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Internal and Emergency Medicine Apr 2021Intracranial bruits (ICB) are faint, high-pitched, and mostly heard on the orbit in the systolic phase of the cardiovascular cycle. This report discusses a case of...
Intracranial bruits (ICB) are faint, high-pitched, and mostly heard on the orbit in the systolic phase of the cardiovascular cycle. This report discusses a case of Listeria monocytogenes meningitis in a 17-month-old male patient in whom ICB were auscultated. ICB is thought to be caused by compression of blood vessels due to increased intracranial pressure and may serve as an additional sign supporting the diagnosis of meningitis. The present report contains video data on the ICB.
Topics: Anti-Bacterial Agents; Auscultation; Diagnosis, Differential; Emergency Service, Hospital; Heart Sounds; Humans; Intracranial Pressure; Male; Meningitis, Listeria
PubMed: 33392970
DOI: 10.1007/s11739-020-02579-7 -
Resuscitation Plus Sep 2024To examine speed and accuracy of newborn heart rate measurement by various assessment methods employed at birth. (Review)
Review
AIM
To examine speed and accuracy of newborn heart rate measurement by various assessment methods employed at birth.
METHODS
A search of Medline, SCOPUS, CINAHL and Cochrane was conducted between January 1, 1946, to until August 16, 2023. (CRD 42021283364) Study selection was based on predetermined criteria. Reviewers independently extracted data, appraised risk of bias and assessed certainty of evidence.
RESULTS
Pulse oximetry is slower and less precise than ECG for heart rate assessment. Both auscultation and palpation are imprecise for heart rate assessment. Other devices such as digital stethoscope, Doppler ultrasound, an ECG device using dry electrodes incorporated in a belt, photoplethysmography and electromyography are studied in small numbers of newborns and data are not available for extremely preterm or bradycardic newborns receiving resuscitation. Digital stethoscope is fast and accurate. Doppler ultrasound and dry electrode ECG in a belt are fast, accurate and precise when compared to conventional ECG with gel adhesive electrodes.
LIMITATIONS
Certainty of evidence was low or very low for most comparisons.
CONCLUSION
If resources permit, ECG should be used for fast and accurate heart rate assessment at birth. Pulse oximetry and auscultation may be reasonable alternatives but have limitations. Digital stethoscope, doppler ultrasound and dry electrode ECG show promise but need further study.
PubMed: 38912532
DOI: 10.1016/j.resplu.2024.100668 -
BMJ Open Respiratory Research May 2022Diagnosis of pneumonia remains challenging. Digitally recorded and remote human classified lung sounds may offer benefits beyond conventional auscultation, but it is...
Digitally recorded and remotely classified lung auscultation compared with conventional stethoscope classifications among children aged 1-59 months enrolled in the Pneumonia Etiology Research for Child Health (PERCH) case-control study.
BACKGROUND
Diagnosis of pneumonia remains challenging. Digitally recorded and remote human classified lung sounds may offer benefits beyond conventional auscultation, but it is unclear whether classifications differ between the two approaches. We evaluated concordance between digital and conventional auscultation.
METHODS
We collected digitally recorded lung sounds, conventional auscultation classifications and clinical measures and samples from children with pneumonia (cases) in low-income and middle-income countries. Physicians remotely classified recordings as crackles, wheeze or uninterpretable. Conventional and digital auscultation concordance was evaluated among 383 pneumonia cases with concurrently (within 2 hours) collected conventional and digital auscultation classifications using prevalence-adjusted bias-adjusted kappa (PABAK). Using an expanded set of 737 cases that also incorporated the non-concurrently collected assessments, we evaluated whether associations between auscultation classifications and clinical or aetiological findings differed between conventional or digital auscultation using χ tests and logistic regression adjusted for age, sex and site.
