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At least 613 records · Page 34Linked to original sources
PubMed1994

Comparison of transesophageal atrial pacing with anticholinergic drugs for the treatment of intraoperative bradycardia.

We compared the effectiveness of atropine, glycopyrrolate, and a transesophageal atrial pacing (TAP) stethoscope for treating intraoperative bradycardia in 64 unpremedicated patients receiving a standardized sufentanil/N2O/vecuronium anesthetic. Patients were allocated randomly to receive either atropine, 5 micrograms/kg (Group 1), glycopyrrolate, 2.5 micrograms/kg (Group 2), or transesophageal atrial pacing (Group 3) after the onset of bradycardia, defined as a heart rate of < or = 50 beats/min (or < or = 60 beats/min with concurrent hypotension). Bradycardia occurred in 15 patients of each treatment group. The time required for the heart rate to increase to > or = 70 beats/min was 270 (range 30-490), 270 (70-465), and 12 (2-30) s in Groups 1, 2, and 3, respectively. Although all patients in Group 3 responded to pacing at 150% of the threshold current, 10 patients in Group 1 and 8 patients in Group 2 required a second dose of anticholinergic medication before a heart rate response was observed. One patient in Group 2 required three doses, and another who did not respond even after four doses was treated with the TAP device. Bradycardia subsequently recurred in five patients in Group 1 and four patients in Group 2. Temporary recurrence of bradycardia occurred in seven patients in Group 3 due to outward migration of the pacing stethoscope. However, heart rates were more consistently maintained in paced patients. There were no significant differences in postoperative side effects between the three groups, or when compared with patients who did not receive treatment for bradycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2001

Auscultation of the Chest and Abdomen by Athletic Trainers.

OBJECTIVE: To present a practical overview of the methods and techniques of auscultation of the chest and abdomen for use during the physical examination of athletes. Our intent is to provide information on this clinical technique to assist athletic trainers in recognizing and referring athletes presenting with potentially serious internal organ conditions. BACKGROUND: Use of the stethoscope is a clinical skill increasingly necessary for athletic trainers. Given the expanding breadth of both the assessment techniques used by athletic trainers and the populations they care for and the fact that clinical instruction guidelines have changed in the newly adopted National Athletic Trainers' Association Educational Competencies, our goal is to provide a framework upon which future instruction can be based. DESCRIPTION: This review covers the use of a stethoscope for auscultation of the chest and abdomen. Auscultation of the heart is covered first, followed by techniques for auscultating the breath sounds. Lastly, auscultation of the abdomen describes techniques for listening for bowel sounds and arterial bruits. CLINICAL ADVANTAGES: During the assessment of injuries to and illnesses of athletes, knowledge of auscultatory techniques is valuable and of increasing importance to athletic trainers. Athletic trainers who do not know how to perform auscultation may fail to recognize, and therefore fail to refer for further evaluation, athletes with potentially serious pathologic conditions.

Journal Article↗
PubMed1992

Hearing irons: the questioning "Y".

It was a day still remembered--the day we medical students got our stethoscopes. They were carefully folded over just enough so the earpieces were easily visible to the world in our white coat pockets. This instrument is to the future doctor what the badge is to the policeman, the white scarf is to the pilot, and the reverse collar is to the clergyman ... a symbol of arrival at a goal, long dreamed of and worked for: we now knew we were accepted into the fraternity of medicine. Yet, the story of how the stethoscope came to be is frequently unappreciated.

Heart Auscultation↗
PubMedDate not supplied

Direct and indirect blood pressure in critical care patients.

The purpose of this study was to determine the relationship between direct intraarterial blood pressure readings and indirect auscultated blood pressure readings by using different listening pieces and auscultation sites. The two listening pieces used for correlation and comparison were the bell and the diaphragm of the stethoscope. The two sites for auscultation were the antecubital fossa and the upper arm immediately superior to the internal medial condyle and medial to the biceps tendon. Simultaneous direct and indirect blood pressure readings were obtained from 50 critical care patients with indwelling radial arterial lines. The averages for three blood pressure readings obtained from each site and for each listening piece were correlated and compared with the averages of three simultaneous direct blood pressure readings. Statistical testing was done separately for systolic and diastolic readings. Auscultation techniques using both listening pieces and sites were found to be accurate, r greater than .8 for all correlations; p less than .0001 for all comparisons, but auscultation using the diaphragm of the stethoscope over the brachial artery in the upper arm provided the most accurate readings.

