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General assessment
Published in Tracy Lapworth, Deborah Cook, Clinical Assessment, 2022
Auscultation – this involves listening for sounds with a stethoscope to determine presence or absence of sound and quality and nature of sound. It is generally performed at the end except in the examination of the abdomen. The head of the stethoscope has two surfaces: the bell and the diaphragm. The bell detects low sounds, the diaphragm high: bell-low, di-high! When using the stethoscope, the diaphragm needs to be pressed firmly on the skin; when using the bell, it needs to be placed lightly on the skin to form a seal. The tubing of the stethoscope should be 38 cm at its maximum length and have snug ear plugs that need to point towards the nose when in place. It will also have both a diaphragm and bell or the two will be integrated
From listening to hearing
Published in Alan Bleakley, Educating Doctors’ Senses Through the Medical Humanities, 2020
In 2012, Mount Sinai School of Medicine in New York began giving medical students handheld ultrasound devices that can generate real-time images of the heart at the bedside, switching of course from ‘listening’ to ‘looking’, in line with Western culture’s preferred perceptual mode (ocular-centrism). The rationale was that auscultation is superfluous for heart sounds, although still useful for lung and bowel sounds (see Marwick et al. 2014). Clinicians wary of the widespread displacement of the stethoscope again say that this is part of a disturbing wider movement in modern medicine sceptical of hands-on physical examinations where laboratory testing offers a far more accurate diagnostic tool. However, like ‘overdiagnosis’ (Welch et al. 2011), ‘overtesting’ is seen as a symptom of modern medicine’s anxiety over misdiagnoses and subsequent potential patient litigation, although such overtesting can put a strain on health system resources.
The cardiovascular system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
The stethoscope has two principal functions: to transmit sounds from the chest wall with exclusion of extraneous noises, and to emphasise the sounds of certain frequencies. The bell of the stethoscope is best for listening to low-pitched sounds, whereas the diaphragm filters out low-pitched sounds and accentuates high-pitched ones. You should initially listen with the bell and diaphragm at the apex (Fig. 2.9) for the low-pitched diastolic murmur of mitral stenosis and the pansystolic murmur of mitral regurgitation. Then, using the diaphragm, listen over the classical areas shown in Fig. 2.10. These are the left sternal edge (for tricuspid murmurs) (Fig. 2.11), the left second interspace (for pulmonary murmurs) (Fig. 2.12) and the right second interspace (for aortic murmurs) (Fig. 2.13).
Dysphagia management: Does structured training improve the validity and reliability of cervical auscultation?
Published in International Journal of Speech-Language Pathology, 2022
Liza Bergström, Julie AY Cichero
While early CA research reported poor/variable reliability, two man are as of methodological flaws can be identified in these earlier studies: (1) recording of the swallow sounds and (2) CA-rater training. Swallow sounds were recorded using suboptimal stethoscope/microphone placement in two studies (Leslie et al., 2004; Stroud et al., 2002) with one study recording sounds via a locally modified stethoscope with a microphone inserted into the stethoscope bifurcation (Leslie et al., 2004). Studies did not report stethoscope information regarding bell or diaphragm use, tubing, use of amplification or treatment of the sounds recorded for analysis (Leslie et al., 2004; Stroud et al., 2002). For all stethoscopes, the headpiece and tubing are known to affect the transmission characteristics of sounds with selective filtering (Richardson & Moody, 2000).
Stethoscope – An essential diagnostic tool or a relic of the past?
Published in Hospital Practice, 2021
Shahraz Qamar, Aysun Tekin, Pahnwat Tonya Taweesedt, Joseph Varon, Rahul Kashyap, Salim Surani
Some physicians believe that the stethoscope is no more than a fashion accessory. This sentiment comes from the fact that there are many other more advanced diagnostic tools at the physician’s disposal. However, the argument in favor of using a stethoscope is more nuanced than one might imagine. Many physicians believe that the stethoscope is the cornerstone of the physical examination and the reason that it is still in use is that it brings the doctor and patient closer. There have been several studies that have documented a deterioration in the communication skills of a doctor [6]. One might argue that this is because doctors spend less time talking to patients and more time maintaining the patient health record [7]. Some thought that the electronic health record (EHR) would reduce the time committed to clinical documentation. Instead, most physicians have been spending up to 3 times longer in clinical documentation compared to the days of paper charting [8]. In an age where most of a physician’s time is spent in the absence of the patient, the use of the stethoscope, which acts as a conduit to connect the patient and the physician, is welcomed by both the doctor and the patient.
Point-of-care ultrasound (POCUS) for hospitalists and general internists
Published in Acta Clinica Belgica, 2021
The efficiency of the stethoscope used as a diagnostic aid has been assessed in several studies. For example, the efficiency of the stethoscope in the diagnosis of pleural effusion is relatively low with a sensitivity and a specificity of 76% and 60%, respectively, [4]. These values are much lower in the diagnosis of pneumonia (sensitivity of 47%, specificity of 67%) [5]. Leuppi et al [6] have assessed the diagnostic value of lung auscultation in patients admitted to the emergency ward for chest syndrome. In this study, 243 patients were evaluated and 287 diagnoses were made (18% had heart failure, 10% pneumonia). In 41% of cases, the diagnosis was correct when it was only based on patients’ history and lung auscultation improved the diagnostic yield in only 1% of cases. In this study, a normal lung auscultation was an independent predictor for not having a lung or heart disease but the authors have concluded that an abnormal lung auscultation did not appear to significantly contribute to the final diagnosis.