Stethoscopes are instruments used to listen to sounds made by the human body, such as heartbeats and breaths. Stethoscopes are very useful diagnostic instruments that can help locate problems and diagnose diseases in people.
Diagnostics and treatments are equally crucial in medical specialties. It is the role of diagnosis to identify and determine the nature of the disease, while treatment is the process of eliminating the disease-causing agent.
Thus, for that purpose, one should have proper knowledge of a stethoscope and its uses.
Therefore, in this article, you will find a complete guide to using the stethoscope and its uses.
What Are The Uses Of A Stethoscope?
Blood pressure, heart, and lung function are all evaluated using the stethoscope as one of the first tools. The stethoscope is a common and essential tool you will see in every doctor’s life.
A stethoscope allows a listener to distinguish between normal and abnormal sounds. Among these are the sounds of your heart, lungs, pleurae, veins, uterus, and intestinal tract.
This instrument can also be used to hear the heart sounds of developing fetuses and the blood flow of peripheral vessels in pregnant women.
Moreover, it can also detect sound from fetuses and animals, not just adult humans.
How To Use A Stethoscope For Checking Blood Pressure?
Learn how to appraise what you hear when using a stethoscope. So for that reason, I am here to instruct you how to examine your patient using a stethoscope thoroughly and adequately.
It is possible to use a stethoscope incorrectly, even though measuring blood pressure may be the most common use of a stethoscope. Using a stethoscope for measuring blood pressure, a blood pressure cuff is blown up around the upper arm to hear audible heartbeats beneath the cuff at the brachial artery.
Blood pressure is calculated by multiplying systolic and diastolic pressures together.
Put the blood pressure cuff on your patient and secure it.
If you are taking an arm blood pressure check, be sure to use a cuff that fits the patient. Put the cuff just above the elbow after the patient rolls up his sleeves. Please don’t make it too tight. Otherwise, it may cause a tangle. Change the size of the blood pressure cuff if it is either too small or too large.
Place the diaphragm of the stethoscope over the brachial artery
If you have trouble hearing the bell, you can use the diaphragm. During the checks, listen for low-tone Korotkoff sounds, which represent a patient’s systolic blood pressure. Furthermore, you can find your brachial artery by finding your pulse in your inner arm.
Your cuff should be 180mmHg or 30 mm above your expected systolic blood pressure
Sphygmomanometers, also known as blood pressure cuffs, can be used to check the reading. After that, release air from the cuff slowly at (3 mm/sec). You should listen to the patient with the stethoscope, and you should look at the sphygmomanometer gauge.
Listen to the sounds of Korotkoff
Listen for the first knocking sound in your patient. That is the systolic blood pressure. Watch the sphygmomanometer as you note that number. Note the reading after you stop hearing that first sound. It represents the diastolic pressure of your patient.
Remove the cuff after inflation
After getting the second number, deflate the blood pressure cuff and remove it from your patient’s arm. You should now have two blood pressure numbers. Using a slash, separate the two numbers. For instance, 110/60.
Wait a few minutes if you want to check the patient’s blood pressure again
In case the patient’s blood pressure is too high, you might want to re-measure it. Patients with systolic blood pressure higher than 120 or diastolic blood pressure greater than 80 are considered hypertensive. You should consult a doctor if your patient has high blood pressure.
How Do You Listen To The Heart’s Sounds Using A Stethoscope?
Over the chest of the patient, position the diaphragm.
Under the left breast, about halfway between the 4th and 6th rib, place the diaphragm. Put your pointer and middle fingers between the tip and the ring of the stethoscope, so your fingers won’t rub against each other while listening.
For one minute, listen to the heart
Observe the patient breathing normally and ask them to relax. Heartbeats sound like lub-dub, and they are also known as systolic and diastolic sounds. The sound is “lub” during systole, and during diastole, the sound is “dub”.
Count how many heartbeats you hear in a minute
An adult’s and a child’s resting heart rate should fall between 60 and 100 beats per minute. Ideally, average resting heart rates for athletes may be as low as 40-60 beats per minute. Children under the age of 10 should have their resting heart rate measured at several different levels.
The stethoscope not only measures the heart rate but also alerts doctors to dangerous “gallops” or “murmurs” in a heartbeat. The sound of irregular heartbeats can be challenging to detect at first, but you’ll be able to spot anything unusual over time. During a complete heart checkup, the four main areas around the heart are listened to, each of which corresponds to a particular heart valve.
- Pulmonary valves left of the sternum, the second rib down
- The aortic valve is to the right of the sternum, 2nd rib down
- The tricuspid valve is located on the left side of the sternum, 4th rib down
- A short distance from the left nipple, down the 5th rib to the mitral valve
Pay attention to abnormal heart sounds.
In addition to counting heartbeats, you should also consider listening for any odd sounds. It would be best if you felt anything that doesn’t sound like lub-dub as being abnormal. The doctor may need to evaluate your patient further if any strange sounds are heard. Find out if the heart sounds you hear are normal by listening to samples of normal and abnormal heart sounds.
