Auscultating

What do you mean no heart sounds? You mean you couldn't hear a heartbeat at all? Did you ask someone else to listen or to find his pulse?

"Auscultation" means "hearing, listening to." I have a friend with an autistic kid who can actually auscultate a radial pulse, but that is clearly abnormal.

If this person has no heart sounds, no pulses, and no reading on the SpO2 monitor, you can go get the morgue wrap.

No, seriously, try making sure your stethoscope eartips are pointed forward, to the tip of your nose. If they aren't and are pointed straight in or backwards (and that's the way they all do it on TV and it makes me laugh every time I see it) the openings in them will be up against the wall of your ear canals, and you will hear nothing at all. Ear canals run back-to-front, not straight in. Number one cause of failure to be able to learn how to take BPs and hear heart and lung sounds.

There are a couple of things that should be addressed. The first thing is that the stethoscope ear tips are supposed to be put in facing forward toward your nose. If the chest piece can rotate so that the diaphragm or the Bell can be put on the patient, make sure that the correct side is selected. If you have the wrong side down you will not hear anything. If you are unable to palpate a pulse, I would suggest that you might be pressing too hard or in the wrong spot for most people. While normal anatomy does vary a bit in where the blood vessels go, you can generally find arteries in basically the same places on most people.

If you are unable to get that stuff, check yourself and your equipment, then the electronic equipment. Of course, this assumes that you're actually looking at the patient and the patient is clearly alive... I'd get a bit wary of a patient that's still talking to me who is at room temperature, has no vital signs, and is asystolic on the monitor... I'm not going to get eaten first!

Sometimes you actually discover that a piece of equipment is no longer functional when you attempt to use it. Over the past few years, I have encountered this a couple of times.

Pulse-ox issues- If you can't get a reading, do a capillary refill on the finger. If it is longer than 3 seconds, pick a different finger. If the finger is cold, warm it up then put the pulse ox on the finger. If a female has nail polish on, especially glitter nail polish, remove it from one finger or turn the probe so the light goes side to side through the finger instead of top to bottom over the nail.

What was the blood pressure? We had a patient like this who had very low BP, and she needed a bolus of fluids to get her BP high enough for the pulsox to even pick up on her pulse and O2.

Next, take the advice about the stethoscope. Also, do you have a cheap stethoscope? Can you hear well with it?

If you're having trouble getting a pulse ox I grab a warm pack and let the patient sit with it for a few minutes in their fingers and try again.

"Auscultation" means "hearing, listening to." I have a friend with an autistic kid who can actually auscultate a radial pulse, but that is clearly abnormal.

If this person has no heart sounds, no pulses, and no reading on the SpO2 monitor, you can go get the morgue wrap.

No, seriously, try making sure your stethoscope eartips are pointed forward, to the tip of your nose. If they aren't and are pointed straight in or backwards (and that's the way they all do it on TV and it makes me laugh every time I see it) the openings in them will be up against the wall of your ear canals, and you will hear nothing at all. Ear canals run back-to-front, not straight in. Number one cause of failure to be able to learn how to take BPs and hear heart and lung sounds.

Last week we had an episode in the state where a family found a loved one unresponsive, the corner was called and pronounced the guy DOA.. The next day at the funeral home, they were moving him to the embalming table and he started to move.. he wasn't so dead after all :)

The warm pack worked for getting pulse ox. I've had other people listen to, to no avail. I've made sure my stethoscope earpieces are pointed in the right direction. I also tried a brachial, and couldn't get that either. Could it have anything to do with him being overweight (not obese)? And my stet isn't cheap (Littman Cardiology III).

Edit: We have an automatic that usually gets an error for his systolic; he's always sitting up when I take it. The patient is usually pretty difficult d/t lewy bodies dementia. Also, because I have a double-sided stethoscope (adult and pediatric), I checked that I was using the selected side, and I was.

as far as apical ?dextrocardia? (sp)