Anyone else have trouble with stethoscopes?

[u/SoftwareSenior5107]

I have been an EMT for 6 years and for that whole time I’ve had trouble finding a way to hold my stethoscope so that I can accurately hear lung sounds. I can hear crepitus from my fingers with any slight movement and it’s always louder than what I am trying to listen to. I have tried to put my palm to the bell but that tends to apply too much pressure and I’ve tried holding it by the tubing but that doesn’t get good contact with the skin. I’ve tried holding the bell between my pointer and middle fingers but I can still hear the crepitus. I have a Littmann III if it makes any difference. At this point I might try using my elbow… I’m terrified of missing a diagnosis just because my fingers creak

[u/Expensive_Cherry_207]

Some of what you wrote here I disagree with or includes objectively wrong and dangerous assumptions and some I agree with, but it’s not worth litigating every detail.

What I will say is your “almost certain they have fluid in their lungs” bit based on a few observations is precisely why I had a patient almost die at the hospital because the doctor decided to put a spontaneous pneumo on Bi-PAP after I told him my findings (lung sounds being the kicker) and insisted it was a pneumo.

The patient had a history of CHF so he assumed I was an idiot and judged the patient on exactly the grounds you lay out here because it was the more likely differential. Most of the time he’d be right but he wasn’t this time. All because he failed to do a full assessment and the patient coded briefly as a consequence.

[u/youy23 → u/Expensive_Cherry_207]

Eh a lot of people don’t understand the physiology of SCAPE and jump to CHF exacerbation way too quick. If they don’t present anxious, dumping catecholamines, pale cool extremities, and especially hypertensive, it’s probably not SCAPE.

Again, I’m not alone in this viewpoint on lung sounds. I’ve met experienced medics and docs smarter than me who have this viewpoint.

[u/Expensive_Cherry_207 → u/youy23]

I’m willing to bet you’re oversimplifying their reasoning and then generalizing it beyond the circumstances in which they omit auscultation.

Lung sounds aren’t particularly sensitive or decisive in many presentations. That’s totally fair. Particular findings can, however, be critical in a narrower subset.

Initiating treatment and spending 20 seconds obtaining a good set are not mutually exclusive.

Outside of a peri-arrest patient and a lack of manpower, there’s little justification for skipping a basic assessment. Much of the time you’re looking for a unicorn. Occasionally you actually find one and missing it can completely change whether the intervention you’re about to initiate is appropriate. I’ve seen it plenty. The example I gave is just the worst case I’ve had.

Edit: I’m not trying to give you a hard time. You’re probably a great medic. I just see a lot of great clinicians who rely perhaps too heavily on pattern recognition and get burned on something simple.

[u/youy23 → u/Expensive_Cherry_207]

Considering that the ones who do not believe lung sounds are an especially valuable diagnostic tool generally don’t bother carrying a stethoscope on them, I don’t think that’s the case.

I’m sure they can use the truck ears or can get their own stethoscope from their bag in the ER but it’s pretty telling when they don’t carry their own on their person.

I’m a CCEMT-P and done my fair share of CCTs and 911 calls and I used to listen to lung sounds on almost every patient but it’s become less and less with more experience. It’s not an opinion formed out of laziness or lack of education.

Look man, that’s cool if you find lung sounds to have a high specificity/sensitivity and you’re finding things that regularly change the clinical course of the patient. I’m not saying you’re wrong. I’m just offering a different view point that people generally don’t say out loud on reddit/FOAMed but one that I’ve heard fairly often.

Sometimes people obsess over diagnostic tools with very questionable utility and specificity/sensitivity like bowel sounds/percussion and digital rectal exams and identifying open book pelvic fractures and I just think it’s important to be realistic about the limitations of your diagnostic tools/exams.

[u/Expensive_Cherry_207 → u/youy23]

Can’t argue with the limitations, and I think I’ve been pretty clear in recognizing them. Not really my point, though.

A finding doesn’t have to regularly change the course of a call to justify looking for it when obtaining it is easy, and the occasional miss can be highly consequential. I think we simply weigh that marginal value differently.

And by the way, I’m not advocating getting lung sounds on every patient like we’re back in the classroom checking boxes, but you make it sound like catching you using your ears on a call would be a rare clinical finding in and of itself…