How to Use a Stethoscope

how to use a stethoscope

Most people who are new to the healthcare field often don’t know how to use a stethoscope. What’s the point of having the best stethoscope but not know how to use it?

You don’t have to be ashamed to the extent of faking your way with it. The following article will give you tips on how to use the instrument and by the end, you will have no difficulties using it.

Importance of Knowing How to Use a Stethoscope

This may seem silly at first but as a medical practitioner, you ought to make some time so that you can get to know your stethoscope. Before using a stethoscope on a patient and colleagues, ensure that it fits properly, you are used to moving around with it and that you can hear clearly through the ear pieces.

Practice at home how to place the stethoscope around, how to position it in the ears and how to tune the diaphragm and bell. A stethoscope is an important instrument to a doctor just like a sidearm is to a police officer.

Parts of a Stethoscope

If you want to learn about how to use the instrument, the best place to begin with is its anatomy. There are five different parts of a stethoscope, and every one of them of them has a significant role in how sounds will be heard.

1.      Chest piece

The chest piece comprises of the bell on one side and diaphragm on the opposite side. The diaphragm is the big and flat side of the chest piece made of a metallic disc that has a second plastic disc. High pitched sounds such as the “lub-lub” of normal breath and heartbeat are easily detected by the diaphragm.

The bell is a metal hollow cup shaped piece that also has a small hole at the top. Low pitched sounds like the “whoosh” from heart murmurs are easily detected by the bell.

2.      Headset

Sound transmitted from the chest piece goes through the tubing to the headset and is then released to the ears through the ear tips on both sides.

3.      Tubing

The tubing runs from the headset to the chest piece. It transfers sounds picked up by the chest piece to the ears.

4.      Stem

This is a metal piece that connects the chest piece to the tubing.

5.      Earpieces

These are fitted into both ears. Sound transmitted from the chest piece is conveyed to the ears through the earpieces. The tips are made of rubber which helps to create a seal inside the ear and block other environmental noises.

Quick Tips about a Stethoscope

Before you begin using a stethoscope, it is best to understand some of the mistakes that are commonly made by new practitioners and students. By memorizing the following points, you will less likely make the errors.

  • The ear tips must be fitted correctly into the ears so that sound can be received properly.
  • Some stethoscopes have earpieces that are turned slightly forward. This is to help transmit sound directly into the ear canal and to the eardrum.
  • Avoid using the stethoscope on a patient wearing clothing or has dry hair. These things often produce rustling sounds and will probably confuse the doctor.

Detecting Sounds

You can simplify the explanation of how a stethoscope works by starting with the use of the flat surfaces of the diaphragm and chest piece. When using a stethoscope, the diaphragm is placed on the patient’s chest where the sound waves from the body will cause vibrations on the diaphragm.

Since the tubing is connected to the diaphragm, the sound waves will only travel in one direction, which is through the tubing into the ears. Sound will be amplified into the ears because the waves have limited space within the narrow tubes of the stethoscope. This means more sound waves will be transmitted into your ears.

Using the diaphragm side of the chest piece will be more effective because it picks high pitched sounds. Therefore, sounds such as heartbeats and breath will cause a greater level of pressure fluctuations over a given period of time.

On the other hand, the bell works in a different way. Unlike the diaphragm, it is able to pick low pitched sounds. This is because it doesn’t pick up the sounds caused by movements of an artery. Instead, it will pick up sound waves from the skin resulting from movements caused by the artery.

How to Wear a Stethoscope

If you are curious about how to wear a stethoscope, you should understand that they have headset which are designed to be worn at a specific angle. This angles position the ear tips directly near the ear canals in order to improve sound delivery. Make sure that the ear tips are pointing forward in your ears.

The ear tips should also provide a good seal to the ear canal. They should neither be too small nor too large. If the ear tips are too small then you will be able to hear environmental noise which in turn will block the stethoscope’s performance. When the stethoscope is not in use, drape it around the neck, preferably around the collar of your coat to prevent it from being in direct contact with the skin.

Using a Stethoscope to Listen to Heart Sounds

Listening to a patient’s heart is part of all physical exams. Unfortunately, the task is not as easy as just using the chest piece to listen to the heartbeat. There are several parts of the chest to locate that are related to the heart’s position.

When properly auscultating the heart, both the diaphragm and bell are used.  By positioning your instrument on the right space found between the second and third ribs, you will be able to hear blood flowing through the aortic valve. This is next to the sternum.

To listen to sounds from the pulmonary valve, move the stethoscope to the left side of the sternum. This will be in the second interspace. If you want to listen to the tricuspid valve, move the instrument down to the lower left part of the sternum.

However, you will be able to hear the mitral valve at the apex of the heart. This is often found at the fifth intercostal space. This is approximately 6cm from the sternum’s border. Abnormalities can be detected and sound radiations should also be noted, especially in cases where there are heart murmurs.

Using a Stethoscope to Listen to Lungs

We all have felt the shock when a cold stethoscope diaphragm is placed on our bare skin during a physical. The somewhat cold shock is part of how the physician is able to listen to the lungs. To be able to hear the lungs, the diaphragm is placed at the front and the pack parts of the thorax. Since breath sounds are high pitched, they will not be heard effectively by the bell.

Using a Stethoscope for Blood Pressure

The “old fashion” way of screening blood pressure is done by placing the bell lightly under the lower end of the sphygmomanometer cuff. Make sure you use the bell because low frequency sounds will be generated like the Korotkoff sounds.

You need the right stethoscope for blood pressure for this exercise.

Using a Stethoscope to Listen to Bowel Sounds

Stethoscopes are used on the abdomen so that they can detect intestinal mobility, signs of obstruction and other problems. When listening to the abdomen, you’ll first need to divide it into imaginary quarters. Don’t percuss or palpate the abdomen until after you have auscultated it.

Percussion and palpations can alter the original sounds produced by the bowel through muscle tensing. Begin the process (abdominal auscultation) by placing the diaphragm on the right lower quadrat. Work your way in a clockwise manner to the other three sections of the imaginary quadrat. Continue by trailing the path of the large intestine. Normoactive bowels will produce gurgling sounds which will occur at a rate of around 5 to 34 per minute.

How to Store a Stethoscope

When the stethoscope is not in use, ensure that it is protected from damage and other elements that can affect how it functions. You should store the stethoscope in a good quality case.

The following are tips you can use for its safekeeping.

  • Store it from extreme temperatures (whether hot or cold) because the tubing can easily crack or get damaged after extended periods of exposure.
  • Avoid storing your stethoscope in your pocket, handbag and other areas where dust, lint, dirt or other materials can enter and get logged in the ear pieces.
  • Don’t expose your stethoscope to oils or solvents since they can also damage the tubing or get into the ear pieces which will otherwise damage or obstruct the instrument.

You should also clean your stethoscope regularly using isopropyl alcohol, soap and water. You do not want bacteria growing on it because it can be dangerous for both you and your patients.

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