RESULTS
Conventional and digital auscultation concordance was moderate for classifying crackles and/or wheeze versus neither crackles nor wheeze (PABAK=0.50), and fair for crackles-only versus not crackles-only (PABAK=0.30) and any wheeze versus no wheeze (PABAK=0.27). Crackles were more common on conventional auscultation, whereas wheeze was more frequent on digital auscultation. Compared with neither crackles nor wheeze, crackles-only on both conventional and digital auscultation was associated with abnormal chest radiographs (adjusted OR (aOR)=1.53, 95% CI 0.99 to 2.36; aOR=2.09, 95% CI 1.19 to 3.68, respectively); any wheeze was inversely associated with C-reactive protein >40 mg/L using conventional auscultation (aOR=0.50, 95% CI 0.27 to 0.92) and with very severe pneumonia using digital auscultation (aOR=0.67, 95% CI 0.46 to 0.97). Crackles-only on digital auscultation was associated with mortality compared with any wheeze (aOR=2.70, 95% CI 1.12 to 6.25).
CONCLUSIONS
Conventional auscultation and remotely-classified digital auscultation displayed moderate concordance for presence/absence of wheeze and crackles among cases. Conventional and digital auscultation may provide different classification patterns, but wheeze was associated with decreased clinical severity on both.
Topics: Animals; Auscultation; Case-Control Studies; Child; Child Health; Humans; Lung; Perches; Pneumonia; Respiratory Sounds; Stethoscopes
PubMed: 35577452
DOI: 10.1136/bmjresp-2021-001144 -
MedEdPORTAL : the Journal of Teaching... Oct 2019Cardiac auscultation skills are essential to the development of a competent physician. We created a hypothesis-driven cardiac auscultation laboratory session utilizing a...
INTRODUCTION
Cardiac auscultation skills are essential to the development of a competent physician. We created a hypothesis-driven cardiac auscultation laboratory session utilizing a high-fidelity simulator to teach these skills to second-year medical students at our institution. This program was grounded in deliberate practice opportunities to aid in the acquisition of cardiac auscultation skills.
METHODS
This session aimed to help students identify and discriminate between normal and pathologic heart sounds in the context of a clinical vignette. Faculty facilitators guided students through unknown patient cases and utilized the auscultation manikin to simulate corresponding heart sounds. Time was also allotted for students to auscultate the manikins and practice their cardiac physical examination skills.
RESULTS
This program has been in place at our institution since 2016 and has been well received by students and facilitators. Since its initial introduction in 2016, 183 second-year medical students have completed the cardiac auscultation lab session each year, for a total of 549 students. Evaluations of the session have improved as faculty have become more familiar with the mechanics of operating the auscultation manikin.
DISCUSSION
The cardiac exam and heart sounds lab can be adapted to any simulator model that is capable of producing heart sounds and can be done in a large- or small-group format. Enough time should be allotted to adequately work through all components of the laboratory. Student and faculty feedback has helped us further refine the session since its initial introduction to the curriculum.
Topics: Clinical Competence; Curriculum; Educational Measurement; Heart Auscultation; Heart Diseases; Heart Sounds; Humans; Manikins; Patient Simulation; Students, Medical
PubMed: 31976362
DOI: 10.15766/mep_2374-8265.10839 -
Journal of Cardiology Nov 2022The effectiveness of cardiac auscultation training with a cardiology patient simulator for medical students is still unclear. Starting such training earlier may help...
BACKGROUND
The effectiveness of cardiac auscultation training with a cardiology patient simulator for medical students is still unclear. Starting such training earlier may help students improve their proficiency. We investigated whether cardiac auscultation training using a simulator for first-year students is feasible and effective.
METHODS
A total of 43 first-year medical students (5-12 in each year, 2015-2019) participated in three 1.5-hour extra-curricular classes comprising mini-lectures, facilitated training, two different auscultation tests (the second test closer to clinical setting than the first), and a questionnaire. The test results were compared with those of 556 fourth-year medical students who participated in a compulsory 3-hour cardiac auscultation class in 2016-2019.
RESULTS
The accuracy rate of all heart sounds and murmurs was higher in the first-year students than in the fourth-year students in both the first (85.8 vs. 79.4 %, p = 0.001) and second (71.3 vs. 61.2 %, p = 0.02) tests. That of second/third/fourth sounds was also higher in the first-year students than in the fourth-year students in both the first (86.0 vs. 79.7 %, p = 0.01) and second (70.9 vs. 53.9 %, p = 0.002) tests. The accuracy rate of murmurs was higher in the first-year students than in the fourth-year students in the first test (85.5 vs. 78.9 %, p = 0.04), but not in the second test (72.1 vs. 75.7 %, p = 0.58). All the first-year students and 65 % of them agreed that they had received sufficient knowledge and built sufficient skills, respectively. All the first-year students and 93 % of them agreed that they were satisfied with the program, and that the program was suitable for first-year students, respectively.
