Difficulty hearing pulse with stethoscope

nursemike, ASN, RN · Jan 8, 2009

Hello, I'm a total newbie to the health field and this looks like a great place to seek advice. I'm an EMT student and we are going to learn how to take BP soon. I just got my Stethoscope and was practicing with it. I'm finding it very difficult to hear a pulse with it. I can hear the heart beat fine, but when I tried to listen to the brachial pulse I couldn't make it out. The stethoscope is the Sprague Adscope.
So can somebody tell me if there's a trick to it? (Any other tips for a rookie would be greatly appreciated)
Thanks!

Are you using a cuff? When the cuff is very tight, the pulse is obliterated and you don't hear anything. Let some pressure off until you hear beats--that's the systolic. Continue to loosen, and when the beats go away, that's the diastolic. So you'll hear beats from, say, 140 to 70 (if the BP is 140/70) but not above or below that. With no cuff, you're well below 70, so no beats.

To locate the brachial pulse before you take the BP, you'll have to feel for it. Sometimes you can hear a little sound without the cuff, but not much. I suppose you could partly occlude the artery above the head of the scope with your thumb and hear beats. Never tried it, though.

zeppzepp2009 · Jan 9, 2009

I have been right where you are, I finished my EMT class in December and doing the blood pressures killed me!!! Are you feeling for the brachial pulse first before listening? I found if I felt it ( on many different classmates ) it made it way easier.

Do-over, ASN, RN · Jan 9, 2009

Are you actually trying to take a BP (with a cuff), or just listening for a pulse? You won't hear a pulse if you are just placing the steth over the brachial artery.

kenny b · Jan 9, 2009

If you are, in fact, listening with a cuff, and you're releasing the pressure slowly, then make sure your stethoscope bell is rotated to the correct position. Some of them rotate, and you have to tap lightly on the bell to determine if it is facing the right way. Also, make sure the ear pieces are facing slightly forward (in line with your ear canal). Finally, try it in a quiet room first to learn what your listening to. It takes practice and it can be learned.

If your ears still have difficulty listening at that level, and you're planning on becoming an EMT, you might consider an electronic stethoscope. They amplify the sound, but they are expensive. There are other high-quality stethoscopes that are pretty loud (much louder than the basic models in many EMT classes).

Let us know what you learn.

Regards,

Kenny B. Smooth Jazz Ballads

getoverit, BSN, RN, EMT-P · Jan 9, 2009

Are you actually trying to take a BP (with a cuff), or just listening for a pulse? You won't hear a pulse if you are just placing the steth over the brachial artery.

I"m not trying to be argumentative, but why do you feel you wouldn't be able to auscult a pulse with a stethoscope over the the brachial artery? That's what you're listening to when you take a manual pressure. You should be able to palpate the pulse, put the bell over it and hear it just fine.

Like I said, I'm not trying to put you down, but I can hear mine and just went over to the bedside and heard my patient's as well with no problem.

to merkleyb:

There's good advice here about taking a pressure and it is something that you become more used to with time. A year from now you won't remember why you were having a tough time with it!! Good luck with your EMT class!

Ausculapius · Jan 9, 2009

Im hard of hearing and bought a litmann 3000 stethoscope. Its expensive but money well spent in my opinion.

Do-over, ASN, RN · Jan 9, 2009

I"m not trying to be argumentative, but why do you feel you wouldn't be able to auscult a pulse with a stethoscope over the the brachial artery? That's what you're listening to when you take a manual pressure. You should be able to palpate the pulse, put the bell over it and hear it just fine.
Like I said, I'm not trying to put you down, but I can hear mine and just went over to the bedside and heard my patient's as well with no problem.

FWIW, I don't generally take correction as an insult. If I am wrong, I can handle it.

As for whether or not one would be able to hear a brachial pulse - I can't (never tried until saw your post - still can't), and never heard of anyone trying/wanting to. Not claiming to be an expert, and I have certainly been wrong before, but the OP wasn't clear on what was being attempted. So, is hearing a brachial pulse something a person who just picked up a steth would be able to hear? And, can you hear a pulse well enough to count and assess? How much pressure are you using on the bell? Why would you do this instead of palpating a pulse?

RN2B123 · Jan 9, 2009

I can hear my brachial pulse all the time with my littman cardiology III steth...but I had a hard time even when using my littman lightweight (it wasnt as strong sounding but you could still hear it) so if you use a 20$ steth or something you might have a difficult time hearing it

morte, LPN, LVN · Jan 9, 2009

you need to have the arm fulling extended, then palpate for the pulse.....then place the steth over the spot were you palpated the pulse, inflate the blood pressure cuff and let it out slowly.....

nursemike, ASN, RN · Jan 9, 2009

I"m not trying to be argumentative, but why do you feel you wouldn't be able to auscult a pulse with a stethoscope over the the brachial artery? That's what you're listening to when you take a manual pressure. You should be able to palpate the pulse, put the bell over it and hear it just fine.
Like I said, I'm not trying to put you down, but I can hear mine and just went over to the bedside and heard my patient's as well with no problem.
to merkleyb:
There's good advice here about taking a pressure and it is something that you become more used to with time. A year from now you won't remember why you were having a tough time with it!! Good luck with your EMT class!

Just tried my own, with a Littman Cardiology III. I could hear a little if I pressed very firmly with the bell (probably occluding the artery a little) but I wouldn't say "just fine." Then again, my ears are 52 y.o. I have had a few patients I could hear before inflating the cuff--again, very faintly--and more that are slightly more audible all the way down to 0 diastolic, except that in those cases the diastolic is where it goes from clearly audible to very faint.

My idea of applying pressure with my thumb above the head didn't work worth a darn, but I still think it could, perhaps if the pt had less meat (and fat) over the artery.

merkleyb · Jan 9, 2009

Thanks all for the input, really appreciate it. Yes I am using a cuff. I'll have to give it another shot. I'll report back.