General[edit | edit source]
A stethoscope is an integral part of any EMT or paramedic's evaluation equipment. Initially, stethoscopes were utilized by doctors who wanted to keep with propriety when examining female patients; eventually it was found to be superior to the unaided ear and stethoscopes have been widespread in healthcare ever since.
A stethoscope consists of a single or double diaphragm or single diaphragm and bell connected to one or two tubes leading to an earpiece that is placed in the ears of the provider. Stethoscopes allow for audition of normal and abnormal sounds within the patient such as lung sounds, heart sounds, blood pressure auscultation, tracheal sounds, and abdominal sounds to name a few. There are electronic stethoscopes available which can artificially enhance sounds; however, these are often substantially more expensive than a "normal" stethoscope and require much more care.
To use a stethoscope, first turn the earpieces so that they are deflected slightly anteriorly and place the earpieces into your ear canals. The headpiece should not be too tight, nor should the earpieces enter your ears at a 90° angle. After placing the stethoscope on your head, if the apparatus is a double sided one, ensure that you have chosen the correct side to listen with by lightly running your finger along its diaphragm or tapping the bell (alternatively most stethoscopes have some sort of marking showing the "active" side). Use the stethoscope by placing the bell or diaphragm lightly on the patient's skin and listening. Certain stethoscopes allow for audition of different frequency sounds based upon pressure to the diaphragm.
Blood Pressure[edit | edit source]
Using a stethoscope for blood pressure is a skill like any other; practice will allow an experienced provider to take blood pressures in non-ideal conditions. When learning to auscultate blood pressure (and any time afterwards, honestly), set yourself up for success: choose as quiet a location as possible, position your patient correctly, limit movement of both yourself and the patient, and instruct the patient not to talk if possible. Some patients have increased amounts of adipose tissue that make blood pressure auscultation or lung sounds difficult, correct identification of anatomical structures and placement of the stethoscope are your friends with these patients.
Commonly, a falsely low reading for blood pressure may be obtained when a provider pushes hard enough with their stethoscope that the stethoscope's pressure on the artery is higher than the blood pressure cuff's. This can cause falsely low systolic and diastolic pressures. If you cannot hear a blood pressure, a slight increase in pressure may help but not as much as a readjustment and re-placement of the stethoscope may.
Lung Sounds[edit | edit source]
Similarly to blood pressure, patients with impediments between their lungs and the stethoscope's diaphragm are more difficult to take lung sounds on. Set yourself up for success by removing physical barriers such as clothing (you can slip the stethoscope under the clothing if needed) and looking for areas with smaller amounts of adipose tissue or muscle. Avoid having the patient talk and advise them to take normal breaths; if you need extra volume, asking the patient to breathe with their mouth open can increase audible volume.