![]() ![]() Next you need to know what you are listening for. I typically perform this auscultation in this manner. So it can be easier to auscultate this valve at the same level, but at the midaxillary line. HOWEVER, this can be difficult to do with some female patients, and auscultation of sound may be difficult if the patient exhibits a bariatric build. To auscultate this structure, place your stethoscope in the left fifth intercostal space at midclavicular line. M is for Mitral (Also known as Bicuspid). To auscultate this structure, place you stethoscope in the left fifth intercostal space, just lateral of the sternal border. Auscultating this structure will require you to place your stethoscope at the left second intercostal space, also at the sternal border. Auscultating this structure will need to be done over the right second intercostal space at the sternal border. The “All Physical Therapists Move” method (also known as the “All Physicians Take Money” method) is the easiest to remember what you are actually listening to.Īll. There are two main methods to do this, but, for the sake of simplicity, I’m just going to discuss this one. So let’s take a look at heart auscultation. ![]() Ultimately, we decided he needed to go in and he was admitted. Thankfully, his primary nurse arrived shortly after I discovered these findings and we had the opportunity to talk it over and attempt to figure it out. I contacted the cardiologist’s office and reported my findings (which probably sounded like I was completely unable to auscultate heart sounds… “uh, your patient’s heart isn’t demonstrating a typical contraction pattern upon auscultation…” was the best I could do without sounding just foolish). I could hardly make sense of the sounds I was hearing. There was some serious electrical disturbance going on here. This man’s heart sounded like an engine misfiring on all cylinders. I noticed when taking his pulse and blood pressure that his heart rhythm was irregular so I took an extra listen to the main equipment. However, yellow flags were going up in my head. ![]() This seemed a bit extreme, but he was also likely dehydrated. I began to perform the standard four-position orthostatic assessment that I mentioned in those posts and found him to be significantly orthostatic, to the point where I could not stand him up for more than a few seconds before he just sat down on his own due to being “lightheaded”. In my article about Beta Blockers, we discussed how these medications are typically prescribed along with other medications after CABG procedures and this frequently results in orthostasis. So I went on to what I typically look for in a patient immediately after CABG: orthostasis. He was a smaller man and did not seem to be exhibiting any signs of fluid overload. His caregiver was reporting to me that he was very fatigued, very confused, very not himself since the surgery. Instead, I had the pleasure of just picking up on these things as I went along through my evaluation. When I evaluated him, I was a bit frustrated because he had impaired cognition and had significant comorbidities for a younger man, none of which was in his referral information. I was seeing a younger man in the home setting after a CABG x3 procedure. ![]()
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