
 
leoemt said:
I don't use my stethoscope to "treat" patients. I am a Basic and as a basic my "treatments" are bandaging, splinting and rapid transport to put it simply.

My stethoscope is used for BP's and lung sounds. While both can be very important and have and impact on patient outcome, there is nothing I can do at the Basic level for them.

Probably the most important thing I do with my stethoscope that can have a negative effect is obtaining a BP when I am going to assist a patient with their Nitro.

My decisions are sick or not sick, ALS or straight to the ER. I don't diagnose (though I do try to narrow it down as much as I can). Therefore I am not making "clinical" decisions. I am not ordering treatments or procedures to be done.
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Out here, if you're working with a medic that trusts you, you will be telling him what the lung sounds are and he will base treatment off of them. I would say that is clinical decision.
 
NYMedic828 said:
It's because EMS is not nationally standardized and probably never will be.

If I'm an RN in NY, I can do the same thing as an RN in California.

EMT/Paramedic could be vastly different. It's moronic.
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Very true, but as long as we have glorified ambulance drivers (EMT-B) as the entry level with next to no education required to get there, it's never going ot change. Plus with various factions who do EMS stating they need certain things, but don't want to get the training or education that's really needed.
 
exodus said:
Out here, if you're working with a medic that trusts you, you will be telling him what the lung sounds are and he will base treatment off of them. I would say that is clinical decision.
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I'm sorry, but that's not how it should be. I have a few partners at my 911 job I trust with my life, but I still will listen to lung sounds myself if it's my patient before I base a treatment off of that.
 
TransportJockey said:
I'm sorry, but that's not how it should be. I have a few partners at my 911 job I trust with my life, but I still will listen to lung sounds myself if it's my patient before I base a treatment off of that.
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So if your going to give nitro and your partner records a set of vitals (even if you've been working with the same partner for a while) you will still get your own set before the nitro?
 
TransportJockey said:
I'm sorry, but that's not how it should be. I have a few partners at my 911 job I trust with my life, but I still will listen to lung sounds myself if it's my patient before I base a treatment off of that.
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Seconded, and I work with other medics. If I am the medic in charge of patient care, and I am giving the treatment, it'll be based off my assessment.
 
TransportJockey said:
I'm sorry, but that's not how it should be. I have a few partners at my 911 job I trust with my life, but I still will listen to lung sounds myself if it's my patient before I base a treatment off of that.
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I don't think it's inappropriate if you know and trust in the competency of the person? I know many EMTs I trust more than medics I work with...
 
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