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At least 1,171 records · Page 65Linked to original sources
PubMed1997

Assessment of breath sounds during ambulance transport.

STUDY OBJECTIVE: To determine whether the environment of a moving ambulance affects the ability of our-of-hospital care providers to auscultate breath sounds. METHODS: Out-of-hospital care providers assessed breath sounds with a previously described breath-sounds model in a quiet environment (control) and in a moving ambulance. The setting was a nonurban emergency medical services system and an interhospital transport agency based at a 600-plus-bed tertiary care center. The participants were physicians, transport nurses, and advanced life support EMS providers routinely involved in the emergency out-of-hospital treatment and transportation of the ill and injured. The accuracy with which participants identified the presence or absence of breath sounds in the two environments was compared with the use of the chi 2 test, with the alpha-value set at .05. RESULTS: The accuracy of breath-sounds assessment in the control environment was 96% (251 of 260); the sensitivity was 96% and the specificity 97%. The accuracy of breath-sounds assessment in the experimental environment was 54% (140 of 260); the sensitivity was .09% and the specificity 98%. Participants were significantly less likely to hear breath sounds in the moving ambulance than in the quiet room (P < .001). CONCLUSION: Assessment of breath sounds is hampered by the environment of a moving ambulance.

Ambulances↗
PubMed2002

[Measurement of arterial distensibility by the QKd method a new vascular marker].

INTRODUCTION: Distensibility is the ability of large elastic arteries to increase in diameter from diastole to systole. Pulse wave velocity (PWV) is one of the ways to measure this parameter. Several techniques, including QKd, are able to measure PWV. PURPOSE: QKd is the time interval between the Q wave on EKG and auscultation of the second Korotkoff's sound at the brachial artery. QKd is measured by a specific apparatus that registers ambulatory blood pressure as well as EKG (normal > 200 ms). Arterial distensibility seems to be able to predict cardiovascular morbidity and QKd has been demonstrated to predict such morbidity in a sample of elderly hypertensives. Currently the relationship between QKd and prognosis is under investigation in systemic sclerosis (ERAMS study). CONCLUSION: QKd is a noninvasive ambulatory method that measures arterial distensibility as well as blood pressure.

Age Factors↗
PubMed1997

Capnography and ventilatory assessment during ambulatory dentoalveolar surgery.

PURPOSE: The purpose of this study was to determine whether capnography is a more sensitive monitor than auscultation of breath sounds in detecting ventilatory changes consistent with hypoventilation, obstruction, or apnea and in detecting ventilatory changes that can be associated with oxygen desaturation. PATIENTS AND METHODS: Fifty-five patients received intravenous agents and supplemental oxygen to achieve a state of deep sedation or general anesthesia for removal of impacted third molars. The surgeon/anesthetist monitored respiratory status using a pretracheal stethoscope and direct observation. A blinded observer with no access to the patient or anesthetist monitored respiratory status using capnography. A second observer monitored all respiratory parameters to allow for correlation between clinical and electronic monitors. RESULTS: Ventilatory status was continuously represented by capnogaphy. The Pearson correlation coefficient showed a positive correlation between increased end-tidal CO2 (PETCO2) and decreased oxygen saturation that became stronger with greater positive changes in PETCO2. An additive relationship was found between PETCO2 and respiratory rate (RR), with increased PETCO2 and decreased RR contributing to decreased oxygen saturation. CONCLUSION: Patients with nasal ventilatory exchange maintain this exchange throughout the anesthesia so that sampling of nasal PETCO2 is an effective way to monitor ventilatory status. Respiratory depression or obstructive ventilatory changes detected by capnography showed a high sensitivity and low positive predictive value in detecting oxygen desaturation. The current technology does not show a clinically satisfactory correlation between PETCO2 and oxygen saturation. However, a combined increase in PETCO2 and decrease in RR suggested a trend of decreasing oxygen saturation.

Adolescent↗
PubMed1983

The physiologic mechanisms of cardiac and vascular physical signs.

