Difficulty hearing pathology through stethoscope

[Apply Pressure]

Hey guys

I'm a third year and have a difficult time hearing pathological heart sounds and lungs. In fact, there are times when I can barely hear either organ system at all. Though sometimes I don't do the examinations on bare skin, I do most of the time and still have issues. Just FYI, I'm quite certain I don't have hearing loss since I have it checked frequently.

Can someone list for me the top reasons why some students are unable to hear sounds well? Is it an issue of experience? Does placement on the skin have to be exactly correct? Do you give up on localizing heart sounds with obese patients? Is the Littmann Cardiology III a lower than average stethoscope? etc etc....

Any help is appreciated

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[Droopy Snoopy]

Hey guys

I'm a third year and have a difficult time hearing pathological heart sounds and lungs. In fact, there are times when I can barely hear either organ system at all. Though sometimes I don't do the examinations on bare skin, I do most of the time and still have issues. Just FYI, I'm quite certain I don't have hearing loss since I have it checked frequently.

Can someone list for me the top reasons why some students are unable to hear sounds well? Is it an issue of experience? Does placement on the skin have to be exactly correct? Do you give up on localizing heart sounds with obese patients? Is the Littmann Cardiology III a lower than average stethoscope? etc etc....

Any help is appreciated

Earpieces should point forward. Yes skin on skin is important, much less artifact sound. And obviously placement is important, you're not going to hear clear heart sounds over the xiphoid. Fat makes everything difficult, but you should be able to pick up obvious stuff with just a little practice. If you're listening to the heart have the pt exhale completely and hold it while you listen (less lung space, no breath sounds interfering). And like everything else in medicine, practice is key. Cardio III is a great scope.

 

[pincheeric]

Number 1 reason is not knowing that some models require you to change which diaphragm is transmitting sounds to the earpieces.

Otherwise it just takes practice. Always listen on bare skin if you want to hear anything well.

 

[Winged Scapula]

I had the same problem early on. It was a matter of practice - mostly I wasn't pressing the scope hard enough onto the skin, just lightly placing it on the patient. With the body habitus of most patients, the heart was several inches away from the scope.

 

[45408]

Try having someone else listen with your scope to make sure it works, and then have someone else listen to heart/lung sounds that should be readily audible and then listening to that exact same spot. Cardio III is a top of the line scope.

 

[scpod]

I'm by no means an expert, but I try to minimize outside noise. When walk in the room I ask if we can turn the TV down. If visitors are there, I ask them to be quiet for a minute and usually close the door, because there's a lot of noise from the nurse's station. When I'm listening for the heart, I close my eyes and try to ignire the lung sounds. I move the diaphragm around some if it isn't clear.

But, the one thing I've found is that lots of practice has made it easier. I actually spend a lot of time after hours going back to patient rooms and "practicing" on them. Face it, they aren't going anywhere and they actually seem to like the attention. I've had quite a lot of them comment on how much they enjoy having me there with them. I practice all kinds of physical exam things on patients after the other students have gone home. A lot of them are bored out of their minds anyway and they get kind of lonely after visiting hours are over.

 

[LuckyBambooGirl]

I had the same problem when I first got my stethescope. I finally realized that the ear pieces were not the correct size for my ears. My stethescope came with a few extra ear pieces in different sizes so I changed them out and all of a sudden the stethescope worked!

 

[JeffLebowski]

Try having someone else listen with your scope to make sure it works, and then have someone else listen to heart/lung sounds that should be readily audible and then listening to that exact same spot. Cardio III is a top of the line scope.

This is good advice. Specifically ask residents if patients have pathological sounds, they make take you in there and show you.

Another bit of advice is to just relax and take a minute to listen, you may be rushing through it, plopping the bell down and not hearing it clearly right away and getting frustrated and moving on. Honestly, you can take an extra 30 seconds to really listen if you have a patient who might have pathology in there. Press a little harder, or press lighter, move it around to find a good spot, take your hand off altogether, switch bell/diaphragm, have them hold their breath, take slow deep breaths, etc. But take your time at first, and try to hear things. Then when you present your patient you can say, "I thought I heard bilateral basilar crackles on auscultation, but I'd benefit from someone confirming that for me" or something.