It brought back memories of a lecture I had back in medical school, when a cardiology professor delivered these helpful quotes:
"This type of murmur sounds like a snowflake landing on a feather."
"You can practice mimicking heart sounds by tapping on Kleenex."
"If you think you heard this murmur, you didn't."
"I've never heard that heart sound, so I don't believe it really exists."
"If you can imagine the sound dandelions make as you blow seeds off them, you should be able to hear this murmur."
24 comments:
I used some of the online sites for ausculation (like this one below) in nursing school because I was so paranoid about that.
http://www.wilkes.med.ucla.edu/
Very helpful, especially if you don't have one of those fancy stereo stethoscopes.
Who knew you got koans in med school?
There are certain heart sounds which can only be heard by medical students and cardiologists
And then there was our deaf cardiologist, whose EVERY patient had a systolic ejection murmur...
I didn't know heart murmurs were so subjective.
I'm just happy if I can hear the heart beating, especially if I'm using the crappy stethoscopes at my school. My slightly less crappy one is mainly used for breath sounds, since as long as the heart is beating, I don't care about anything else, lol.
talk about worst-timing-to-shut-down-a-blog. sometimes i amaze myself!
Going to that site led me to this one, and I think you should add them to your blogroll:
http://anondoc.blogspot.com Nurse K would probably like them too.
One of our completely awesome professors offered this helpful analogy for a pericardical friction rub: "It sounds like someone wearing pleather pants getting up from a pleather couch" Love her for that. :)
Our cards professor had all the sounds down to states of the union.
An S3 gallop was "Ken-tucky, Ken-teucky, Ken-tucky. Ans S4 was "Tenn-ah-see, Tenn-ah-see"
But he had a sharp Italiano accent so when we said it, it sounded nothing like when he said it.
Turn on your heartlight.
Never mind. I'm going to pull a Lancet and retract the dire post. Thanks Dr. G for the link over, you've officially tripled my daily readership w/in 5 hours. I'll put the graph up tomorrow. It's pretty impressive to see.
Also I've never heard any of the heart sounds other than maybe lub-dub... if I'm lucky... and the patient is thing... and they have a giant healthy heart.
heart tones present. ok for general anesthesia. finis.
we were told in vet school that a 1/6 murmur doesn't exist, unless you are a cardiologist in a sound-proof room. and a 6/6 murmur can be heard without a stethoscope (more common than you would think!)
Quick! Get that pin-drop guy from the phone ads long ago.
I'm with the guy who doesn't believe they exist, given that I can't hear them either.
Soundss, like the doc should put in his/her hearing aid and give the ol' imagination a run for its money.
I don't believe most nurses bother listening to heart sounds. I can't tell you how many times I got a patient and as soon as I laid a stethoscope on them I could hear the clicking of their artificial valve that was somehow NEVER mentioned in any of the previous nursing notes.
I also had the misfortune of spending a few months in the hospital as a patient a few years back and in all that time there were only two nurses who ever laid a stethoscope on me.
Note to the younger generations: once upon a time,long, long ago, ultrasound and even fancy cardiac stethoscopes, did not exist(just like TV, microvawe ovens, computers and cellphones didn't, believe it or not!). The guys who trained and worked back then, THEY knew what heart sounds sounded like! They learned to apply all their senses to the max and could usually make a pretty accurate diagnosis with their old fashioned stethoscopes, eyes and hands. Not too many of them around any more - most retired or dead. I am fortunate to have known a number of them.
I work with a nurse who, I swear,hears a murmur on every baby she takes care of.....and the majority of time NO ONE else hears them....docs, other nurses, etc. But I must admit I am not the best at hearing murmurs - so many times when people hear them I think they are jsut breath sounds intermingled with heart sounds!
Anonymous , 4 March , 0747 - gals, too. otherwise you are on spot.
Sadly, recent articles on the demise of good bedside exam skills, like ausculatation, abound.
Listening with a stethoscope takes time, and training, and self determination. There are several web sites and programs (which the AHA can sell you or send along a link for about 250.ooUS)....
There is a lot of joy doing a real exam, and finding hidden pathology, which can mean initiating life enhancing care for patient.
Not so much joy to be bearing bad news, but glad to find it, and let patient/family be aware of what can be ahead.....
Having said that, still the history is the best time spent...
Heh, at my vet school our equine specialist got a fancy new stethoscope that magnified sound, and suddenly EVERY horse had alveolar emphysema!
Arkie:
Yes, met more than a few of those patients with artificial valves.
They are disconcerting, particularly if no one tells you about them.
Got used to the click, click, click.
Went to the Hotel and rarely used my stethoscope. I swear some of the RNs I work with think taking an apical pulse is punishment.
You want a challenge listening for a murmur? Examine a baby in contact isolation for RSV, with one of those crappy disposable stethoscopes, whose heart is beating at 180 and who is wheezing like a freight train.
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