Why are you listening to the heart?

Nalon1 RN/EMT-P, BSN, RN · Dec 31, 2016

Not all the time, unless there is an indication to do so (elderly, chest pain, SOB, weakness, fatigue, severe trauma, etc). That is maybe 1/3 of my patients that fall into that. But this is the same group that I am already listening to breath sounds on, so my stethoscope is already on their chest. Even then, not really anything particular I am listening for, they are on a monitor so I know if it is regular or irregular, palpated pulse tells me if they are perfusing beats; heart murmurs, clicks, gallop, rub (almost impossible to hear in an ER) are usually ongoing things that cannot be fixed in the ER, and are usually benign chronic issues.

Interested in what your answer is to why your doing it (on everyone?).

brownbook · Dec 31, 2016

An ER is based on the triage system. Sorting and allocating treatment to a large number of patients in a timely manner based on their medical needs.

A quick assessment is done when you walk into the patient's room. They are sitting up, breathing "normally" on room air, talking to you, skin color "normal", vital signs normal. That tells you a lot before you have even touched the patient. Yes I know you can't chart any of that, you have to use medically correct terminology.

If a patient is complaining of chest pain the protocol is, (used to be, ACLS changes every two years), MONA, or IV/ O2/ monitor, or a combination of both. None of that includes listening to heart sounds!

Honestly I can imagine very few situations in a busy ER where a nurse, and even a doctor, would listen to heart sounds! The cardiac monitor and pulse ox are going to give the quick and dirty picture of the patient's needs?

grizun · Dec 31, 2016

What about if hypertrophic cardiomyopathy is suspected?

chare · Dec 31, 2016

When I worked ED I assessed heart sounds and lung sounds on all of my patients. No longer than it takes, in my opinion, you really can't make an argument that you shouldn't do it.

nurse2033, MSN, RN · Jan 1, 2017

I would listen to heart sounds if it was indicated, such as a suspected valve problem. But focused assessments are the standard, meaning you don't listen to heart sounds on patients that it is not indicated. If you worked in tele, ICU, or a heart unit this would be very different. Anything you suspect by listening to the heart can be confirmed by imagery or labs. If I were a manager I would never forbid anyone to listen, but your manager is right, it is not going to change what you do. The ED is not a place for a deep dive, just get them to definitive care.

grizun · Jan 2, 2017

Begs the question, why listen to heart sounds on a med/surg floor then? What would that change?

Other question, does the time it takes to do a slightly more thorough assessment when time permits make a major impact?

Just curious.

Nalon1 RN/EMT-P, BSN, RN · Jan 3, 2017

What about if hypertrophic cardiomyopathy is suspected?

I would not know it if I heard it.

What does it sound like?

grizun · Jan 3, 2017

I would not know it if I heard it.
What does it sound like?

Murmur that gets better with increased volume.

allnurses Guide · Jan 9, 2017

I don't listen at the 4 valve spots (A,P,T,M) very often, but as long as I'm listening to breath sounds I listen for regularity as well. I've picked up a few murmurs that the pt either said "oh I forgot about that" or "no, I don't have a murmur!". Also feel for a brief radial at the same time, for correlation of beats to pulse. Only takes 5 seconds or so!

offlabel · Jan 11, 2017

Incidental murmurs get picked up every day somewhere during routine physicals. That's what routine physicals are for...to pick up stuff you didn't know the patient has. If heart sounds are important enough for that, why not during an ER visit?

As for not changing what the RN does if a murmur is picked up...pretty nonsensical statement. Of course it does. It could lead to a visit with a cardiologist at the very least.

Sheesh...it isn't as if care ends when the patient leaves the ER.

amzyRN · Jan 11, 2017

We should be doing assessments. I find myself getting a little lazy but later have kicked myself when I missed a pneumothorax that I might have picked up on first had I actually listened to lung sounds. The patient was fine but nevertheless, I am now a little more careful with people who I think might be really sick.