Auscultation "dilemma" (for lack of a better word)

[Knicks]

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When listening to a pt.'s heart/lungs/abdomen, I keep hearing the articulations of my DIPs and PIPs; kind of annoying.

I try holding my breath and keeping my arm/hand/fingers as motionless as possible, but to no avail most of the time.

Anyone else know what I'm talking about?

What's your solution, if any?

Thanks.

 

[BigRedder]

I know what you mean, I've noticed it myself. It comes from all the little movements as you stabilize the stethoscope. I have found that if you hold it up against the body with your hand actually touching the patient (go figure), it makes it so your fingers aren't forced to make so many corrections. Try it on yourself.

 

[airplanes]

😕

good luck.

 

[Knicks]

I know what you mean, I've noticed it myself. It comes from all the little movements as you stabilize the stethoscope. I have found that if you hold it up against the body with your hand actually touching the patient (go figure), it makes it so your fingers aren't forced to make so many corrections. Try it on yourself.

Thanks, will test it out.

 

[cpants]

2 tips you might try. 1. Hold it by the rubber tubing. 2. Put the whole end of the steth in your palm, and then put your whole hand flat on the pt (great for bowel sounds).

 

[Instatewaiter]

When listening to a pt.'s heart/lungs/abdomen, I keep hearing the articulations of my DIPs and PIPs; kind of annoying.

I try holding my breath and keeping my arm/hand/fingers as motionless as possible, but to no avail most of the time.

Anyone else know what I'm talking about?

What's your solution, if any?

Thanks.

When I listen with the diaphragm, I place the bell between my index and middle finger. Then I place my hand flat onto the patient. The base of my palm rests on the patient. It keeps my hands from shaking and my joints from moving/creaking

 

[Dirt]

Yeah, adjust your grip to whatever is comfortable and works.

 

[SoCuteMD]

I have never had this problem, but it really should only affect your auscultation of heart sounds. A lot of cardiologists will rest their stethoscope on the patient and pull their hands away while they listen. This would eliminate your problem.

It's taken me a few years, but I an now do a pretty good job of listening through background noise and determining by listening for a few heartbeats what is actually a murmur and what is background noise.

 

[Knicks]

I have never had this problem, but it really should only affect your auscultation of heart sounds. A lot of cardiologists will rest their stethoscope on the patient and pull their hands away while they listen. This would eliminate your problem.

Yeah, that's pretty much my main concern.

It's taken me a few years, but I an now do a pretty good job of listening through background noise and determining by listening for a few heartbeats what is actually a murmur and what is background noise.

I'd like to achieve this as well, but in a shorter time than "a few years". 😀

 

[cpants]

One other tip to get better is to make sure you listen to every patient's heart regardless of complaint while you are learning.

 

[Bartelby]

You know how people in martial arts movies kind of make a tunnel of fingers to pull someone's eye out? I hold the stethoscope kind of like that on the bell. It works well once you are used to it and lets you move quickly for the lung exam.

 

[MossPoh]

You know how people in martial arts movies kind of make a tunnel of fingers to pull someone's eye out? I hold the stethoscope kind of like that on the bell. It works well once you are used to it and lets you move quickly for the lung exam.

And you're ready to eye gouge any surprise ninja attacks.

 

[Knicks]

You know how people in martial arts movies kind of make a tunnel of fingers to pull someone's eye out? I hold the stethoscope kind of like that on the bell. It works well once you are used to it and lets you move quickly for the lung exam.

LoL, nice piece of interesting [helpful] advice.

 

[turkeyjerky]

When I listen with the diaphragm, I place the bell between my index and middle finger. Then I place my hand flat onto the patient. The base of my palm rests on the patient. It keeps my hands from shaking and my joints from moving/creaking

I tried doing this yesterday and noticed a big improvement.

 

[SoCuteMD]

Yeah, that's pretty much my main concern.


I'd like to achieve this as well, but in a shorter time than "a few years". 😀

It takes most people "a few years" to learn what they are really hearing. By the end of third year I could recognize a murmur on those learning dummies or on a tape, but putting it all together with the patient definitely took until part way through intern year. I read a study about identification of murmurs by practitioners. Med students, residents, cardiology fellows, primary care attendings - all of them pretty much suck at identification. The only group that stood out was cardiology attendings.

 

[Knicks]

It takes most people "a few years" to learn what they are really hearing. By the end of third year I could recognize a murmur on those learning dummies or on a tape, but putting it all together with the patient definitely took until part way through intern year. I read a study about identification of murmurs by practitioners. Med students, residents, cardiology fellows, primary care attendings - all of them pretty much suck at identification. The only group that stood out was cardiology attendings.

That's definitely reassuring. 😀

 

[dpmd]

I found that the quality of the stethoscope played a role as well. I had a $12 one from nursing school that I could hold however I wanted and not hear anything but the patient. When I got a Littmann for med school graduation all of a sudden it was like I had popcorn in my hands. Got used to it pretty quickly though and if all else fails the no hands approach works well.

 

[nlax30]

And you're ready to eye gouge any surprise ninja attacks.

Haha! Alright, that made me laugh.

Anyway, I agree with the others... play around with your grip and see if holding it different minimizes the noise. I had the same issue and found it helps if I place my palm on the pt with the diaphragm between two fingers like someone already mentioned. If I'm listening to the heart on a female I may just hold the tubing to avoid an awkward handfull.

Also agree with listening to heart sounds on every patient, I know I definitely need the practice/experience.

 

[Zoom-Zoom]

This problem can be remedied by doing vitals in the back of a moving ambulance for a couple hours 😀

But seriously, if you rest your palm on the patient and hold the head of the stethoscope in your finger tips, it should give you a pretty stable/quiet platform. I sometimes struggle with hearing my fingers rubbing and it's usually from not getting a good enough grip before I plant the diaphragm down on the pt.

 

[DrBubbles]

I like the idea of placing your palm on the patient *while* you're holding the diaphragm between two fingers... no wonder that method hasn't made much difference for me yet! I'll definitely give that a shot today.

Some other tricks I do use though:
- allow the stethoscope to rest on the patient without touching it (already mentioned)
- hold it by the tubing (already mentioned)
- close my eyes while listening (then I'm not distracted by anything else)
- use the bell, moving from firm pressure (thus recreating a diaphragm) to minimal pressure--this will help you move through sounds of higher frequency to lower frequency; this really helps with gallups, especially if you know your patient carries a diagnosis of something like left heart failure; then I switch it to the diaphragm to grade a murmur if present, switch back for bruits, back for lungs...

And I'm still learning...!

 

[xanthomondo]

When I listen with the diaphragm, I place the bell between my index and middle finger. Then I place my hand flat onto the patient. The base of my palm rests on the patient. It keeps my hands from shaking and my joints from moving/creaking

I feel like this could get me into trouble when listening to heart sounds on a female.

 

[RoyBasch]

- all of them pretty much suck at identification. The only group that stood out was cardiology attendings.

🤣

Now I dont feel so bad at being unable to hear murmurs.