How To Use A Stethoscope For Listening To The Lungs?
Stethoscopes are a valuable tool for checking for proper breathing and identifying airway obstructions as well as lung inflammation.
To complete a lung examination, you must listen to six pairs of areas on the chest and seven pairs of spots on the back. By comparing both sides of the body at the same time, it is possible to reach the lungs directly. Detecting abnormalities is much easier when we compare both sides of the body simultaneously.
During the back examination, the patient should incline forward to allow for the most accurate hearing. The physicians should work their way down from the clavicle, starting at the top and working their way down.
Listen to your patient’s lungs with the diaphragm of your stethoscope.
Examine the lungs on the front and back of the patient and in the upper and lower lobes. It would help if you listened to the upper chest, then the midclavicular line of the chest, and then the lower part of the chest with a stethoscope. Be sure to listen to those areas both on the front and back.
Note any abnormalities you see in your patient’s lungs on both sides. You will be able to listen to all three lobes of your patient’s lungs when you cover all these positions.
Listen for normal breath sounds.
The sound of a healthy breath is as clear as if you were listening to someone blow into a cup of water. Using healthy lung samples, compare them with sounds coming from your patient’s lungs. A typical breath sound consists of two types:
The tracheobronchial tree contains the sounds associated with bronchial breath.
Those sounds picked up over the lung tissue are called vesicular breath sounds.
Take note of any abnormal breath sounds
There are many breathing abnormalities, including wheezing, crackles, stridor, rhonchi, and cough. If the patient does not sound breathy, they may have air or fluid surrounding their lungs, thickening their chest wall, or a slowed or overinflated flow of air to the lungs.
Abnormal breath sounds fall into four categories:
- When an individual is wheezing, a high-pitched noise can be heard when they exhale, as well as when they inhale. Most asthmatics experience wheezing as well. Even without a stethoscope, you can listen to the wheezing. It’s like a whistling sound.
- The sound of Rhonchus is similar to snoring. The rhonchi can only be heard with a stethoscope and occur when the air moves roughly through the lungs or when a blockage is there in the path.
- There is a rattling in the lungs when you hear a rale. A doctor can listen to a rale when the patient breathes in.
- Finally, the stride is a high-pitched breathing sound, similar to wheezing, that is heard most often when the patient breathes. Blockages to the airway or throat cause this condition. Many times, this sound is also audible without a stethoscope.
Note: You should provide your patient with further sophisticated evaluation and treatment if you detect any of these types in his breath. This needs to be taken seriously.
How To Use A Stethoscope For Bowel Sounds?
In cases of suspected obstruction or paralytic ileus, abnormal bowel sounds are vitally important. Bubbles or gurgling noises are generally harmless and do not need to be taken seriously. They are sometimes called borborygmi.
Placing the diaphragm on the patient’s stomach
You can divide your listening around the belly button into four sections and focus your attention on the belly button. Pay attention to the left, right, upper left and lower left parts.
Check for normal bowel sounds
In normal circumstances, your stomach grumbles or growls when your bowels are empty. Anything else is a sign of an underlying problem, and the patient needs to be evaluated further.
Each section should contain “growling.” In some cases, those sounds may not return until a week or so after surgery.
Listen for unusual sounds coming from the bowels
When you listen to your patient’s bowel movements, most of the sounds you hear are just digestion noises. Some abnormalities in bowel sounds can indicate a problem, though most are standard. You should consult a doctor if you are unsure whether you hear normal bowel sounds or if the patient is exhibiting any other symptoms.
A patient who does not make any bowel sounds may have something stuck in the stomach. A bowel sound may return by itself if this occurs because of constipation. In the event they do not return, a blockage can occur. A doctor would need to evaluate the patient in that situation.
How To Use A Stethoscope For Listening Bruits?
Detecting abnormal blood flow (bruises)
A bruit is a distinctive, whooshing sound that indicates vascular problems. In most cases, bruises reveal a less elastic artery, which may indicate dangerous conditions such as aneurysms or arteriosclerosis. Bruits typically appear in the following arteries:
- The carotid (neck)
- Aortic abdomen
- The renal system (kidney)
- The femoral (thigh) bone
- Pelvis (Iliac)
- The temporal region (forehead)
Check for bruits if necessary
It is essential to check for a bruit if you hear a sound that appears to be a heart murmur. A murmur sounds similar to a bruit, so checking both is important if one exists.
The stethoscope diaphragm should rest on one of the carotid arteries.
Your patient’s carotid arteries can be found in the front of the neck. You can trace the carotid arteries in the front of the throat by running your index and middle fingers along with it.
Make sure the artery does not get cut off by pressing too hard. Otherwise, your patient might faint. Never apply pressure simultaneously to both carotid arteries.
Take note of bruits
Bumps indicate narrowing of an artery by making a whooshing sound. It is possible for bruits and murmurs to sound alike, which makes them difficult to differentiate. There will be a whooshing sound if the patient has a bruit in the carotid artery but not in the heart.
Aside from the abdominal aorta and renal arteries, listen for bruits in the iliac arteries and femoral arteries.
