Auscultation sites

[unsung]

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Okay, so I'm obviously a newbie at this. I'm trying to palpate the 4th intercostal space, etc. and specifically locate each site.

But I see others around me just stick their stethescope at a spot, and I'm like... how did you locate it?? So basically, I'm just wondering if most people are actually "guess-timating" the spot visually?

 

[Knicks]

Practice. (noun)

 

[MilkmanAl]

I don't believe I've ever seen anyone who knows what he's doing better than I do (older students and doctors) examine before putting the stethoscope down. I guess that as long as you know generally where you're supposed to be, you're in good shape.

 

[la petite mort]

Actually using the steth will help you find the right spot. I mean, having a general knowledge of where the triangle of auscultation is is very useful, but have you ever seen a doctor plant a steth spot-on on someone's back?

 

[xrevision]

A Cardiologist I shadowed once told me that those spots are where you should hear certain parts of the heart, but don't hold true for everyone so don't waste your time with strict rules. Instead, he said that we should be listening to amplify whatever sound we are looking for (right-sided heart sounds in the case of 4th ICS), by touching down in the general area and moving the steth around till you can hear whatever you are looking for the best.

 

[plauto]

think about blood flow and the sound will project that way. so for 4th ICS the blood is being ejected into the RV so you'll be hearing the tricuspid, and so on. The key is to be in the ICS. Usually the 2nd, 4th, and 5th ICS are good regions to go to at first because normally that is where things should be. Especially for the 5th, if it's not there (the PMI) and you have to go off a lot then there is pathology. And yes, you'll "walk around" with the steth to find the best spot, but usually the best spot is right where it's supposed to be.

 

[bleeker10]

If you are on the front, the way we were taught was to find the sternal angle. Rib 2 attaches here and if you go just below rib 2, that is the 2nd IC space. Just count down the IC spaces until you hit the 4th IC space. Its tedious but it works until I can get it down quicker