Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “AUSCULTATION”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMed1995

Hold that x-ray: aspirate pH and auscultation prove enteral tube placement.

We report here a prospective study evaluating an alternative to the roentgenographic confirmation of "fine-bore" nasoenteral feeding tubes. Of 78 nasoenteral intubations in 46 patients using a Dobbhoff (Biosearch Medical Products) weighted enteral feeding tube, gastric aspirates were evaluated in 28. Auscultation was performed in all 78. Data was collected at initial placement prior to x-ray confirmation. Observers used color-coded pH paper to analyze gastric aspirate (pH < or = 4) and/or auscultation of the epigastrium to determine feeding tube position prior to x-rays. Auscultation alone was ineffective as a confirmatory test with only 6.3% specificity (p = 0.31). Aspiration to ascertain tube position was very accurate when pH < or = 4.0 (p = 0.0005) and when it was performed. A pH value of > 4 was not very helpful in predicting malposition (37%) especially when pH altering medications were used. Aspiration of contents was successful in 85% of patients. We conclude that when the pH of the nasogastric tube aspirate is < 4.0, x-ray films are not needed to prove the accuracy of tube placement. In other situations, a film is indicated since auscultation is inaccurate.

Adult↗
PubMed1993

[From cardiac auscultation to echo-Doppler. Limitations of both methods].

Physiological tricuspid and pulmonary regurgitations are very often found by Echo-Doppler. They are generally slight, inaudible and devoid of significance. Tricuspid insufficiency nevertheless has the great advantage of enabling the calculation of pulmonary pressures. Auscultation is a good method for the diagnosis of rheumatic mitral insufficiency or related to prolapse, but is not reliable in other situations. Doppler is an excellent method for the qualitative and etiological diagnosis of mitral insufficiency but enables only semi-quantification. It also has the disadvantage of discovering minimal mitral insufficiency, the significance of which is uncertain. In contrast to auscultation, Doppler enables precise quantification in mitral stenosis. Auscultation is a good method for the diagnosis of aortic valve disease with the exception of slight insufficiency and stenosis in the elderly. Doppler enables the quantification of stenosis and semi-quantification of insufficiency. The existence of physiological aortic regurgitation is by no means certain. In conclusion, auscultation remains an important tool in cardiological diagnosis but has notable limitations. Echo-Doppler is a major advance but it is important to be aware of its limitations.

Echocardiography, Doppler↗
PubMed2001

Randomised controlled trial of cardiotocography versus Doppler auscultation of fetal heart at admission in labour in low risk obstetric population.

OBJECTIVE: To compare the effect of admission cardiotocography and Doppler auscultation of the fetal heart on neonatal outcome and levels of obstetric intervention in a low risk obstetric population. DESIGN: Randomised controlled trial. SETTING: Obstetric unit of teaching hospital PARTICIPANTS: Pregnant women who had no obstetric complications that warranted continuous monitoring of fetal heart rate in labour. INTERVENTION: Women were randomised to receive either cardiotocography or Doppler auscultation of the fetal heart when they were admitted in spontaneous uncomplicated labour. MAIN OUTCOME MEASURES: The primary outcome measure was umbilical arterial metabolic acidosis. Secondary outcome measures included other measures of condition at birth and obstetric intervention. RESULTS: There were no significant differences in the incidence of metabolic acidosis or any other measure of neonatal outcome among women who remained at low risk when they were admitted in labour. However, compared with women who received Doppler auscultation, women who had admission cardiotocography were significantly more likely to have continuous fetal heart rate monitoring in labour (odds ratio 1.49, 95% confidence interval 1.26 to 1.76), augmentation of labour (1.26, 1.02 to 1.56), epidural analgesia (1.33, 1.10 to 1.61), and operative delivery (1.36, 1.12 to 1.65). CONCLUSIONS: Compared with Doppler auscultation of the fetal heart, admission cardiotocography does not benefit neonatal outcome in low risk women. Its use results in increased obstetric intervention, including operative delivery.

Acidosis↗
PubMed1990

Detection of prosthetic mitral valve leak: a comparative study using transesophageal echocardiography, transthoracic echocardiography, and auscultation.

Paravalvular leakage is a major complication of prosthetic valve dysfunction. Sixty-one subjects with valvular heart disease who had received prosthetic mitral valve replacement 5 months to 5 years before (43 received a porcine prosthesis and 18 received Bjork-Shiley valve prostheses) were evaluated for this complication. Careful auscultation was performed by two experienced cardiologists followed by transthoracic and transesophageal echocardiography. Physiologic leaks were detected in all Bjork-Shiley valves, but in only 30% of porcine valves using transesophageal echocardiography. These regurgitant jets were flame-like, with mean low velocities of 50 +/- 12.3 cm/sec and 48 +/- 18.2 cm/sec in the two types of valves. Neither transthoracic echocardiography nor auscultation could detect physiological regurgitant jets. Ten cases with paravalvular leak were detected by transesophageal echocardiography and subsequently demonstrated by left ventriculography (7 porcine, 3 Bjork-Shiley valves). Pathologic regurgitant jets were seen as high-velocity, systolic-retrograde turbulent flow across the prosthesis. However, only 6 cases of prosthetic valve dysfunction were detected by transthoracic echocardiography, 4 cases of mild paravalvular leakage went undetected. Thirteen of the 61 subjects had an apical systolic murmur and suspected prosthetic valve leakage; in 10 of the 13 cases the findings corresponded to those obtained by transesophageal echocardiography. In 3 cases of double valve replacement with Bjork-Shiley valves the magnitude of the leakage was overestimated by auscultation.

Adult↗
PubMed1982

The thermic vascular anastomosis (TVA). II. Microvascular auscultation applied to thermic vascular anastomoses.

The study shows that microvascular auscultation with a diplomicrophone is a useful method in recording and analyzing the blood flow in nonsuture thermic vascular anastomoses. In 320 anastomoses on the rat carotid artery microvascular auscultation was found to be applicable immediately after performing an anastomosis and up to 30 days postoperatively. Records of sound tracks made at various periods of postoperative survival of the animals are presented and analyzed. A comparison with auscultation results of sutured microvascular anastomoses and of ligated arteries is made.

Animals↗
PubMed2004

Comparison of the Omron HEM-637 wrist monitor to the auscultation method with the wrist position sensor on or disabled.

BACKGROUND: To determine whether the Omron HEM637 wrist model with the wrist positioning sensor turned on (Son) is more accurate relative to upper arm auscultation by trained professionals than when the sensor was manually turned off (Soff). METHODS: Forty-four subjects, at least 30 years old, had repeated, sequential dual-observer upper arm auscultatory measurements (5 to 6 each) and oscillometric Omron HEM637 wrist measurements (4 each). Nineteen subjects were assigned to the wrist sensor On group and 25 were assigned to the wrist sensor Off group. A total of 425 auscultatory and 164 wrist measurements were analyzed. RESULTS: The Omron HEM-637 measured the blood pressure (BP) with equal accuracy to the observers using the auscultatory technique (difference -1.37 +/- 8.51/3.47 +/- 8.07 mm Hg, P =.71/.14). The wrist sensor did improve the accuracy of the measurements compared to the subjects that had the sensor deactivated. The sensor On group (Son) measured the systolic BP (0.82 +/- 9.83 mm Hg) and diastolic BP (-0.72 +/- 9.07 mm Hg) statistically the same as by auscultation (P =.86 for systolic BP and P =.83 for diastolic BP). The sensor Off (Soff) group measured the SBP (-3.03 +/- 7.12 mm Hg) and diastolic BP (-5.56 +/- 6.68 mm Hg) statistically different than auscultation (P =.46 for systolic BP and P =.02 for diastolic BP). The higher (negative) measurement for both the systolic BP and diastolic BP suggests that the average position of the wrist was 1.75 inches (4.4 cm) below the heart level in this group with the sensor off. CONCLUSIONS: This study demonstrated that the Omron HEM-637 monitor with a wrist sensor more accurately measured BP compared to the same model with the sensor turned off.

Adult↗
PubMed2006

[Heart murmur--auscultation or echocardiography in the diagnostic assessment of congenital or valvular heart disease?].

The incidence of patients with degenerative valvular but also of patients with congenital heart disease surviving until adulthood or even old age will increase in the next decades. Auscultation with the stethoscope remains an important diagnostic means in the detection and treatment of heart disease. Heart murmurs (especially systolic heart murmurs) are extremely common. There are helpful clues to differentiate heart murmurs. It can occasionally be relatively simple to differentiate a systolic murmur due to valvular heart disease from an innocent, ejection murmur; however, there are important limitations of auscultation. Overall, auscultation and clinical examination alone do not suffice to correctly diagnose and treat patients with heart failure or a murmur Clinically significant aortic stenosis, aortic regurgitation and mitral regurgitation as well as hypertrophic cardiomyopathy are not uncommonly missed or misinterpreted. An echocardiographic exam is mandatory in all patients with more than a soft systolic murmur, any diastolic murmur, cardiac symptoms and/or ECG changes.

Auscultation↗
PubMed1998

Auscultation of the heart: a trial of classroom teaching versus computer-based independent learning.