Examination of the heart and circulation includes five items: 1) the patient's physical appearance, 2) the arterial pulse, 3) the jugular venous pulse and peripheral veins, 4) the movements of the heart--observation, palpation and percussion of the precordium, and 5) auscultation. This report deals with specific examples that relate cardiac and vascular physical signs to their mechanisms, focusing on each of the five sources. It draws liberally on early accounts, emphasizing that modern investigative techniques often serve chiefly to verify hypotheses posed in the past.

Cardiovascular System↗
PubMed1992

Assessment of the cardiovascular and lymphatic systems.

Assessment of the cardiovascular and lymphatic systems first requires a complete signalment, history, and general physical examination. Further assessment of the cardiovascular system begins with evaluation of the cardiac borders through palpation and thoracic percussion. Complete cardiac auscultation requires careful evaluation of several parameters. The location, intensity, and character of normal heart sounds are first determined. This is followed by assessment of heart rate and rhythm. Finally, special attention should be placed on identifying abnormal heart sounds and describing them based on their location, intensity, duration, sound quality, and radiation. Assessment of the arterial, venous, and capillary systems provides additional information on the status of the cardiovascular system. Assessment of the lymphatic system primarily involves evaluation of external and palpable internal lymph nodes. Commonly palpable external lymph nodes include the intermandibular, parotid, retropharyngeal, superficial cervical, subiliac, mammary, and scrotal lymph nodes. Palpable internal abdominal lymph nodes include the iliofemoral lymph nodes and the iliosacral lymph center. Other lymph nodes that may be palpable include the renal, ruminal, and mesenteric lymph nodes. Lymph nodes should be evaluated for size, consistency, and tenderness.

Animals↗
PubMed1992

Medical evaluation of the cardiovascular system.

The approach to pre-purchase evaluation of the equine cardiovascular system is discussed with emphasis on cardiac auscultation and on the terminology that should be used when reporting clinical findings. Innocent cardiac murmurs and arrhythmias are contrasted with those that should be considered as reliable signs of cardiovascular disease. Ultrasonography and electrocardiography are recommended to establish baseline values for future reference, to support opinions rendered by the examining veterinarians, or to provide for diagnosis and treatment.

Animals↗
PubMed1985

Diagnosis and treatment of cardiac arrhythmias.

Cardiac arrhythmias are probably more common in horses than in any other domestic animal species. The most frequent clinical complaint associated with cardiac arrhythmias is exercise intolerance. Physical examination is characterized by auscultation abnormalities such as fast or slow heart rate, irregular rhythm, extra sounds, long pauses, or abnormal heart sounds. The electrocardiogram is used to make a definitive diagnosis of the dysrhythmia. Other laboratory and cardiac function tests are employed to determine the etiology and to assess the significance of the arrhythmia. Antiarrhythmic therapy is given when clinical signs specifically related to the arrhythmia are present, when hemodynamic parameters are compromised by the arrhythmia, or when the ECG reveals abnormalities that put the patient at risk for development of more severe arrhythmias. The cardiovascular drugs most frequently used are digoxin and quinidine. Digoxin is most commonly used for supraventricular arrhythmias, especially arrhythmias characterized by fast heart rates. Quinidine is very effective for short-term treatment of ventricular and supraventricular arrhythmias but must be used with caution because of the potential for toxic side effects. The cardiac arrhythmias due to vagal tone (sinus arrhythmia, sinus block, sinus arrest, sinus bradycardia, wandering pacemaker, first-degree AV block, and second-degree AV block) that are found in resting horses are generally considered to be normal and generally do not require therapy.

Animals↗
PubMedDate not supplied

The innocent heart murmur in children.