Adult↗
PubMed1986

Endotracheal tube leak pressure and tracheal lumen size in swine.

Endotracheal tube "leak" is often estimated in children to judge the fit of uncuffed endotracheal tubes within the trachea. Twenty-five swine were intubated with uncuffed tracheal tubes to determine whether a more sensitive measurement of leaks could be devised and whether leak pressure estimates fit between tracheal tube and trachea. We compared leak pressure measurement using a stethoscope and aneroid manometer with a technique using a microphone, pressure transducer, and recorder, and found no differences between the two methods. The tracheas were then removed and slides prepared of tracheal cross-sectional specimens. Regression analysis revealed a linear relationship between tracheal lumen size and tracheal tube size for both low leak pressure (y = -0.4 + 0.79x, r = 0.88, P less than 0.05) and high leak pressure (y = -2.9 + 0.71x, r = 0.92, P less than 0.05) groups. We conclude that leak testing with a stethoscope and aneroid manometer is sensitive and accurate, and that tracheal tube leak pressure accurately portrays fit between tube and trachea.

Animals↗
PubMed1984

[Possibilities and limitations of ventilation monitoring during anesthesia of the newborn and infants].

The following methods for monitoring the ventilation in general anaesthesia can theoretically be applied for neonates and small infants: The use of a precordial stethoscope, measurements and observation of the ventilation pressure, analysis of the inspiratory oxygen concentration, measurement of the expiratory volume, analysis of end-tidal CO2, transcutaneous O2 and CO2 measurement and blood gas analysis. These methods are evaluated and their limitations discussed. Special attention is paid to the application of these methods used in the different paediatric anaesthetic systems. A three graded plan which classifies the risks for the patients and/or the operations is presented in order to rationalize the use of these methods, some of which require expensive equipment. The basic ventilation monitoring includes, even for short operations in healthy patients (Grade I), the precordial stethoscope, the measurement of the inspiratory oxygen concentration, the measurement of the ventilation pressure and, for school age children also measurement of the expiratory volume. For operations lasting longer than one hour (Grade II) end-tidal CO2 analysis should be used when the ventilation-perfusion ratio is undisturbed. Transcutaneous O2 is desirable, but at the present time not accurate for conditions of general anaesthesia. For all high risk patients and/or operations (Grade III), particularly in the neonates, arterial blood gases are indispensable as well as the other methods for monitoring ventilation.

Age Factors↗
PubMed1983

Auscultatory indirect measurement of blood pressure in dogs.

An indirect method of measuring blood pressure (cuff plus stethoscope) was evaluated in 70 dogs weighing 15 to 30 kg (17.5 +/- 8.8 kg; mean +/- standard deviation). A cuff 12 cm wide was used. The measurements were most audible with the cuff on the upper foreleg of the dog and with the stethoscope placed in the medial epicondylar region just distal to the cuff. The cuff was inflated to greater than systolic pressure and allowed to deflate slowly. In 70 lightly sedated dogs, systolic blood pressures averaged 145 +/- 25 mmHg (mean +/- standard deviation) and diastolic blood pressures averaged 84 +/- 14 mmHg. Indirect measurements were compared to direct measurements (femoral arterial catheter). Systolic pressures obtained by this direct method averaged 138 +/- 29 mmHg (mean +/- standard deviation) and diastolic pressures averaged 84 +/- 17 mmHg. The correlation coefficient for systolic pressure was 0.96 and for diastolic pressure 0.97.

Animals↗
PubMed1995

Intraoperative and postoperative physiological monitoring practices by pediatric dentists.

The medical and dental literature has described successful sedations and those which have resulted in injury and death. Physiologic monitoring of patients is essential in assuring the success and safety of sedations in the dental office. The purpose of this study was to investigate the utilization and preferences of various physiologic monitoring methods and utilization of dentist anesthesiologists by pediatric dentists during sedations. Pediatric dentists in California were surveyed [n = 261] regarding monitoring methods in five different case scenarios. The most frequently utilized methods were clinical observation, pulse oximeter, and precordial stethoscope. Eighty seven percent of the pediatric dentists who use sedation do so without the involvement of a dentist anesthesiologist. Eighteen percent of pediatric dentists do not use any sedative agents in their practice. In the five case scenarios described in the survey, clinical observation was the most frequently utilized monitoring method during intra- and postoperative periods, followed by the pulse oximeter and precordial stethoscope. Intra- and postoperative monitoring varied with the complexity of the case scenario and most respondents monitored continuously. The trends observed from this study indicate that recent graduates use more sedative agents and find the pulse oximeter to be useful for physiologic monitoring during sedation.

