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At least 1,153 records · Page 64Linked to original sources
PubMed1994

Prehospital blood pressures: inaccuracies caused by ambulance noise?

Blood pressure measurements in a moving ambulance can be difficult to obtain. Sirens, engine noise, and road noise can all interfere with the accurate detection of a patient's blood pressure. This study was undertaken to determine the influence of ambulance noise and vibration on auscultated blood pressures. A model was developed that used dynamic pressures to simulate systolic Korotkoff sounds. Forty-nine emergency personnel were asked to obtain blood pressures using the model in both a quiet environment and in a moving ambulance. A total of 485 blood pressure measurements were obtained. Systolic pressures were randomized to two settings: 76 mm Hg and 138 mm Hg. Stationary readings were compared with moving readings using analysis of variance for repeated measures. Systolic blood pressure measurements obtained in the quiet environment averaged 133 +/- 5 mm Hg at the high setting, and 45 +/- 6 mm Hg at the low setting. Systolic blood pressure measurements obtained in a moving ambulance averaged 86 +/- 7 mm Hg at the high setting, and 41 +/- 7 mm Hg at the low setting. The average differences between quiet and moving measurements were 47 mm Hg at the "high" setting (P < .01) and 4 mm Hg at the "low" setting (P > .01). At physiological levels, blood pressures obtained in moving ambulances differ significantly from those obtained in a quiet environment, which may be caused by road noise and ambulance motion.

Ambulances↗
PubMedDate not supplied

Malposition of pediatric gastric lavage tubes demonstrated radiographically.

Gastric lavage may be indicated in the initial treatment of toxic substance ingestion. We retrospectively surveyed the charts of 36 pediatric patients who underwent gastric lavage to evaluate the clinical and radiographic evidence indicating proper tube placement. Only 14 patients had a radiograph prior to lavage, and 50% of these documented malposition. The most common was excess tube insertion, stretching the stomach inferiorly towards the pelvis. The traditionally acceptable clinical test by auscultation of insufflated air was favorable in 100% of patients, thus failing to detect all of the malpositionings documented radiographically. We suggest that initial insertion of tube length be based on the patient's height or length using an adaptation of Strobel's previously published formula for esophageal pH probe placement: Tube Insertion Depth (TID), orogastric = 9.7 cm + (0.226 x length of patient in cm) and TID, nasogastric = 8 cm + (0.252 x length of patient in cm). These formulae have been displayed in graphic form for easy use. Diagnostic imaging remains the only certain means to document tube placement. Prospective studies to validate the formulae in clinical use are ongoing.

Adolescent↗
PubMed1993

A study of clinical signs and symptoms of temporomandibular dysfunction in subjects with normal occlusion, untreated, and treated malocclusions.

In the light of the universally growing concern over the suggested relationship between orthodontic treatment and temporomandibular (TM) dysfunction, the purpose of the present investigation was to compare the status of signs and symptoms of TM disorders in three groups of adolescents and young adults. The groups consisted of 30 persons with normal occlusions, 41 with untreated malocclusions, and 31 with treated malocclusions. The clinical status and subjective symptoms of TM dysfunction were recorded according to the principles introduced by Helkimo. The results showed that the normal occlusion group had the maximum number of persons free from any dysfunction, but the differences between the groups in the distribution of persons according to the anamnestic and clinical dysfunction indices were not significant. The only statistically significant finding was the difference in the clinical dysfunction index scores of the persons with normal occlusions and untreated malocclusions. According to anamnesis, the most frequently reported symptoms were related to periods of stress. Among the clinical signs and symptoms, the most commonly occurring were crepitations on palpation and sounds on auscultation of the joints in all the three groups. In conclusion, the absence of substantial differences between the three groups indicates that the role of orthodontic treatment in either precipitation or prevention of TM dysfunction remains questionable.

Adolescent↗
PubMed1992

The utility of a double-lumen tube for one-lung ventilation in a variety of noncardiac thoracic surgical procedures.