CONCLUSIONS
Although training time was different between the two groups and it is possible that only motivated first-year students participated in the program, these results suggest that our cardiac auscultation training is feasible and effective for first-year medical students.
Topics: Cardiology; Clinical Competence; Feasibility Studies; Heart Auscultation; Heart Murmurs; Humans; Students, Medical
PubMed: 35750554
DOI: 10.1016/j.jjcc.2022.06.007 -
Pediatric Pulmonology Mar 2023Lung auscultation is an important tool for diagnosing respiratory diseases. However, the ability of observers to recognize respiratory sounds varies considerably and...
BACKGROUND
Lung auscultation is an important tool for diagnosing respiratory diseases. However, the ability of observers to recognize respiratory sounds varies considerably and depends on the sound. The present study aimed to assess the auscultatory skills of healthcare professionals and medical students.
METHODS
A total of 295 physicians (185 pediatricians, 69 pulmonologists, and 41 physicians of general/internal medicine and subspecialties), 55 residents, and 50 medical students participated in the survey. They listened to five audio-recorded respiratory sounds and described them in free-form answers.
RESULTS
The rates of correct answers were 55.2% for fine crackles, 74.5% for coarse crackles, 72.2% for wheezes, 18.75% for squawks, and 11.25% for pleural friction rub. The medical specialty was correlated with the correct answers and both pediatricians and physicians of general/internal medicine and subspecialties recognized fewer sounds compared with respiratory physicians (odds ratio [OR]: 0.37; confidence interval [CI]: 0.22-0.62; p < 0.001 and, OR: 0.47; CI: 0.22-0.99, p = 0.048, respectively). Years of experience were negatively correlated with the number of correct answers (OR: 0.73; CI:0.62-0.84; p = 0.001).
CONCLUSIONS
Gaps remain in both terminology and recognition of lung sounds among a wide population of Greek physicians. Less experienced physicians perform better on lung auscultation, indicating that continuing education with critical feedback should be offered.
Topics: Humans; Respiratory Sounds; Lung; Auscultation; Physicians; Pulmonologists
PubMed: 36453611
DOI: 10.1002/ppul.26266 -
Diagnostics (Basel, Switzerland) Apr 2023Stethoscopes were originally designed for the auscultation of a patient's chest for the purpose of listening to lung and heart sounds. These aid medical professionals in... (Review)
Review
Stethoscopes were originally designed for the auscultation of a patient's chest for the purpose of listening to lung and heart sounds. These aid medical professionals in their evaluation of the cardiovascular and respiratory systems, as well as in other applications, such as listening to bowel sounds in the gastrointestinal system or assessing for vascular bruits. Listening to internal sounds during chest auscultation aids healthcare professionals in their diagnosis of a patient's illness. We performed an extensive literature review on the currently available stethoscopes specifically for use in chest auscultation. By understanding the specificities of the different stethoscopes available, healthcare professionals can capitalize on their beneficial features, to serve both clinical and educational purposes. Additionally, the ongoing COVID-19 pandemic has also highlighted the unique application of digital stethoscopes for telemedicine. Thus, the advantages and limitations of digital stethoscopes are reviewed. Lastly, to determine the best available stethoscopes in the healthcare industry, this literature review explored various benchmarking methods that can be used to identify areas of improvement for existing stethoscopes, as well as to serve as a standard for the general comparison of stethoscope quality. The potential use of digital stethoscopes for telemedicine amidst ongoing technological advancements in wearable sensors and modern communication facilities such as 5G are also discussed. Based on the ongoing trend in advancements in wearable technology, telemedicine, and smart hospitals, understanding the benefits and limitations of the digital stethoscope is an essential consideration for potential equipment deployment, especially during the height of the current COVID-19 pandemic and, more importantly, for future healthcare crises when human and resource mobility is restricted.