Adolescent↗
PubMed1995

[Respiratory sounds].

After having invented the stethoscope, Laennec published his treatise on auscultation in 1819, describing the acoustic events generated by ventilation and linking them with anatomopathological findings. The weak points of his semiology lay in its subjective and interpretative character, expressed by an imprecise and picturesque nomenclature. Technical studies of breath sounds began in the middle of the twentieth century, and this enabled the American Thoracic Society to elaborate a new classification of adventitious noises based on a few physical characteristics. This terminology replaced that of Laennec or his translators (except in France). The waveforms of the different normal and adventitious noises have been well described. However, only the study of the time evolution of their tone (frequency-amplitude-time relationship) will enable a complete analysis of these phenomena. This approach has been undertaken by a few teams but much remains to be done, in particular in relation to discontinuous noises (crackles). Technology development raises hope for the design, in near future, of automatic processes for respiratory noise detection and classification. Systematic research into the production mechanisms and sites of these noises has progressed equally. It should, in time, reinforce their semiological value and give to auscultation, either instrumental or using the stethoscope or instrumentally, an increased diagnostic power and the status of respiratory function test.

Auscultation↗
PubMed1993

Three methods of taking the brachial systolic pressure to measure the ankle/brachial index: which one is best?

This study was designed to determine which method of measuring the brachial systolic blood pressure is most accurate when determining the ankle/brachial index (ABI). The accuracy of the stethoscope diaphragm was compared with the accuracy of the stethoscope bell and Doppler methods in measuring the brachial systolic pressure. These pressures were used in the calculation of the ABI, and then the ABI was compared by method and time since surgery. The sample consisted of 31 subjects who had peripheral arterial bypass surgery. The findings of this study indicate that there is no significant difference in the ABI when the brachial systolic blood pressure is measured by any of the three methods. A difference was found between the right-arm and left-arm brachial systolic pressures in many of the patients, and this would make a difference in the calculation of the ABI.

Aged↗
PubMed1993

Low predictive value of positive Osler manoeuvre for diagnosing pseudohypertension.

Pseudohypertension is a condition where indirectly determined BP (e.g. via sphygmomanometry) significantly overestimates actual intraarterial pressure. A patient who has a palpable, although pulseless, radial artery while the blood pressure cuff is inflated above systolic pressure, has a positive 'Osler sign'. This 'Osler manoeuvre' has been reported to predict the presence of pseudohypertension. To evaluate its importance in diagnosing pseudohypertension, 19 hypertensive patients deemed Osler-positive by at least two observers were studied. BP was determined indirectly using a stethoscope and mercury sphygmomanometer. Intraarterial pressure was determined by a brachial artery catheter-transducer-monitoring system. For both pressure-measurement techniques and each patient, six readings were averaged to give a single systolic and diastolic value. Mean arterial pressure was calculated as diastolic pressure plus one-third the pulse pressure. Pseudohypertension was defined as a sphygmomanometric mean pressure that exceeded intraarterial mean pressure by > or = 10 mmHg. In this group of 19 Osler-positive patients, stethoscope-sphygmomanometry underestimated systolic and overestimated diastolic intraarterial pressure. For mean pressure, sphygmomanometry was > or = 10 mmHg higher than intraarterial in two patients and > or = 10 mmHg lower than intraarterial in three patients. Thus, while two patients had pseudohypertension, three could be considered to have pseudohypotension, defined as a condition where indirect blood pressure significantly underestimates intraarterial pressure. Accordingly, a positive Osler manoeuvre did not reliably predict the presence of pseudohypertension in this population.

Aged↗
PubMed1997

Color Doppler imaging in the diagnosis of the acute scrotum.