Declining skills in auscultation of the heart prompted an evaluation of teaching methods for medical students. A comparison of classroom teaching and computer-aided independent learning of auscultation was carried out with two groups of approximately 20 second-year medical students. Both groups used approximately 20 recorded normal and abnormal heart sounds and murmurs, chosen to illustrate learning issues. For the classroom group a cardiologist presented each case through multiple stethophones and led the discussion. The individual study group used a new CD-ROM collection of cases and recordings in quiz format, with a hypertext link to a comprehensive text on auscultation and additional recordings. Students were tested with 16 multiple choice and 5 open questions on eight selected recordings, and evaluated the teaching by questionnaire. The classroom-taught students scored higher on open questions than the CD-ROM-taught group, but in general performance by both groups was satisfactory and equivalent. Students of both groups repeatedly had difficulty classifying regurgitant and ejection murmurs and identifying characteristics of the second heart sound. Both CD-ROM and classroom teaching methods were highly rated by students but most students preferred a combination.

CD-ROM↗
PubMed2002

Reliability of epigastric auscultation to detect gastric insufflation.

BACKGROUND: We studied the reliability of epigastric auscultation to detect gastric insufflation in 30 anaesthetized, paralysed intubated patients. METHODS: A 16FG gastric tube was positioned with the tip in the mid-oesophagus with the proximal end attached to an injection port with a one-way valve. Four observers participated in the study. Observers were paired and each pair studied 15 patients. Each patient underwent four test sequences in random order, two by each observer. Each test sequence comprised one observer injecting different volumes of air (0.25 ml, 0.5 ml, 1 ml, 2 ml, 3 ml, 4 ml, 5 ml, 10 ml, 15 ml and 0 ml as a control) in random order whilst the second blinded observer listened with a stethoscope over the epigastrium. Each randomized volume was injected rapidly at 5 s intervals for 1 min. The number of injections required to detect air entering the stomach was recorded. The stomach was deflated between each test sequence. RESULTS: To detect air entering the stomach with 95% confidence, 11 injections were required for 0.25 ml; 7 for 0.5 ml; 3 for 1 ml; 2 for 2 ml and 3 ml, and I for > or =4 ml. The mean (range) inter- and intraobserver reliability was 0.73 (0.71-0.75) and 0.76 (0.76-0.89), respectively. The incidence of false positives was 21% (25/120) and the incidence of false negatives was 10% (103/1080), making the specificity and sensitivity 79% and 91%, respectively. CONCLUSIONS: We conclude that epigastric auscultation can detect gastric insufflation of 0.25 ml air after 11 breaths and > or = 4 ml air after one breath with 95% confidence. Inter- and intraobserver reliability is moderate to excellent. Epigastric auscultation should be repeated to reduce the risk of false positives.

Adolescent↗
PubMed1994

The reliability of detecting screw penetration of the acetabulum by intraoperative auscultation.

Open reduction and internal fixation of the acetabulum frequently requires placement of screws in a blind fashion that risks penetrating the joint surface. While in the operative suite, direct visualization of the joint surface may not be possible, and fluoroscopy can be difficult to interpret. Auscultation of the hip with motion in a quiet room has been suggested as a useful adjunct to detecting screw penetration. Carrying that concept further, we auscultate the hip using a sterile esophageal stethoscope at the operating table and have found this to be a highly reliable method of detecting intraarticular screw placement. To test the reliability and reproducibility of this technique, an experiment was performed using inexperienced volunteers. In part I, two adult mongrel dogs were prepared. A screw was placed violating the hip joint in one dog, and in the other dog a screw was placed near but not penetrating the joint. Screw placement was verified under direct vision. Seventy-seven volunteers who did not know which hip was penetrated then auscultated both hips in random order and recorded their impressions after each hip was heard. After hearing both hips, 74 of 77 were able to identify the screw in the hip joint correctly; 69 were able to recognize the extraarticular screw correctly. In part II, both hips of a human cadaver were exposed and dislocated. In one hip, a screw was placed that tangentially violated the joint, and in the same area of the contralateral hip a screw was placed that did not penetrate the joint surface.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1994

Oesophageal intubation can be undetected by auscultation of the chest.

Prompt detection of oesophageal intubation is a primary concern in anaesthetic practice. This blind, randomised study evaluates three widely used tests of intubation. Forty patients had both their trachea and oesophagus intubated, each patient was studied twice. Auscultation of the epigastrium, right and left axilla is more reliable than auscultation of the chest, and the anaesthetist's feeling when he squeezes the bag. P = 0.001 and P = 0.048, respectively. The tests were carried out after gastric distension with gas had occurred. We conclude that auscultation of epigastrium, right and left axilla, are recommended.