To determine the utility of one-lung ventilation (OLV) in a variety of noncardiac thoracic surgical procedures, 200 patients were studied to document the ease of double-lumen tube (DLT) placement, associated complications, intraoperative respiratory changes, and methods for managing hypoxic events. Most tubes could be placed, repositioned when necessary, and secured within 12 minutes. By defining tube position with fiberoptic bronchoscopy, auscultatory assessment of placement was found to be incorrect in 38.0% of patients. The tip occluded the respective upper lobe orifice in 40.5% of this subgroup, the endobronchial cuff was at or above the carina in 38.7%, and in the wrong mainstem bronchus in 20.8%. During OLV, PaO2 initially fell to approximately 200 mmHg in most patients but gradually rose during the balance of the operation. Hypoxia (PaO2 less than 80 mmHg) during OLV developed in 28.5% of patients. Preoperative spirometry and arterial blood gases had no predictive value for this complication. Pulse oximetry values between 95% and 100% reliably reflected systemic arterial oxygen saturation. Hypoxia occurring during OLV was successfully reversed in 40.0% of instances by positive end-expiratory pressure (PEEP) to the ventilated lung. The addition of continuous positive airway pressure (CPAP) to the nonventilated lung reversed persistent hypoxia in virtually all cases. There was no difference in oxygenation, carbon dioxide elimination, airway pressures, or intraoperative complications noted between right and left double-lumen tubes. In conclusion, a DLT for OLV can expeditiously and safely be placed. Because auscultation for tube position is unreliable, bronchoscopic assessment of final position should be performed in every instance. Hypoxia during OLV can be detected reliably by pulse oximetry.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

[Testing nasogastric tube placement: evaluation of three different methods in intensive care unit].

OBJECTIVE: Evaluation of three methods (aspiration of gastric fluid, pH measurement of gastric fluid, and insufflation of air) in order to determine the right position of the nasogastric (NG) tube. STUDY DESIGN: Prospective, observational study in an intensive care unit. PATIENTS AND METHODS: All patients requiring a NG tube were included. Since the NG tube was inserted three tests were successively performed: aspiration of gastric fluid, pH measurement of the gastric fluid, and auscultation over the epigastrium of air injected through the NG tube. The feasibility and the results obtained for each test were noted and compared to chest X-ray, considered as the reference. Chest X-ray classified the complications as major or minor. RESULTS: A total of 419 NG tube (202 decompressive NG tube and 217 gastric feeding tube) were analysed in 280 patients. Malpositions of the NG tube were observed in 10% (majors, n=11 and minors, n=31). Aspiration of gastric fluid and pH measurement were not sensible (77% and 49%, respectively) and not specific (38% and 74%, respectively). Insufflation of air was sensible (96%) but not specific (17%). The combination of the three methods did not improve the sensibility and specificity. Two complications were only detected by chest X-ray (one insertion in the intrapleural space, and one pneumothorax). CONCLUSION: None of the test evaluated, alone or associated, was sufficient to avoid chest X-ray. Moreover the occurrence of two potential and serious complications only detected by chest X-ray increase this assertion.

Auscultation↗
PubMed2006

Wheeze detection based on time-frequency analysis of breath sounds.

Abnormal breath sounds like wheezes are observed in patients with obstructive pulmonary diseases. The aim of this study was to construct an automatic technique for wheeze detection and monitoring using spectral analysis. Wheezes from 13 patients with diagnosed asthma, chronic obstructive pulmonary disease and pneumonia were recorded and a time-frequency wheeze detector (TF-WD) based on TF wheeze characteristics was constructed. The TF-WD was evaluated using 337 wheezes by comparing its findings with those from clinical auscultation performed by two experts. In addition, the TF-WD was tested against artificial noise. The experimental and testing results justified the efficient performance and high noise robustness of the TF-WD.

Adult↗
PubMed2004

Acoustic study of swallowing behaviour in premature infants during tube-bottle feeding and bottle feeding period.

The premature infant has limited ability to integrate the swallowing-breathing cycle during feeding. The aim of this study was to assess the pattern of swallowing between the period of tube-bottle (TBF) and bottle (BF) feeding by means of cervical auscultation in premature infants. Twenty-three premature infants were enrolled (mean gestational age 34.7 +/- 1.7 weeks). Audiosignal recordings were made during TBF and BF with a small microphone set in front of the cricoid cartilage. The following parameters were calculated for 2 min and reported at 1 min: the percentage of time involved in swallowing (ST), the numbers of swallows (SN) and swallowing bursts (SB) and swallowing groups (SG). Individual histograms were established to show the individual pattern of swallowing behaviour and the distribution of groups, bursts and swallows over 2 min. Mean (STm), (SNm), (SBm), (SGm) values were calculated (+/- S.D.). Statistical analysis was used to compare the means and to establish correlations between parameters and curves. (STm), (SNm) and (SBm) increased significantly during BF compared with TBF for all premature infants and during follow-up. The histograms showed that in BF the groups were high in bursts. These findings and the histograms for each infant will allow determination of transition to bottle feeding without risk corresponding to the stage of maturation of swallowing function.