Most children have an audible murmur at some point from infancy through adolescence. Fortunately most of these murmurs are innocent. These murmurs are asymptomatic and require no follow-up care. On the other hand, pathologic murmurs are symptomatic and do require assessment by a pediatric cardiologist. Referrals are not only anxiety-provoking for the family but are also costly. The pediatric nurse practitioner must therefore be able to differentiate between the innocent and pathologic murmur. Auscultation of heart sounds is the most effective method used to assess murmurs. Given that innocent murmurs are asymptomatic, they require minimal follow-up care, and the expected outcome for a child with the diagnosis of such a murmur is excellent.

Adolescent↗
PubMed1994

Tracheal wheezes during methacholine airway challenge (MAC) in workers exposed to occupational hazards.

Methacholine airway challenge (MAC) is a simple and useful means to assess bronchial hyperreactivity in workers exposed to various occupational hazards. Recently, wheeze detection by tracheal auscultation has been proposed as an indicator of bronchial responsiveness during bronchial provocation test in children. Our aim was to examine the relationship between the appearance of wheezes and the concurrent changes in forced expiratory volume in one second (FEV1) observed during MAC test in adults. Three cumulative doses of a methacholine solution (100 micrograms, 500 micrograms and 1500 micrograms) were inhaled by 45 workers with occupational exposure to flour dust. Spirometry was done using an electronic spirometer. Tracheal sounds were recorded with an electronic stethoscope placed over the anterior cervical triangle, 2 cm above the sternal notch. The amplified sounds were stored on magnetic tape, band-pass filtered (50-2000 Hz), and digitized at a sampling rate of 4096 Hz into a GenRad Vibration Control System. Wheezes were detected by fast Fourier transform (FFT) analysis and their presence compared to a 20% fall in FEV1. A positive MAC test by spirometry was found in 12 subjects whereas wheezes were identified in 14 subjects. Among the wheezing subjects, nine had a positive MAC test (range of fall in FEV1 = 20.6 to 42.3%) and five had a negative one (range of fall in FEV1 = 3.6 to 16.9%). Moreover, no wheezes were found in the remaining three subjects with a positive MAC test (range of fall in FEV1 = 20.7 to 27.4%). Taking a 20% fall in FEV1 as reference, wheezes were 75% sensitive and 84.8% specific to detect airflow obstruction. In conclusion, since it carries a significant although small false-negative rate, the acoustic technique based upon wheeze detection cannot, at the present time, fully replace spirometry during airway challenge testing in subjects with suspected asthma.

Adult↗
PubMed1998

Can nurses safely assess the need for endotracheal suction in short-term ventilated patients, instead of using routine techniques?

Most literature describes endotracheal suction as a hazardous procedure associated with numerous complications and proposes that it should only be performed as necessary to minimize these complications. Other authors suggest endotracheal suction only after assessment predisposes patients to a number of different complications. This article describes a controlled study to compare and contrast the differences in endotracheal suction outcomes in patients who received ritualized 2 hourly suctioning and those who received it following assessment. A group of qualified nurses in an Intensive Care Unit were taught auscultation skills to assess a patient's needs for suctioning and all the nurses received educational training regarding endotracheal suctioning. Short-term ventilated patients were allocated to receive endotracheal suctioning either when the need for it was determined by assessment only or routinely, using a standardized suctioning technique. The results demonstrated a clear increase in nurses' knowledge regarding endotracheal suctioning. The assessed group of patients demonstrated significantly better outcomes and less complications than the controlled group in relation to changes in peak airway pressures, heart rate and mean arterial pressure pre- and post-endotracheal suctioning, and the amount of secretions obtained on suctioning. Although only preliminary, these results do provide support for the view that endotracheal suction only in response to assessment is better practice for short-term ventilated patients.

Auscultation↗
PubMed1997

Blood pressure measurement in the hemodialysis setting.

Blood pressure measurement is an important component of the care of the hemodialysis patient. Invasive methods, as used in the intensive care setting, are the most accurate. In the ambulatory setting, noninvasive methods, such as palpitation, auscultation, and oscillometry, are used. When care is taken to avoid operator error, these techniques should yield results that are sufficiently accurate for clinical use. All new devices should be validated for accuracy.

