My EMT program required that I buy a stethoscope. I bought a cheap one that came with a sphygmomanometer for about $40 at my college. I gave it away after I finished EMT to another friend who signed up for EMT also, and I never cared to get it back. At work, I used to use the stethoscope provided in the ambulance. When I started clinicals for paramedic school, the paperwork said we were required to buy a stethoscope so while buying scrubs, I decided to treat myself with a Littman for the first time (been an EMT for three years, working as one for 2 years). I was a little hurt because it costed so much. I expected it to be like $70 or something, lol. The sales clerk laughed when I said "How much is it? $70?" Probably thought I was a complete noob. Meh, whatever. The first time I tried using the stethoscope, I tried taking a blood pressure in triage on a early 20s male psych patient, and I couldn't hear the korotkoff sound. It was embarrassing, and I stopped using the stethoscope afterwards up until recently. We really didn't need it at clinicals. They didn't check if we had it, and it seemed like a hassle to ask a nurse if I could listen to breath sounds (and at the time, I didn't ask to listen to heart sounds either) so I stopped bringing it to clinicals too. I probably wouldn't have bought it if I had known that they were gonna really check for it and not have us listen to breath sounds. I started using it again while trying to listen to my own heart sounds after watching that murmur revised video abckidmom shared, and also watched heart sounds by the same guy (Eric Strong, MD from Stanford and Palo Alto VA hospital I think?). A long time ago, I also watched videos and read about breath sounds, and I haven't been trying to listen for specific features when listening to breath sounds. So now I've started using it again trying to listen to specific features/characteristics of breath sounds and heart sounds.
Only murmur I've heard so far was a 3-month-old male with ventricular septal defect (VSD). I couldn't tell if the murmur was systolic, diastolic, or continous. I couldn't tell what it sounded like. I could say that it's pitch was a III/loud. Couldn't say if it was crescendo-decrescendo, decrescendo, or holosystolic/uniform/pansystolic (sic?). I do know what VSD is suppose to be systolic (most murmurs are), usually holosystolic. I forget where it is best heart, and if it radiates anywhere. I think I read something like tricupsid radiating to the right axillary (make sense in the tricupsid or mitral area since there is a freaking hole there). My best description for this infant heart sound was "abnormal", haha! The 3-month old also had the diagnosis of heart failure, but I couldn't hear S3 like I hoped I would. I blame my inexperience and the patient's heart rate was ridiculously fast (was like 150-160 if I recall correctly). ^^ This patient was not work related. This is all school related.
Since watching that video, I've only heard of two patients with adventitious breath sounds (also not work related). A 4-year old male (I think) with rales so loud that it was actually palpable (does that make the pitch IV if you apply the heart sound stuff?). I heard another patient who was non compliant with her medications, and I wasn't sure what it was. The paramedic I rode along with said "junky". It sounded like wheezing, but not really typical, it was inspiratory-expiratory too. I would have figured rhonchi, but I didn't know. The patient's shortness of breath reduced with two treatments of 5 mg albuterol nebulized.
^^ None of these are work related. This is all school related.
I don't think it's wrong for an EMT to have a fancy stethoscope, but they definitely need more training and guidance to optimally use it. If they don't regularly take breath sounds and listen for those specific characteristics, and really some of the scopes are made for heart sounds (like that Littman Cardiology III that everyone seems to have) so they should be listening to heart sounds too if they want to make the most out of their scope, it's not worth it if they aren't doing those two things.
Only murmur I've heard so far was a 3-month-old male with ventricular septal defect (VSD). I couldn't tell if the murmur was systolic, diastolic, or continous. I couldn't tell what it sounded like. I could say that it's pitch was a III/loud. Couldn't say if it was crescendo-decrescendo, decrescendo, or holosystolic/uniform/pansystolic (sic?). I do know what VSD is suppose to be systolic (most murmurs are), usually holosystolic. I forget where it is best heart, and if it radiates anywhere. I think I read something like tricupsid radiating to the right axillary (make sense in the tricupsid or mitral area since there is a freaking hole there). My best description for this infant heart sound was "abnormal", haha! The 3-month old also had the diagnosis of heart failure, but I couldn't hear S3 like I hoped I would. I blame my inexperience and the patient's heart rate was ridiculously fast (was like 150-160 if I recall correctly). ^^ This patient was not work related. This is all school related.
Since watching that video, I've only heard of two patients with adventitious breath sounds (also not work related). A 4-year old male (I think) with rales so loud that it was actually palpable (does that make the pitch IV if you apply the heart sound stuff?). I heard another patient who was non compliant with her medications, and I wasn't sure what it was. The paramedic I rode along with said "junky". It sounded like wheezing, but not really typical, it was inspiratory-expiratory too. I would have figured rhonchi, but I didn't know. The patient's shortness of breath reduced with two treatments of 5 mg albuterol nebulized.
^^ None of these are work related. This is all school related.
I don't think it's wrong for an EMT to have a fancy stethoscope, but they definitely need more training and guidance to optimally use it. If they don't regularly take breath sounds and listen for those specific characteristics, and really some of the scopes are made for heart sounds (like that Littman Cardiology III that everyone seems to have) so they should be listening to heart sounds too if they want to make the most out of their scope, it's not worth it if they aren't doing those two things.
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, there's quite a difference in quality. My backup steth happens to be a Littmann Lightweight II SE. While the quality isn't quite as good, I can hear what I need to with it. "Patient has scattered ronchi throughout the LLL superimposed on constant/pervasive road noise.":rofl:
