THE STETHOSCOPE AND THE AUSCULTATION
The stethoscope
The stethoscope is the most important diagnostic instrument during the first contact with your patients. Thanks to auscultation, you can gain an initial overview of the heart, lungs and abdomen and arrive at the correct diagnosis.
History
Did you know that the first stethoscope was developed as early as 1816? René Laennec invented the stethoscope by holding a roll of paper to his ear and using it to listen to his patients' incubators.
The auscultation
In medicine, listening to the body is called auscultation. This is one of the first diagnostic methods that you should learn and master during your studies.
The stethoscope
You can listen to the heart, lungs and abdomen with a stethoscope. But how does auscultation actually work? The body sounds are picked up by a membrane in the chest piece and then transmitted to your ear via the tube. There are different types of stethoscope. With the double-headed stethoscope, the chestpiece can be rotated 180° because there are two sides with which you can listen: the diaphragm and the funnel.
History
The invention of the stethoscope in 1816 was one of the pioneering developments in medicine. Even today, 200 years later, the stethoscope is still the most important diagnostic instrument for doctors around the world. The French physician René Laennec did not want to hold his ear directly to his patient's chest, as his medical colleagues of the time did, but took a sheet of paper and formed it into a roll. With this, he was able to hear the heart sounds even louder and thus developed a wooden tube with a funnel, which he named "stethos" after the Greek word for chest (stethos).
"Surprised and grateful, I listened to the heartbeat".
René Laennec on the use of his first stethoscope, 1816
(Image source: Medicine, the visual history of the art of healing)
The auscultation
Auscultation of the heart, lungs and abdomen is one of the first diagnostic measures you should be good at.
Heart:
The heart is best listened to with the upper body slightly elevated. Pay attention to the following points during auscultation: Heart rhythm, heart rate and heart murmurs. To help you remember where to listen for the heart valves, use the following mnemonic: "Anton Pullmann drinks milk at 22:45." So you auscultate the aortic valve over the 2nd ICR on the right, the pulmonary valve over the 2nd ICR on the left. The tricuspid valve over the 4th ICR on the right, and the mitral valve over the 5th ICR on the left.
Abdomen:
When we talk about auscultation of the abdomen, we are mainly talking about listening to the bowel. You should pay particular attention to bowel sounds. Can you hear them? Are they rather brisk or sparse? Another organ that you can listen to in a certain way is the liver. In order to estimate its size, you can "scrape" it with a spatula and listen to it at the same time (=scratch auscultation). The scratching sound changes as soon as you stop scratching the liver with the spatula.
Lungs:
The lungs are best auscultated over the back. To do this, ask the patient to sit up and breathe in and out deeply with their mouth open. It is important that you listen to the entire lung, always comparing the sides. Listen for secondary noises, such as rales or crackles in the lungs. These are indications of certain lung diseases. You can also assess during auscultation whether the breathing sounds are weakened in some parts of the lungs, or whether you can hear a wheezing or humming noise.
Soon, educational videos with all the information you need for correct auscultation await you here!
10 tIpps for the best auscultation
If you're culling the heart, the following tips can help:
1. in order for you to hear optimally, ask the patient to sit up and bend his upper body slightly forward.
If you want to listen to the mitral valve, it is best to do so lying down and with the upper body slightly turned to the left side.
3. if you cannot hear the heart sounds loud enough, ask the patient to take a deep breath in and out, and then hold it.
For auscultation of the lungs, you should consider the following:
Ask the patient to breathe in and out deeply with his mouth open. If he breathes only through his nose, the sounds are not as audible.
To listen to the middle lobe of the right lung, you must auscultate the patient ventrally.
Let the patient cough before starting auscultation. This prevents false auscultation findings, as mucus in the airways can sound similar to rales in lung disease.
The following clues will help you with abdominal auscultation:
For correct auscultation, always listen to the abdomen before palpation to avoid distorting the bowel sounds.
When listening to the abdomen, you must auscultate for at least 10 seconds per quadrant in the absence of bowel sounds.
9. do not forget that a complete abdominal examination includes scratch auscultation of the liver!
And finally: listen, listen, listen! The more experience you have, the easier auscultation will be. Have fun 🙂
Contact
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