Auscultation↗
PubMedDate not supplied

Monitoring the fetus in labor: evidence to support the methods.

Electronic fetal monitoring (EFM) was implemented across the United States in the 1970s. By 1998, it was used in 84% of all U.S. births, regardless of whether the primary caregiver was a physician or a midwife. Numerous randomized trials have agreed that continuous EFM in labor increases the operative delivery rate, without clear benefit to the baby. Intermittent auscultation (IA) is safe and effective in low-risk pregnancies and may play a role in helping birth remain normal. Clinicians and educators are encouraged to reconsider the use of IA in the care of healthy childbearing women.

Adult↗
PubMedDate not supplied

Teaching basic EMTs endotracheal intubation: can basic EMTs discriminate between endotracheal and esophageal intubation?

HYPOTHESIS: Advanced airway intervention techniques are being considered for use by basic emergency medical technicians (EMTs). It was hypothesized that basic EMTs would be able to discriminate reliably between intratracheal and esophageal endotracheal tube placement in a mannequin model. DESIGN: An airway mannequin with a closed chest cavity was intubated randomly either esophageally or tracheally, and the cuff was inflated. A stethoscope, bag ventilator, and laryngoscope were available next to the mannequin. Placement was assessed by auscultation or direct visualization at the discretion of the EMT. A blinded investigator graded the student. SETTING: A classroom in a large, urban medical center. PARTICIPANTS: Subjects were basic EMTs who volunteered to take part after the conclusion of a six-hour endotracheal intubation training course. RESULTS: Thirty-three subjects were tested. Seventeen of 18 (94%) tracheal intubations and 11 of 15 (73%) esophageal intubations were identified correctly. Only 72% of the students listened to the epigastrium, 81% listened to the lungs, and 85% attempted ventilation. The 10 students who visualized the cords discovered all five esophageal intubations. The 23 students who did not visualize the cords missed four and found six esophageal intubations. CONCLUSION: Basic EMTs had difficulty assessing endotracheal tube placement in a mannequin model. The 27% miss rate for identifying esophageal intubations suggests that basic EMTs will require additional training for safe field use of any airway that requires assessment of tube placement.

Auscultation↗
PubMed2001

Enterotachogram analysis to distinguish irritable bowel syndrome from Crohn's disease.

Crohn's disease is often initially misdiagnosed as irritable bowel syndrome. The goal of this research was to determine if computerized auscultation (fasting enterotachogram analysis) could have a role in distinguishing between these diagnoses. Patients with irritable bowel syndrome, Crohn's disease, and a control group were enrolled in the study. The fasting sound-to-sound interval, standard deviation of the interval, sounds per minute, and percentage time involved with bowel sounds was determined by computerized enterotachogram analysis. The mean sound-to-sound interval for the Crohn's group (1232 msecs) and the controls (1706 msecs) was significantly higher than the irritable bowel group (511 msecs, P < 0.0001). We conclude that Crohn's is not characterized by a shortened interval. The high negative predictive value of the fasting enterotachogram for irritable bowel syndrome suggests that an interval greater than 740 msecs should trigger a search for an alternative diagnosis to irritable bowel. Crohn's disease should be included in that differential.

Adolescent↗
PubMed2000

The mercury sphygmomanometer should be abandoned before it is proscribed.

