Thumb on stethoscope

[Steven29]

I am currently in school for medical assisting, so please forgive my ignorance but I didn't know who to ask for a straight answer. Why can't I use my thumb on the stethoscope when ausculating for blood pressure? I understand my thumb has a pulse, but how would that interfere with anything? How would the pulse in my thumb make any audible distraction?

 

[illegallysmooth]

I am currently in school for medical assisting, so please forgive my ignorance but I didn't know who to ask for a straight answer. Why can't I use my thumb on the stethoscope when ausculating for blood pressure? I understand my thumb has a pulse, but how would that interfere with anything? How would the pulse in my thumb make any audible distraction?

You're listening for sounds in the blood vessels in the arm, so you don't want the blood moving in your thumb pressing on the stethoscope to obscure that. FWIW, people do it all the time. It would be pretty hard to ear the thumb pulse on most ****ty stethoscopes.

 

[The right Path]

I am currently in school for medical assisting, so please forgive my ignorance but I didn't know who to ask for a straight answer. Why can't I use my thumb on the stethoscope when ausculating for blood pressure? I understand my thumb has a pulse, but how would that interfere with anything? How would the pulse in my thumb make any audible distraction?

You should not use your thumb to palpate a pulse because you can confuse your own thumb's pulse with the patient's pulse. However, I have never heard that you should not use your thumb on the stethoscope when auscultating a bp. I can't think of any reason this could be a problem. I even consulted two nursing texts (Jarvis' Physical Exam and Health Assessment, 3rd ed. and Perry & Potter's Clinical Skills and Techniques, 5th ed.) Neither text mentions anything about which digits to use and both are ridiculously detailed in method. The only thing which is applicable in this case is that you should use the bell end of the stethoscope as it is better for listening to low pitched sounds and to press with a firm seal against the skin, but not too tight as you may get a falsely low diastolic reading.

If I may, who/what was the source of this "rule of thumb". Wakka, wakka, couldn't resist. I know that was horrible. If possible I would ask for a rationale, and then evaluate that. There is a lot of misinformation (at all levels) that can be perpetuated to students- that is why you keep asking why (kuddos). Even experts can be wrong.

You're listening for sounds in the blood vessels in the arm, so you don't want the blood moving in your thumb pressing on the stethoscope to obscure that. FWIW, people do it all the time. It would be pretty hard to ear the thumb pulse on most ****ty stethoscopes.

I don't think blood flow in your thumb on the opposite side of the diaphragm is an issue at all, even with an electronic stethoscope, but if anyone has any evidence to say otherwise, I'm all for hearing it.

 

[illegallysmooth]

You should not use your thumb to palpate a pulse because you can confuse your own thumb's pulse with the patient's pulse. However, I have never heard that you should not use your thumb on the stethoscope when auscultating a bp. I can't think of any reason this could be a problem. I even consulted two nursing texts (Jarvis' Physical Exam and Health Assessment, 3rd ed. and Perry & Potter's Clinical Skills and Techniques, 5th ed.) Neither text mentions anything about which digits to use and both are ridiculously detailed in method. The only thing which is applicable in this case is that you should use the bell end of the stethoscope as it is better for listening to low pitched sounds and to press with a firm seal against the skin, but not too tight as you may get a falsely low diastolic reading.

If I may, who/what was the source of this "rule of thumb". Wakka, wakka, couldn't resist. I know that was horrible. If possible I would ask for a rationale, and then evaluate that. There is a lot of misinformation (at all levels) that can be perpetuated to students- that is why you keep asking why (kuddos). Even experts can be wrong.



I don't think blood flow in your thumb on the opposite side of the diaphragm is an issue at all, even with an electronic stethoscope, but if anyone has any evidence to say otherwise, I'm all for hearing it.

:: it was taught to me when training for EMT, ITA and MA. But as I said, I don't really think it matters.