Auscultation↗
PubMed2004

Third heart sound: genesis and clinical importance.

Auscultation of third heart sound has been performed for more than a century, an interest that not only persists today, but also has experienced renewed emphasis. Sophisticated study of the third heart sound by current investigative techniques has underscored the value of clinical detection with the time-honored stethoscope. This review re-examines the mechanisms of genesis of third heart sound in regard to the hemodynamic and echocardiographic aspects, and its clinical importance.

Heart Auscultation↗
PubMed1996

Value of the cardiovascular physical examination for detecting valvular heart disease in asymptomatic subjects.

To determine the accuracy of the cardiovascular physical examination for the diagnosis of asymptomatic valvular heart disease (VHD), we prospectively studied 143 subjects, 68 apparent normal subjects and 75 patients with diseases known to produce VHD. All subjects underwent a complete physical examination with dynamic cardiac auscultation by a physician blinded to clinical data and compared with the results of transesophageal color Doppler echocardiography (TEE). By TEE, 33 subjects (23%), and by physical examination, 25 subjects (17%) had at least 1 form of VHD. Despite a high frequency of mild valve abnormalities and a 31% prevalence of functional murmurs, the physical examination showed a sensitivity of 70%, a specificity of 98% (confidence interval = 0.51 to 0.84, and 0.94 to 0.99, respectively), and a positive and negative predictive value of 92% for the diagnosis of VHD. Only 2 of the 10 patients with VHD by TEE, but not by physical examination, had clinically important VHD. We conclude that the physical examination is a sensitive and highly specific method of screening for VHD in subjects without cardiac symptoms. Therefore, its use should be encouraged rather than the routine application of echocardiography.

Adult↗
PubMed2000

Stereophonic stethoscope with teaching attachment.

A stethoscope is described in which stereophonic auscultation is achieved by attaching a sound-conducting tube and chest piece to a 2-way stopcock close to the main binaural. In the monophonic mode, a second binaural and conducting tube can be attached via a Y-connector close to the chest piece, permitting 2 observers to listen simultaneously.

Auscultation↗
PubMed2004

Neural classification of lung sounds using wavelet coefficients.

Electronic auscultation is an efficient technique to evaluate the condition of respiratory system using lung sounds. As lung sound signals are non-stationary, the conventional method of frequency analysis is not highly successful in diagnostic classification. This paper deals with a novel method of analysis of lung sound signals using wavelet transform, and classification using artificial neural network (ANN). Lung sound signals were decomposed into the frequency subbands using wavelet transform and a set of statistical features was extracted from the subbands to represent the distribution of wavelet coefficients. An ANN based system, trained using the resilient back propagation algorithm, was implemented to classify the lung sounds to one of the six categories: normal, wheeze, crackle, squawk, stridor, or rhonchus.

Algorithms↗
PubMed1979

Noninvasive assessment of surgical systemic to pulmonary artery shunts by range-gated pulsed Doppler echocardiography.

Suprasternal range-gated pulsed Doppler echocardiography was used to evaluate surgical shunt patency in children with cyanotic congenital heart disease and right ventricular outflow obstruction following systemic artery to pulmonary artery anastomoses. Normal patients had laminar Doppler auditory signals and time interval histogram flow patterns because right pulmonary artery turbulence was not present during systole or diastole. Patients with pulmonary valvar stenosis had turbulence during systole only. In all nine postoperative patients with surgical shunts, turbulent systolic and diastolic time interval histograms and abnormal auditory signals were present. A typical shunt murmur was not audible to auscultation in six of the postsurgical patients at the time of the study. Suprasternal range-gated pulsed Doppler echocardiography affords an accurate, safe and simple noninvasive bedside means for confirming shunt patency in patients who have undergone surgical systemic artery to pulmonary artery anastomoses.

Adolescent↗
PubMed1980

Sounds and pulses as aids to cardiac diagnosis.

Areas of auscultation are reviewed. Heart sounds, clicks, snaps, and murmurs are discussed as they appear in various cardiac problems, particularly with respect to their usefulness in differential diagnosis.

Adolescent↗
PubMedDate not supplied

A red eye and then a really red eye.

