Stethoscope techniques

[anbuitachi]

Just a couple of questions regarding using stethoscopes. Do you guys press the scope onto the patients back or do you just let it rest on it? I'm not sure if I'm using it right b/c most of the time all i hear are my finger joints rubbing against each other.

Also do you guys use diaphragm for murmurs?

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[DocVapor]

What type of stethoscope are you using? Is it a dual-side with a bell on one side and a diaphragm on the other, or is it one where you vary the pressure to make it act like a bell or a diaphgram?

If it's the former, just resting the stethoscope on their skin is the way to go. Obviously the latter requires a little more practice.

Hearing your own finger joints rubbing together sounds more like a problem with how you are holding the scope versus how much pressure you are using. Just focus on really keeping your hands still and it will get better with practice. You won't be able to eliminate all noise completely, but you will also get better at tuning it out.

 

[TooMuchResearch]

Use light pressure- play around until you get it right. I like to hold it between my index and middle finger with the sides of my fingers doing the holding. This seems to cut down on the finger rubbing noises. You won't get great sounds from every very obese person.

 

[evilbooyaa]

Don't move your fingers while you're auscultating and you won't hear your joints moving.

 

[anbuitachi]

i'll practice more. i think it's prob b/c i tried to press the scope down a bit instead of just resting it lightly, and thus got joint noises

 

[evilbooyaa]

i'll practice more. i think it's prob b/c i tried to press the scope down a bit instead of just resting it lightly, and thus got joint noises

Depends on your stetho. Mine, laying it lightly down allows me to auscultate just fine, even on obese patients. If you can't hear, make sure you're in the right spot.

 

[tco]

I have to push on mine to use the diaphragm... On obese patients I push harder to hear lung sounds. You also have to push hard and have the pt lean forward to hear aortic regurgitation. If you push too hard when listening with the bell, it becomes a functional diaphragm...It depends on your stethoscope, what you're trying to hear, and the pt.

 

[ArcGurren]

Proper technique for the diaphragm is to press down hard enough that it makes a tight seal with the skin for auscultation.

Proper bell technique usually involves resting it so that it's a seal but LIGHTLY because if it's placed too tightly it essentially just becomes another diaphragm and you need it in order to hear an S3

 

[Druggernaut]

If I remember correctly, my stethoscope's little instruction card said that you should use enough pressure to leave a faint outline of the diaphragm on the patient, which means applying more pressure than simply setting it on the patient. This is even more important when using one with a tunable diaphragm.

Use less pressure when using the bell, as ArcGurren said.

Try holding like TooMuchResearch suggested (there's a picture at http://www.mypatraining.com/stethoscope-and-how-to-use-it, which is very similar to how I've seen many attendings do it). Since your fingers are extended and locked out, there should be less joint movement, and thus, less noise. Doing it this way also has the benefit of allowing you to palpate a patient's abdomen while making them think you're only auscultating, useful for when you think they're overreacting or malingering.

 

[survivordo]

Also, I had a cardiologist point out to me once that it is a long tube, keep that tube straight for the best conduction.

Survivor DO

 

[ArcGurren]

Also, I had a cardiologist point out to me once that it is a long tube, keep that tube straight for the best conduction.

Survivor DO

ba-zing

 

[duckie99]

Also, I had a cardiologist point out to me once that it is a long tube, keep that tube straight for the best conduction.

Survivor DO

meh. I've had a cardiologist say that it essentially doesn't matter much at all. Most littmann's are of similar quality and the tube is better long because it is so much more convenient. Obviously the cheap steths suck though. And finally gotta remember that a lot of stuff cards does now is based imaging rather than auscultation...

I really don't understand the OP's issue. Using a stethoscope is one of the easiest things to do on a physical exam. I would suggest if you having an issue hearing something it is because you have not yet developed the skills to hear what is there... for example, I hear a lot of murmurs that no one ever mentions and that is usually because they are quiet grade II murmurs that you have to go a little slower to hear.

 

[tco]

meh. I've had a cardiologist say that it essentially doesn't matter much at all. Most littmann's are of similar quality and the tube is better long because it is so much more convenient. Obviously the cheap steths suck though. And finally gotta remember that a lot of stuff cards does now is based imaging rather than auscultation...

I really don't understand the OP's issue. Using a stethoscope is one of the easiest things to do on a physical exam. I would suggest if you having an issue hearing something it is because you have not yet developed the skills to hear what is there... for example, I hear a lot of murmurs that no one ever mentions and that is usually because they are quiet grade II murmurs that you have to go a little slower to hear.

And because you're obviously a phenom...The world's greatest medical student...

 

[anbuitachi]

meh. I've had a cardiologist say that it essentially doesn't matter much at all. Most littmann's are of similar quality and the tube is better long because it is so much more convenient. Obviously the cheap steths suck though. And finally gotta remember that a lot of stuff cards does now is based imaging rather than auscultation...

I really don't understand the OP's issue. Using a stethoscope is one of the easiest things to do on a physical exam. I would suggest if you having an issue hearing something it is because you have not yet developed the skills to hear what is there... for example, I hear a lot of murmurs that no one ever mentions and that is usually because they are quiet grade II murmurs that you have to go a little slower to hear.

i hear things, but even with the most tiny movements, i hear the loud noises of my joints creaking... which interferes w/ sounds that i should be hearing

 

[duckie99]

i hear things, but even with the most tiny movements, i hear the loud noises of my joints creaking... which interferes w/ sounds that i should be hearing

well you know you're always going to hear noise like clothes rubbing, distracting noises from the room, etc. I suggest investing in a good littmann stethoscope (either classic II or cardio III - most people have a cardio III), only listening directly on the skin, going very slowly, making sure the patient takes good breaths (through the mouth, big as possible), feeling the pulse while listening to the heart, make the environment around you as quiet as possible, etc. Again it takes practice as well. The biggest issue I notice with people is that they go too fast and listen over the clothes.