What Else Can A Stethoscope Do?
Using a stethoscope can also detect abnormalities in the intestinal tract, such as over-responsive or under-responsive movements. As an additional result, a stethoscope can assist in determining the vertical measurement of the liver at the nipple line. Although this is not frequently carried out, it is uncommon.
Furthermore, pregnant women use a stethoscope to listen to the fetal heartbeat of their unborn baby. Thus, every health care provider and medical student should learn how to use a stethoscope.
How To Operate A Stethoscope?
Assessing and monitoring patients could be easier and more efficient if you could accurately identify heart, lung, and bowel sounds. You can perform accurate auscultations by following these conditions and using the equipment correctly:
In order to seal the ear tips, they should be twisted. The right way of wearing a stethoscope is to point toward the nose when done right, and outside noises should become more muffled and blocked.
Hold the chest piece between your middle and index fingers in your dominant hand, just above the knuckle level. Keeping the tube still with your thumb will reduce interference noise. A patient can be examined seated, lying down, or in a left-lateral recumbent position. Different sounds will be heard in various positions, significantly abnormal sounds.
The stethoscope should ideally be placed right against the skin, or at most one layer of clothing apart if necessary. It is important for the patient to take deep, slow breaths. When using the bell, the listener should note various sounds in different chest areas for one minute. Then, you may use the diaphragm in the same way.
There Are Differences In Performance Between Stethoscopes.
Stethoscopes are not all designed the same and do not have the same features. Each type of stethoscope offers a unique set of characteristics that can be enhanced in order to detect specific diseases or illnesses in patients more effectively.
Most stethoscopes are often made of rubber tubing that looks like a Y shape. Sound can enter the device through one end, travel up tubes, and then go through earpieces and to the ears of the listeners.
A chest piece with different heads.
For listeners who need to hear both high and low pitches, many stethoscopes have a two-sided sound-detecting head. However, some recent models only have a single pressure-detecting head.
Medical professionals working with patients suffering from a variety of heart/cardiovascular conditions could benefit significantly from a single-headed chest piece that permits the device to tune in to a range of sounds and frequencies.
Moreover, there are various stethoscopes available, including binaural stethoscopes, designed to be used with both ears while with single stethoscopes, users can use them on a single ear. In addition, there are differential stethoscopes, which let listeners compare sounds of the patient’s body at two different body sites.
Also, electronic stethoscopes are commonly used today, thanks to modern technology. Users can record and save audio and amplify tones electronically with these stethoscopes. There are stethoscopes specifically designed to listen for the sounds coming from the esophagus or fetal heartbeat.
Which Side Of A Chest Piece To Use While Examining?
The stethoscope produces two sounds, low-frequency sounds or high frequency/pitched sounds. A stethoscope’s chest piece vibrates the diaphragm when focused on the body when it is held against high-frequency sounds. However, if you want to hear low-frequency sounds, then you need to use the bell.
The diaphragm, or bigger part of the chest piece, is also necessary when examining a patient’s heartbeat. Generally, stethoscopes that are used these days have a tunable diaphragm. For high-frequency sounds, these types of stethoscopes require only pressure put on the skin, while low-pitched sounds require no pressure.
In A Stethoscope, What Parts Are There, And What Is Their Purpose?
Thus, we will begin with the Stethos, which means chest. And it is the central part of the stethoscope. In order to use the chest piece, you hold it against the patient’s body to hear low and high-frequency sounds, which it detects.
Single- or double-sided, both versions are possible.
A two-sided chest piece is typically composed of a diaphragm on one side which is the more significant part of the chest piece, and a deep, cup-shaped side known as a bell on the other side.
As with double-sided pieces, both of the single-sided pieces will typically have a flexible ring known as a chill ring around them, which provides an airtight seal and acts as a cushion against the coldness of the device.
The stem is what connects the chest piece to the tubing.
As the name implies, acoustic tubes are hollow rubber tubes connecting the headset’s chest part to the earpieces. Sound travels through these tubes and reaches your ears.
A stethoscope’s metal portion is called the headset.
These are the hollow metal tubes located between the earpieces and the acoustic tubes that connect the two devices.
The ends of the ear tubes have small tips that go into your ears, known as earpieces. There are stethoscopes that offer a choice between hard plastic and soft silicone earpieces of different sizes that fit into your ears.
Maintenance And Aftercare Of Your Tool
A stethoscope does not pose any risks to those being examined. The instrument is therefore safe for use.
Warning: If a stethoscope is dropped or hit against a hard surface with its earpieces in place, the bell may cause a loud bang, which may cause users to hear loud noises and may cause damage.
To make sure your tool lasts, there are some aftercare precautions
Cleaning is essential to ensuring the safety of patients using stethoscopes, and using alcohol to clean and disinfect the chest piece before each use is recommended. In situations where the chest piece will be directly touching the skin, this precaution is particularly vital.
This is an instrument of great sensitivity. Handle it with care so as to prevent your tool from damaging. It requires periodic cleaning. Also, the user may keep their tool away from liquids and extreme temperatures.