The Analyzed Body
Roger Cooter, John Pickstone in Medicine in the Twentieth Century, 2020
In the course of the nineteenth century the idea of diagnosis based on the testimony of the patient and the doctor’s intuition gradually gave way to the conviction that the body itself could yield data independently of what the patient thought or felt. Physical signs in the patient came to be seen as indications of underlying structural abnormalities, and careful observation as necessary to detect them. In the beginning, these careful bedside observations were made with unaided senses, their focus being primarily anatomical, the precise localization of lesions. Soon, however, instruments were developed to reach where the eye, the ear, and the hand could not. The stethoscope, for example, extended the possibilities of auscultation and percussion when examining sounds in the chest cavity. Likewise, the ophthalmoscope, the laryngoscope, and scopes permitting the examination of stomach, bladder, rectum, and vagina extended the range of visual examination of gross anatomical changes. Reiser points out that because these instruments were developed from an anatomical perspective on diagnosis, their use contributed to an atomization of the body, partitioning medical examination and orienting it toward smaller and more precisely defined areas.
From listening to hearing
Alan Bleakley in Educating Doctors’ Senses Through the Medical Humanities, 2020
Just as the stethoscope was once a technology that significantly enhanced listening, so new technologies have eclipsed the stethoscope and the power of auscultation as a diagnostic device. The stethoscope has become more a symbol of the profession rather than a necessary tool (English 2016). The availability of a variety of coloured stethoscopes allowed students to personalise an otherwise universal symbol. Future generations of students will have less and less need for bedside diagnostic skills of auscultation, percussion and palpation as technologies and tests replace these. In an era of political correctness and high standards of professionalism, touch is increasingly taboo even in medicine, except for necessary clinical investigations. Yet bedside diagnostic talk and touch, listening and sensitive examination or appropriate touch for reassurance and empathy are important for successful clinical encounters (Kelly et al. 2014), as repeated insistently in this book.
Assessment of Cardiac and Noncardiac Risk Factors
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
The evaluation of cardiac risk always involves a thorough history and directed physical exam. The primary goal of any cardiac risk assessment is to evaluate for active cardiac conditions. The initial history, physical examination, and electrocardiogram (EKG) assessment should focus on the identification of these conditions. The active conditions that should delay elective surgery until they are addressed include unstable coronary syndromes, acute heart failure, and significant arrhythmias or valvular disease. Through appropriate questioning about chest pain, palpitations, orthostasis, or dyspnea along with adequate heart and lung auscultation for murmurs, rhythm irregularities, and respiratory rales, these conditions should be identified. A resting EKG can also help detect abnormalities specifically related to arrhythmias, ischemia, and conduction abnormalities. An EKG is indicated in certain groups of patients: (a) patients undergoing major vascular surgery; (b) patients with known CAD, peripheral artery disease, or cerebrovascular disease, undergoing intermediate-risk surgery; and (c) patients with clinical risk factors for CAD that will be undergoing intermediate or high-risk surgery. The identification of active cardiac conditions should prompt the surgical team to delay nonemergent surgery and obtain medical consultation to evaluate and medically optimize the patient prior to surgery.
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
The discovery of auscultation was a momentous milestone that has played a key part in advancing medicine. Auscultation, which comes from the Latin verb auscultare ‘to listen’, refers to the practice of listening to the internal sounds of the body. Identifying and analyzing the various sounds that are produced by the body are integral to the training of a physician. It is said that Hippocrates (c.460-c.370BC) used to directly apply his ear to the chest of a patient to detect the accumulation of fluid within the chest [1]. This practice of laying the ear directly against the patient’s body came to be known as ‘immediate auscultation’. Immediate auscultation was used frequently by many people to diagnose diseases such as Robert Hooke (1635–1703), of Hooke’s Law fame, who was familiar with heart sounds and recognized the importance of auscultation, and Allan Burns (1781–1813), a cardiologist, who used it to described heart murmurs [2].
Digital devices for teaching cardiac auscultation - a randomized pilot study
Published in Medical Education Online, 2018
Malcolm E. Legget, MeiYen Toh, Andries Meintjes, Sarah Fitzsimons, Greg Gamble, Robert N. Doughty
Digital stethoscopes and hand-held echocardiography (HHE) devices are modern portable digital devices that allow physicians to evaluate patients with heart murmurs. Digital stethoscopes provide improved sound quality and the ability to record and play back sounds multiple times to multiple listeners [1]. HHE devices provide real-time visual display of cardiac valvular pathology at the patient bed-side. While well established as tools that help in the clinical assessment of patients, these tools also have the potential to facilitate effective teaching of cardiac auscultation, a core skill integral to clinical medicine. A conventional stethoscope’s inability to act as an ‘audio platform’ may be a significant obstacle to the effective teaching of cardiac auscultation [1]. The use of digital stethoscopes and HHE as teaching aids to improve the diagnostic accuracy of evaluation of heart murmurs, compared to conventional bedside examination, has not yet been evaluated in depth.
The effect of chewing gum on bowel function postoperatively in patients with total laparoscopic hysterectomy: a randomised controlled trial
Published in Journal of Obstetrics and Gynaecology, 2022
Pinar Kadirogullari, Kerem Doga Seckin, Pinar Yalcin Bahat, Zubeyde Aytufan
Before the operation, the patients were informed about the post-operative follow-up protocol. Both groups were treated with routine post-operative routine follow up protocol. None of the patients in both groups was prescribed enema for bowel cleansing. All patients were operated on under general anaesthesia. The patients who are included in the study group were asked to chew sugar-free gum for 15 min every 2 h starting from the post-operative 4th hour. Since each patient was completely recovered from general anaesthesia, pharyngeal reflexes were normal. These patients were given eight gums in a plastic bag attached to the patient file. Each gum was numbered. After the patient describes gas discharge the remaining gums were returned to the health professional. The number of the last gum chewed was recorded. The patients in the control group did not chew gum and standard postoperative care was followed. The in-patient unit physician in the research team performed auscultation every 2 h starting from post-operative third hour. The patients were asked to keep the attached plastic bags among personal belongings. The physicians analysing result parameters were blinded to group information.
Related Knowledge Centers
- Heart Murmur
- Palpation
- Stethoscope
- Heart Sounds
- Lung
- Circulatory System
- Heart
- Respiratory System
- Respiratory Sounds
- Physical Examination