Abdomen↗
PubMed1990

Observer variation in equine abdominal auscultation.

The reliability of abdominal auscultation was investigated via an observer variation study. Clinicians listened to a variety of minute-long equine gut sound recordings. They evaluated the amount of gut sounds as 'absent', 'decreased', 'normal', or 'increased'. They subsequently evaluated the same recordings replayed in a different order. Intra- and inter-observer agreement was measured by the statistic kappa. There was significant intra-observer (kappa 0.57) agreement, but less agreement between observers (kappa 0.37). The best agreement was on the classification of sound tracks as 'absent' (intra-observer kappa 0.72 and inter-observer kappa 0.55). There was significant correlation between the clinicians' average assessment of the recordings and their acoustic energy levels. In this study abdominal noise was reliably assessed by auscultation. Standardised techniques and definitions would probably enhance the reliability of abdominal auscultation for the evaluation of gastrointestinal disease.

Abdominal Pain↗
PubMed2004

Auscultation of bilateral breath sounds does not rule out endobronchial intubation in children.

We performed orotracheal intubation in 153 consecutive pediatric patients undergoing cardiac catheterization. Auscultation of bilateral breath sounds was confirmed. By fluoroscopy, the tip of the endotracheal tube (ETT) was seen in the right mainstem bronchus in 18 patients (11.8%) and in a low position, defined as within 1 cm above the carina, in 29 patients (19.0%). All of the 18 patients with right mainstem intubation were children <120 mo of age, and 7 were infants <12 mo of age (Fisher's exact test; P = 0.013). The age, weight, and ETT size for children who had endobronchial and low tracheal positions were significantly (P < 0.001) less than for those who had midtracheal positions. The failure to diagnose mainstem intubation by auscultation alone may be related to the use of the Murphy eye ETT, which reduces the reliability of chest auscultation in detecting endobronchial intubation. Suggested measures for preventing endobronchial intubation include maintaining increased awareness of the imperfection or lack of accuracy of the auscultatory method, assessing insertion depth by checking the length scale on the tube, and minimizing the patient's head and neck movement after intubation. When extreme flexion or extension of the neck is expected after ETT insertion, the resultant change in ETT final position must be anticipated and taken into consideration when deciding on the depth of ETT insertion. This approach resulted in a decrease in improper tube positioning from 20% when the study was initiated to 7.1% in the last 98 patients.

Adolescent↗
PubMed1986

Observer agreement, chest auscultation, and crackles in asbestos-exposed workers.

Investigators cite observer variability as a problem in using crackles to diagnose asbestosis. We measured agreement on the presence or absence of crackles noted during auscultation of 64 asbestos-exposed workers in order to clarify this question. There was 89 percent agreement between two observers who simultaneously examined subjects breathing from functional residual capacity (FRC). Kappa (kappa), a statistic accounting for chance agreement, was 0.73. Unanimous agreement between four observers who listened to tape recordings of the breath sounds was 81 percent (kappa = 0.69). When the subjects breathed from residual volume (RV) there was 78 percent (kappa = 0.53) and 67 percent (kappa = 0.60) agreement, respectively. Comparing direct to tape-playback auscultation, there was 90 percent (kappa = 0.77) and 84 percent (kappa = 0.58) intraobserver agreement when the subjects breathed from FRC and 90 percent (kappa = 0.79) and 75 percent (kappa = 0.39) when they breathed from RV. We conclude that observer variability is sufficiently low to allow trained observers to monitor asbestos-exposed workers for crackles directly and during tape-playback auscultation.

Adult↗
PubMed2002

[Agreement between tracheal auscultation and pulmonary function in methacholine bronchial inhalation challenge in asthmatic children].