OBJECTIVES: To determine the value of color Doppler imaging (CDI) in the diagnosis of acute scrotum. MATERIALS AND METHODS: We evaluated 102 consecutive patients referred to our institution with scrotal pain. All patients were evaluated by physical examination, ultrasound with stethoscopic Doppler followed by CDI. Radionuclide scanning was performed only in 14 patients. Patients with a diagnosis of testicular torsion by CDI underwent surgical exploration. Patients with CDI diagnosis of epididymorchitis were treated with intravenous antibodies and underwent repeat CDI evaluation after treatment. RESULTS: Of the 102 patients evaluated ages 11-44, CDI diagnosed 18 patients with testicular torsion and 78 patients with epididymorchitis. Cases of testicular torsion were found to have absent flow on CDI. CDI findings of normal or increased flow were present in all patients with epididymorchitis. All cases of torsion were confirmed on surgical exploration, 11 patients underwent orchidopexy and 7 patients underwent orchiectomy. No cases of testicular atrophy were encountered on long-term follow-up in patients with epididymorchitis. Diagnoses in the remaining patients were testicular tumor 1, testicular abscess 2, scrotal hematoma 2 and incarcerated hernia 1. CDI was found to be 100% sensitive and 100% specific in the diagnosis of the acute scrotum. CONCLUSION: We found CDI to be more accurate and reliable than physical examination in conjunction with gray-scale ultrasound and Doppler stethoscopic examination in the differential diagnosis of the acute scrotum. CDI is practical and can be performed in a rapid manner. CDI should become an integral part of the urologist's armamentarium in the differential diagnosis of the acute scrotum.

Adolescent↗
PubMed2004

Is clinical wheezing reliable as the endpoint for bronchial challenges in preschool children?

The present study was designed to compare the clinical finding of wheeze by auscultation with an objective evaluation by acoustic means at the endpoint of a bronchial challenge in preschool children. Challenges were undertaken using a tidal breathing method in 51 preschool children as part of the investigation of possible asthma. An electronic stethoscope was used for auscultation of each lung and for the simultaneous recording of the acoustic sonogram for analysis. In 24 children, the pediatrician determined that the challenge was positive, and in 22 of these, he heard wheezing at the endpoint of the challenge. In 2 children the challenge was considered positive, based on a modest fall in saturation. The acoustic record was scanned manually for presence of wheeze defined in terms of duration, and power spectrum without reference to auscultatory findings. In positive challenges, the mean wheeze rate was 28.1% (95% CI, 19.5-36.8%), while no wheeze was detected acoustically in negative challenges. Using a cutoff wheeze rate (duration of wheeze/duration of breath phase x100) of 10% for the whole group, clinical wheezing detected by the pediatrician had a sensitivity of 100% (no false negatives) and a specificity of 91%. In conclusion, the clinical observation of wheeze agrees very well with its detection by acoustic measurement at the endpoint of a bronchial challenge in preschool children.

Asthma↗
PubMed1997

Stethoscopy during anaesthesia.

PURPOSE: First, to determine when, following the description of stethoscopy by Laennec, it was used by anaesthetists in an operating room and, second, to describe the developing possibilities for stethoscopic monitoring. METHODS: A manual search of the medical literature based on Index Medicus and relevant publications were obtained and analyzed. Textbooks randomly available were also read. PRINCIPAL FINDINGS: Stethoscopy was first described early in the 20th century but was not widely recommended for anaesthesia until the 1950s. The change in attitude to stethoscopy during anaesthesia was probably due to alterations in anaesthesia delivery; increasing difficulty in employing direct human sensing. However the complexity of practice often makes traditional stethoscopy ergonomically unsatisfactory. Substantial research in the sensing and analysis of lung sounds support the contention that cheap visual displays of information from suitably designed sensors could be made available for anaesthetists. CONCLUSION: Current advances in sensing, analysis, and display of lung sounds could be used to create a simple and cheap device helpful for monitoring in the operating room.

Anesthesia↗
PubMed1997

Comparison of distal oesophageal temperature with "deep" and tracheal temperatures.

