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Lung/Heart Sounds


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I applaud you for wanting to expand beyond the narrow box that paramedic education tends to reside inside. It seems like most medics come out of school knowing little more than the difference between "crackles" and "wheezes," yet no true understanding of what they actually mean or where they come from. There are certainly a lot more sounds than just those two, and they can be quite valuable to your ability to accurately diagnose illness. Others have given you some resources here, so just let me give you this piece of advice; lung and heart sounds are not something that you can listen to a few sound clips of and forget about, then expect to know them a few months later, much less what they actually mean. It takes constant practise to master them. And if you don't intend to master them, don't even waste your time studying them. Take every possible opportunity you get to listen to every set of lungs you can find. Your friends, your family, your classmates... they are all your patients when you are a student. Even if you don't hear a lot of abnormal breath sounds, you benefit. Because the more normal breath sounds you hear, the easier it becomes to recognise when you hear an abnormal sound. If you are doing a rotation in the ER, your job is not limited to just taking vital signs and starting IVs. Listen to EVERYBODY's chest, even if they are there for an ingrown toenail. IVs are easy. ASSESSMENT is the one real skill that paramedics have a hard time mastering. Use every opportunity you have to practise it.

As for heart sounds, this is really not terribly important to understand at this stage of your education. However, I still encourage you to pursue it for the very same reason as above. Because the more you hear, the more you will begin to get the feel of what is normal, making the abnormal more recognisable.

With both lung and heart sounds, your ears will do you absolutely no good if you do not fully understand the anatomy and physiology of the lungs and the heart. You need to know a lot more than just the typical "tracing the drop of blood through the heart" and basic lung anatomy. You need to know a lot more than what your school is teaching you, unless your school requires the full two semester, dedicated A&P courses. Otherwise, those clicks and glallops and murmurs are just sounds without meaning. You won't impress anybody by recognising a gallop if you can't describe what is happening to produce it, as well as why it is significant.

The point is, just like with every other diagnostic skill, to keep your eye on the big picture. Make sure you understand the pathology and implications of your findings. Don't settle for simply recognising a sonorous rhonchi or a grade VI systolic murmur. Be able to explain what it means and what implications that has on your treatment plan.

And one last thing, don't let your enthusiasm for deeper understanding sidetrack you from staying primarily focused on the standard curriculum that you are studying. If you spend so much time learning about heart murmurs that you don't study enough to pass your next exam on basic cardiology, you haven't done yourself any favours!

Best of luck!

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It bodes well that you are willing to expand what you are being told in class. If you take the time to practice, as Dust suggests, even better. Understand the physiology of what you are hearing, so you can make good decisions about what to do for it. The time and effort you put into your ability to perform a good assessment will be well worth it.

Good luck to you.

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I applaud you for wanting to expand beyond the narrow box that paramedic education tends to reside inside. It seems like most medics come out of school knowing little more than the difference between "crackles" and "wheezes," yet no true understanding of what they actually mean or where they come from. There are certainly a lot more sounds than just those two, and they can be quite valuable to your ability to accurately diagnose illness. Others have given you some resources here, so just let me give you this piece of advice; lung and heart sounds are not something that you can listen to a few sound clips of and forget about, then expect to know them a few months later, much less what they actually mean. It takes constant practise to master them. And if you don't intend to master them, don't even waste your time studying them. Take every possible opportunity you get to listen to every set of lungs you can find. Your friends, your family, your classmates... they are all your patients when you are a student. Even if you don't hear a lot of abnormal breath sounds, you benefit. Because the more normal breath sounds you hear, the easier it becomes to recognise when you hear an abnormal sound. If you are doing a rotation in the ER, your job is not limited to just taking vital signs and starting IVs. Listen to EVERYBODY's chest, even if they are there for an ingrown toenail. IVs are easy. ASSESSMENT is the one real skill that paramedics have a hard time mastering. Use every opportunity you have to practise it.

Thank you for this post... I've printed it out.

The benefit of listening to normal breath sounds makes alot of sense to me now. I already listen to everyone's chest now, but you're right, recognizing normal makes abnormal jump out at you that much more. I just don't run across many patients that have abnormal sounds. Breath sounds have been an area I really need to work on.

Thanks again!

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I have to admit, I appreciate calls where nothing is really wrong with the patient. Even when we do transfers I like to do a quick assessment of the patient. V/S, Lung sounds, that sort. It's like Dust, and coincedentally enough, my medic instructor said "If you know what normal is, it makes abnormal easier to recognise."

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