A 90-year-old woman presented with a 4-week history of a presumed infectious conjunctivitis resistant to topical antibiotic medications. Examination revealed tortuous, dilated conjunctival vessels in the right eye, retinal hemorrhages, and an orbital bruit suggestive of a carotid-cavernous sinus fistula (CCF). While awaiting a magnetic resonance imaging study, she returned to the clinic the next day with a painful, swollen right eye and an intraocular pressure of 69 mm Hg. A cerebral arteriogram confirmed a direct CCF. Because of the tortuosity of the systemic vascular anatomy, a right carotid artery cut-down with balloon occlusion was performed with successful closure of the fistula and prompt resolution of the orbital congestion. This case illustrates the spectrum of subtle to conspicuous ocular manifestations that can be seen in patients with CCF and its potential to present as an emergency. CCF should be included in the differential diagnosis of an "atypical" red eye. Recognition of arteriolized conjunctival vessels and auscultation of an orbital bruit raises the possibility of a CCF, requiring prompt diagnostic studies.

Aged↗
PubMed1997

Muscle sounds in Parkinson's disease.

BACKGROUND: A sound with a frequency of around 40 Hz can be heard, with a stethoscope, in the muscles of the hand and forearm during tonic contraction or movement. This sound is the acoustic correlate of the Piper rhythm seen in electromyographic records of muscle activity. The way in which motor activity is organised at the cortical level may determine the frequency of the sound heard. METHODS: The wrist extensor muscles in the forearm of seven patients with idiopathic Parkinson's disease, studied with and without antiparkinsonian treatment, and a control group of seven healthy men were auscultated during very strong extension of the wrist and during repeated slow flexion and extension of this joint. FINDINGS: In healthy people, the Piper-band sound made by muscle activity is 40-50 Hz. In all seven parkinsonian patients, when off medication, the normal Piper-band sound was replaced by a pulsatile muscle activity of 10 Hz during strong wrist extension, and in four patients during repeated flexion and extension of the wrist. After treatment with dopaminergic drugs, the Piper mode of muscle discharge was restored and motor performance was improved. INTERPRETATION: The Piper mode of muscle discharge is dependent on the normal functioning of pallidal projections to the motor areas of the cortex. In abnormal function a muscle discharge of 10 Hz dominates, which is suboptimal when fast or powerful contractions are necessary.

Adult↗
PubMed1977

A systematic approach to the bedside differentiation of cardiac murmurs and abnormal sounds.

Fortified by knowledge gained from cardiac catheterization studies, a more precise physiologic approach to cardiac auscultation has evolved in recent years. This system involves observing changes in the characteristics of murmurs and abnormal sounds during respiration, the Valsalva maneuver, exercise, changes in posture, after pharmacologic agents and during arrhythmias, These techniques will aid in the accurate identification of the origin of the murmur or abnormal sound but do not necessarily indicate the presence or severity of cardiac disease. The auscultatory results must be interpreted in the light of the complete clinical evaluation, which may include the ECG, chest x-ray and echocardiogram. Thus, the careful physiologic approach to the physical examination represents a powerful noninvasive tool that, when combined with other noninvasive studies, can accurately diagnose cardiac disease in many patients without the necessity for cardiac catheterization.

Amyl Nitrite↗
PubMed1991

Lack of association between keratoconus, mitral valve prolapse, and joint hypermobility.

The authors enrolled 95 patients with keratoconus and 96 matched controls in a cross-sectional study to determine if mitral valve prolapse and hypermobile joints occur with greater frequency in individuals with keratoconus than in individuals without keratoconus. The hypothesis that keratoconus may not be a distinct eye disease, but a nonspecific sign representing a more generalized systemic disorder, possibly a mild collagen tissue abnormality, was considered. M-mode and two dimensional echocardiography and cardiac auscultation detected no statistically significant difference in the prevalence of mitral valve prolapse in patients with keratoconus compared with controls. Formal, systematic examination of five joints also failed to detect a statistically significant difference in the prevalence of hypermobile joints in keratoconus patients and controls. However, as an ancillary finding, a significantly higher proportion of patients with keratoconus was found to have a history of hay fever than was the case with controls.

Adult↗
PubMed2000

Physical examination of the pulmonary system.

Physical examination of the pulmonary system includes inspection, auscultation, percussion, and palpation. By integrating these findings, it is often possible to diagnose and differentiate pulmonary edema, pleural effusion, pneumothorax, pulmonary fibrosis, and tracheal collapse. The veterinarian can use the physical examination optimally by initially performing examinations with those who are experienced with the methods and with an understanding of the relatively simple laws of physiology and physics governing transmission of sounds from the patient's lung.

Animal Diseases↗