PURPOSE: To compare distal oesophageal (reference) temperature with "deep-sternal," "deep-forehead," and tracheal temperatures, establishing the accuracy and precision of each. METHODS: We studied 20 patients undergoing general anaesthesia for gynaecological surgery. Their lungs were mechanically ventilated with a circle system, at a fresh-gas flow rate of 6 L.min-1 Respiratory gases were not warmed or humidified. Tracheal temperatures were recorded from a Trachelon tube inserted approximately 21 cm. Deep-body temperatures were measured at the sternum and forehead using a Coretemp thermometer. The principle of the method is to null thermal flux through a cutaneous disk, thus obliterating thermal gradients between the sides of the disk, skin surface, and subcutaneous tissues. Distal oesophageal temperatures were measured from thermocouples incorporated into oesophageal stethoscopes. Tracheal and deep-tissue temperatures were compared with oesophageal temperature using regression and Bland and Altman analyses. RESULTS: Tracheal, sternal, and forehead temperatures correlated similarly with distal oesophageal temperature, correlation coefficients (r2) being 0.7 in each case. The offset (oesophageal temperature minus study site) was considerably larger for tracheal temperature (0.7 degree C) than for the other sites (0.2 degree C). However, the precision was only 0.3 degree C at each site. CONCLUSION: Our data suggest that tracheal temperatures may not be an adequate substitute for conventional core-temperature monitoring sites. In contrast, the accuracy and precision of deep-tissue temperature monitoring at the sternum and forehead was sufficient for clinical use.

Anesthesia, General↗
PubMed2004

Cross your heart: Some historical comments about fibrinous pericarditis.

This article briefly describes the origin of one of the more common (food-related) pathologic terms--"bread and butter pericarditis." The eminent French physician, Laennec, the inventor of the stethoscope amongst several other important medical contributions, can be credited for having coined the term that is still in common usage amongst pathologists.

Auscultation↗
PubMed1998

The fourth sound of Korotkoff in pregnancy: a myth.

OBJECTIVE: To determine the detection rate and the reproducibility of the first (K1), the fourth (K4) and the fifth (K5) phases of the Korotkoff sounds in pregnant women. STUDY DESIGN: In 77 pregnant women receiving antenatal care in a tertiary referral centre, two observers took 231 simultaneous blood pressure measurements with a shared mercury sphygmomanometer and a multi-aural stethoscope. Detection rates, percentages of observer agreement within 5 mmHg and kappa values were calculated for K1, K4 and K5. RESULTS: Both observers were able to detect K1, K4 and K5 in 98, 24 and 98% of all 231 measurements, respectively. In 46% of measurements, and in 23% of women, neither observer was able to detect K4. The observers agreed within 5 mmHg in 98 (kappa = 0.99), 69 (kappa = 0.42), and 96% (kappa = 0.99) of measurements for K1, K4 and K5, respectively. CONCLUSION: K4 cannot be detected and reproduced accurately in a significant proportion of pregnant women, and therefore should be abandoned as diastolic endpoint in pregnancy.

Auscultation↗
PubMed1997

Lung auscultation in airway challenge testing.

The appearance of wheezes and changes in inspiratory breath (vesicular) sound intensity (BSI) were monitored in patients undergoing routine methacholine challenge test (MCT). The results were compared with changes in spirometry and to airway hyper-responsiveness (AH). Fifty-four patients were examined. Spirometry was performed before and after the inhalation of cumulative doses of methacholine starting from 25 micrograms; a fall in forced expiratory volume in 1 s (FEV1) by 20% or more was considered as significant. Lung auscultation was performed by two observers simultaneously using a special stethoscope placed sequentially over the posterior right and left upper (interscapular region, 5 cm from the fourth thoracic vertebra) and lower lung zones (5 cm below the scapulae). Symptoms were recorded by the patients on a visual analogue scale. In 27 patients, the MCT was positive (MCT+) and in 27 patients it was negative (MCT-). Wheezes were identified at PD20 in 12 MCT+ patients while reduced BSI alone was found in 11 patients; in four patients, auscultation was normal. In 20 MCT+ patients, either wheezes, diminished BSI or both were heard, one to several steps before reaching PD20. In the MCT- group, wheezes were detected in two patients and diminished BSI in four. In MCT+ patients, the mean (+/-SD) perception of symptoms at end-challenge was 33% (+/-26), whereas in MCT- patients, it was 13.6% (+/-22). Complete inter-observer agreement was found in 95.7% of auscultations performed (Kappa coefficient = 0.846). Coupled to spirometry, lung auscultation may prove useful in airway challenge testing provided the concept is accepted that wheeze appearance and, by extension, an acute decrease in BSI, is as legitimate a manifestation of AH as a fall in FEV1.

Adolescent↗