PubMed: 37174938
DOI: 10.3390/diagnostics13091545 -
Frontiers in Veterinary Science 2020Cardiac auscultation is an important, albeit underutilized tool in aquatic animal medicine due to the many challenges associated with in-water examinations. The aims of...
Cardiac auscultation is an important, albeit underutilized tool in aquatic animal medicine due to the many challenges associated with in-water examinations. The aims of this prospective study were to (1) establish an efficient and repeatable in-water cardiac auscultation technique in bottlenose dolphins (), (2) describe the presence and characterization of heart murmurs detected in free-ranging and managed dolphins, and (3) characterize heart murmur etiology through echocardiography in free-ranging dolphins. For technique development, 65 dolphins cared for by the Navy Marine Mammal Program (Navy) were auscultated. The techniques were then applied to two free-ranging dolphin populations during capture-release health assessments: Sarasota Bay, Florida (SB), a reference population, and Barataria Bay, LA (BB), a well-studied population of dolphins impacted by the oil spill. Systolic heart murmurs were detected at a frequent and similar prevalence in all dolphin populations examined (Navy 92%, SB 89%, and BB 88%), and characterized as fixed or dynamic. In all three populations, sternal cranial and left cranial were the most common locations for murmur point of maximal intensity (PMI). An in-water transthoracic echocardiogram technique was refined on a subset of Navy dolphins, and full echocardiographic exams were performed on 17 SB dolphins and 29 BB dolphins, of which, 40 had murmurs. Spectral Doppler was used to measure flow velocities across the outflow tracts, and almost all dolphins with audible murmurs had peak outflow velocities ≥1.6 m/s (95%, 38/40); three dolphins also had medium mitral regurgitation which could be the source of their murmurs. The presence of audible murmurs in most of the free-ranging dolphins (88%) was attributed to high velocity blood flow as seen on echocardiography, similar to a phenomenon described in other athletic species. These innocent murmurs were generally characterized as Grade I-III systolic murmurs with PMI in the left or sternal cranial region. This study is the first to describe an efficient technique for in-water dolphin cardiac auscultation, and to present evidence that heart murmurs are common in bottlenose dolphins.
PubMed: 33240948
DOI: 10.3389/fvets.2020.570055 -
Sensors (Basel, Switzerland) Jul 2021Conventional lung auscultation is essential in the management of respiratory diseases. However, detecting adventitious sounds outside medical facilities remains...
Conventional lung auscultation is essential in the management of respiratory diseases. However, detecting adventitious sounds outside medical facilities remains challenging. We assessed the feasibility of lung auscultation using the smartphone built-in microphone in real-world clinical practice. We recruited 134 patients (median[interquartile range] 16[11-22.25]y; 54% male; 31% cystic fibrosis, 29% other respiratory diseases, 28% asthma; 12% no respiratory diseases) at the Pediatrics and Pulmonology departments of a tertiary hospital. First, clinicians performed conventional auscultation with analog stethoscopes at 4 locations (trachea, right anterior chest, right and left lung bases), and documented any adventitious sounds. Then, smartphone auscultation was recorded twice in the same four locations. The recordings (n = 1060) were classified by two annotators. Seventy-three percent of recordings had quality (obtained in 92% of the participants), with the quality proportion being higher at the trachea (82%) and in the children's group (75%). Adventitious sounds were present in only 35% of the participants and 14% of the recordings, which may have contributed to the fair agreement between conventional and smartphone auscultation (85%; k = 0.35(95% CI 0.26-0.44)). Our results show that smartphone auscultation was feasible, but further investigation is required to improve its agreement with conventional auscultation.
Topics: Auscultation; Child; Feasibility Studies; Female; Humans; Lung; Male; Respiratory Sounds; Smartphone
PubMed: 34300670
DOI: 10.3390/s21144931 -
The American Journal of Cardiology Dec 2022Cardiology has progressed beyond classic auscultation, but the doctor-patient relationship must be preserved.
Cardiology has progressed beyond classic auscultation, but the doctor-patient relationship must be preserved.
Topics: Humans; Stethoscopes; Physician-Patient Relations; Auscultation; Cardiology
PubMed: 36153180
DOI: 10.1016/j.amjcard.2022.08.020