How to Use a Stethoscope

Medicine's Simple Marvel Perhaps one of the greatest abilities in today's medical world is the ability doctors and nurses have to listen to heartbeats, pulses, and breathing patterns with simplicity. It doesn't require any high-tech equipment. It doesn't require a myriad of tests and examinations. It doesn't cost thousands of dollars per minute to operate. In fact, the abilities that I just mentioned are made possible by this instrument: a stethoscope. The stethoscope that we know today is not the stethoscope that was invented nearly 200 years ago. In 1816, a young physician in Paris, France, named R.T.H. Laennec, created the first recorded stethoscope, thanks to his noble convictions. You see, Dr. Laennec was examining a female patient, and was embarrassed to put his ear to her chest. This was common practice among physicians in this time period, but Laennec was simply resistant. Instead, he recalled that sound travels through solid materials. He rolled up 24 sheets of paper, and placed one end to his patient's chest. The other end he placed to his ear, and to his amazement, listened to the noises of her chest cavity. Not only could he hear the sounds his patient was making, he noticed the sounds were louder and clearer. Of course, Laennec's design was much like a paper towel tube, so it is not at all representative of this instrument: the modern binaural stethoscope. This design was created only years after the creation of the stethoscope and it has evolved into some pretty complex, highly-technical, rather pricey models we see on the market today. However, the basic operation of any stethoscope is essentially the same. In order to realize the full benefits of using a stethoscope, there are some basic rules one must follow. First, you should become familiar with the parts of your stethoscope. These are called the ear tips. They position comfortably in the outer ear, much like a headphone or a cellular phone earpiece may. The tubing follows downward, and may vary in length between different stethoscopes. At the end of the tubing is the chest piece, or diaphragm. This is the instrument that actually receives and magnifies the sound vibrations. At this point in my demonstration, I'm going to need a volunteer from the audience. I've already arranged for my friend Damien to come to the front with me and serve as a patient. In order to use your stethoscope correctly, begin by placing the ear tips in each ear, like this. Please note that you should not force the ear tips into the ear canal or any further than they comfortably fit. They are made to rest in the outer ear, and it is not necessary to have them resting flush against your ear drum. Once you have placed the ear tips in their correct positions, handle the chest piece with care. These pieces tend to be highly sensitive, and any misuse can easily result in permanent damage to the internal ear. It is fun, however, to scream obscenities, insults, and various other nondescript noises into the diaphragm of those you don't care for. Damien, would you like to try on my stethoscope? I'm only kidding! Now that your ear tips are comfortably in place, it is essential that you know where to listen for different sounds. This instrument will do you no good if you don't know where to use it. If you're listening for a heartbeat, place the chest piece on the left side of the patient's chest, directly over the left breast. You may move the chest piece around to hear the heartbeat from several different angles. Normally, a doctor or nurse would perform this task on bare skin, in an effort to hear the heartbeat in a clear manner. However, for the sake of keeping this class rated ‘G,' we won't be asking Damien to remove his shirt. If you're listening for breathing patterns or lung and airway blockages, you may place the chest piece anywhere on the patient's upper chest. You may also place it on the upper back of the patient, as well. Each position may offer a different angle of sound. Another technique used when listening for breathing and airway patterns is called percussion. To do this, you place the chest piece on the patient's chest, and solidly "thump" around it. In this case, you're not listening for the actual sound of the "thump," you should be listening to the reaction of internal sounds. Finally, you may also use the stethoscope to monitor abdominal sounds. This one can be quite fun, but also extremely disgusting. Much like we did before, place the chest piece on the upper abdomen to listen to the stomach. You can place it in on the lower abdomen to listen to the intestines. Now, depending on when the last time your patient has eaten, this experience can be quite…well…interesting. Juicy noises in this region of the body are quite normal, although doctors will determine whether or not your abdominal activity is normal or high. You see, with this instrument doctors and nurses are able to obtain a wealth of information about a patient and their condition without any intrusive or abrasive examinations. Doctors and nurses can monitor a patient's heart rate, pulse rate, breathing patterns, and abdominal activity with the use of this relatively simple instrument. No high-tech machines or day-long procedures. It's really quite simple, and yet so highly effective. Thank you, Damien, for your help. Any questions?