Both in clinical practice and medical research, blood pressure is still largely measured by auscultation using a mercury sphygmomanometer. Blood pressure is the most important predictor of life expectancy. Treatment of high blood pressure reduces strokes, heart attack and heart failure. Accurate measurement is therefore essential. At a large London teaching hospital, just under 500 mercury sphygmomanometers and their associated cuffs were examined. More than half had serious problems that would have rendered them inaccurate in measuring blood pressure. At the same time, assessment of the technical knowledge needed to measure blood pressure by the ausculatory technique was also carried out amongst medical and nursing staff. This showed a considerable level of ignorance. These results inevitably lead to inaccurate measurement of blood pressure with serious consequences. In addition mercury is a non-degradable pollutant, eventually accumulating on the sea bed. The use of mercury in sphygmomanometers is already in the process of being eliminated in Scandinavia and Holland and other countries are likely to follow. Our results suggest that mercury sphygmomanometers are not adequately maintained and require expertise that is not available for accurate measurement of blood pressure. Their use should be dispensed with on these grounds before a ban for other and, perhaps less justifiable reasons. Validated automatic devices, which are less liable to measurement and observer error should be used instead. At the same time a concerted effort is needed to instruct health care professionals on the importance of more accurate measurement of blood pressure. Journal of Human Hypertension (2000) 14, 31-36.

Adult↗
PubMed1998

Caudal epidurals: the whoosh test.

Caudal epidural injection is a simple procedure that carries a low risk of complications. The whoosh test (injection of air into the caudal epidural space with simultaneous auscultation over the thoracolumbar spine) has been recommended as an aid to correct needle placement. A 1-year prospective study, using fluoroscopic imaging to identify needle position, was conducted to compare the sensitivity and specificity of the whoosh test with that of clinical impression alone in assessing correct needle placement in the caudal space. Of 131 patients studied, correct needle placement was achieved in 121 on the first attempt (92%). Clinical impression alone had a sensitivity of 94% and a specificity of 20%. The whoosh test had a sensitivity of 80% and a specificity of 60%. The whoosh test is superior to clinical judgment in detecting incorrect caudal needle placement.

Air↗
PubMed1999

Evaluation of the SCOTI device for confirming blind nasal intubation.

The sonomatic confirmation of tracheal intubation (SCOTI) is a new device used to confirm the correct placement of tracheal tubes. It utilises a sonic technique for recognition of a resonating frequency for detection of tracheal intubation. We compared its predictive value with that of the clinical auscultatory method and a capnograph to confirm 132 blind nasal intubations using three different tracheal tubes [red rubber (n = 82), polyvinyl chloride (n = 33) and RAE preformed nasal (n = 17)]. SCOTI correctly identified 70.8% of intubations and chest auscultation did so 99.2% of times. All results were confirmed using a capnograph. The SCOTI device gave a false-negative value in 37 patients (28%) and a false-positive result in two patients (1.5%). The response time for confirming intubations was 2.5 (1.5) s for the SCOTI, 4.1 (1.1) s for a capnograph and 40 (9.4) s for the auscultatory method. The erroneous results shown by the SCOTI device were highest when polyvinyl chloride tubes with a Murphy's eye were used for intubation. This study shows that this device is not very useful for ascertaining the correct placement of tracheal tubes after blind nasal intubation.

Adult↗
PubMed2001

Prediction of demand for treatment of temporomandibular disorders.

Baseline (BL) data on signs and symptoms characteristic of temporomandibular disorders (TMDs) were analysed in 67 young non-patients participating as controls in a clinical trial. Data on the incidence of demand for treatment of TMD were collected during the 4-year follow-up period, and, by means of a mailed questionnaire, during an additional 2 years. The variables analysed included palpation and auscultation of the joints, palpation of the muscles of mastication, experience of joint sounds, of pain on jaw movements, of ear symptoms, awareness of a clenching habit, and frequency of headache. A present-absent dichotomy was applied throughout. Palpation tenderness of masticatory muscles was significantly (P=0.02) more often present at BL in those who subsequently requested treatment than in those who did not. The same was true of the combination of palpatory tenderness and clenching habit (P=0.007), whereas the clenching habit alone failed to show a significant difference (P=0.06). However, the predictive values remained too low to be clinically useful, with a possible exception of the negative predictive value of muscle tenderness. The findings indicate that the variables conventionally used to describe the functional status of the masticatory system are at best of modest value in the estimation of individual risk of TMD in healthy young subjects.

Adolescent↗