BACKGROUND: PC wheezing (PCw) is defined as the concentration of methacholine at which wheeze is detected on auscultation of the trachea. PCw has been suggested as a measure of bronchial hyperresponsiveness in methacholine challenge testing (MCT). OBJECTIVE: The aim of this study was to determine the agreement between the concentration of methacholine that produces a 20 % decrease in forced expiratory volume in 1 second (FEV1) (PC20) and PCw in MCT in asthmatic children. PATIENTS AND METHODS: Eighteen asthmatic children with a mean age of 11.5 years (range: 6-16 years) were studied. Fifteen of the children were under treatment with inhaled glucocorticoids. MCT was performed according to the guidelines of the American Thoracic Society (1999) using a Hudson nebulizer calibrated to obtain a mean output of 0.14 ml/min. After each nebulization, two independent observers registered FEV1 and tracheal auscultation. FEV1 was determined by forced spirometry 30 and 90 seconds after the end of nebulization and PC20 was registered (exponential model). Respiratory rate and transcutaneous oxygen saturation were continuously monitored. Tracheal auscultation was performed at 0, 60 and 120 seconds after the end of nebulization. The end point was defined as the appearance of wheezing over the trachea. The values of PC20 and PCw, as well as the concentration of methacholine corresponding to a decrease in FEV1 equal to or higher than 20 %, were compared using Student's matched pairs-test and Wilcoxon's test. The degree of agreement between variables was compared by using Bland-Altman's test. RESULTS: MCT was positive in 17 of 18 patients. No differences were found between PC20 and PCw (p 0.15). Both variables showed agreement in 12 of 17. A clear association was found between both measures (log PCw, log PC20): R: 0.92; p < 0.001. The mean decrease in FEV1 on reaching PCw was 24.8 % (range: 10-41). No adverse effects were observed. CONCLUSION: The agreement between PC20 and PCw in MCT in asthmatic children is excellent. PCw could be helpful in determining bronchial hyperresponsiveness in young asthmatic children in whom spirometry is not feasible.

Adolescent↗
PubMed1992

Pediatric cardiology: auscultation from 280 miles away.

New long-distance audio/video and data communications links among health-care facilities promise to reduce rural patients' travel time and waiting time for subspecialty consultations. To offer a satisfactory alternative to face-to-face examination, the long-distance system must meet the subspecialty's minimum criteria. For pediatric cardiology in particular, the system has to permit satisfactory cardiac auscultation. A preliminary test of remote auscultation that uses an electronic stethoscope involved two pediatric cardiologists, one listening hands-on with an acoustic stethoscope, the other listening independently at long distance with the electronic instrument. Taking the acoustic findings as the reference standard, the electronic stethoscope did not miss the one case of heart disease, correctly recommended echocardiogram follow-up in the two cases requiring it, and agreed on 80% of the murmurs' qualitative specifics. The patients' parents also indicated that the system was highly acceptable. We are following up these results with a full-scale study of the effectiveness and parental acceptance of remote auscultation.

Cardiology↗
PubMed1991

[Clinical features of main and peripheral pulmonary artery stenosis: significance of auscultation and phonocardiography].

Twenty-five patients with main and peripheral pulmonary artery stenosis were studied to determine the most frequently observed diagnostic sign of this abnormality regardless of the underlying etiologies, such as intrinsic or extrinsic narrowing of the pulmonary artery due to tumor, fibromuscular dysplasia, thromboembolism, angitis including the aortitis syndrome (Takayasu arteritis) and a variety of other disease entities. Among a variety of signs and symptoms, we emphasized the importance of cardiac auscultation and phonocardiography, which were often the initial diagnostic clues. The diagnostic features included a systolic murmur of pulmonary arterial origin and the behavior of the splitting of the second heart sound. The systolic murmur was often trans-systolic or continuous. In cases with left-sided cardiac murmurs (Takayasu arteritis, etc), the pulmonary systolic murmurs were not identified by auscultation alone and required phonocardiographic confirmation. In many cases the second heart sound was split and this was sometimes the first clue to the diagnosis. The split intervals varied, but were more marked in cases with pulmonary hypertension, and were accompanied by the accentuated pulmonic component (IIP). Phonocardiographic analysis disclosed that wide splitting was caused by the delayed appearance of IIP as well as the concomitant early appearance of the aortic component (IIA). It was concluded that, although the final etiological diagnosis is not identified, auscultation and phonocardiography provide important clues for further diagnostic and etiological studies of pulmonary artery stenosis.

Adolescent↗
PubMed1987

Clinical aspects of fetal heart auscultation.

The widespread belief that fetal heart tones are first detected with an unamplified fetoscope at about 20 weeks' gestation has been studied prospectively only twice. Using data collection prospectively from 352 visits of 77 patients between 15 and 23 weeks' pregnancy, we studied various clinical aspects of fetal heart tone detection. We determined the gestational age at the time of initial auscultation of fetal heart tones with an ordinary fetoscope, and its relationship to quickening, parity, and placenta location. Fetal heart tones were first identified by auscultation at a mean gestational age of 19.4 weeks (range 17-22 weeks). Detection was possible in 81% of patients examined at 20 weeks and in virtually all patients examined at 21 weeks or later. Once heard, fetal heart tones were identified in every subsequent visit for all patients. Parity and placenta location were significant factors influencing initial fetal heart tone detection. Auscultation preceded quickening in only 12% of patients. Recommendations for using initial fetal heart tone detection in clinical practice are given.

Female↗