 Hey guys, my name is Boris. I'm a board certified physician assistant and today's video is going to be about using your Stethoscope so I know it might seem a little bit silly Especially to those of you who have been practicing a while or might be kind of deep into your PA school education That I have to make a video explaining how to use the stethoscope kind of from the ground up Listening for murmurs listening for breweries listening for heart sounds long sounds bowel sounds Just measuring blood pressure Manually the stethoscope does a lot for us It's one of our most important tools in medicine And so a lot of what we learned in school is different findings how to interpret different findings that we may find using our Stethoscope on auscultation, but I don't think enough people talk about is how to properly actually use the stethoscope So for me personally I have bad hearing I know I'm only 33 but I already have some hearing loss mostly because I really like motorcycles guns Loud rock concerts and stuff like that and I use all these things frequently. You know, I fire my gun pretty regularly I ride my motorcycle as a daily driver in the summer I used to have a much louder motorcycle now It's mostly just wind noise because my bike's pretty quiet, but either way definitely destroys my hearing I love love love going to rock concerts just this year. I went to Metallica twice I just saw Rammstein or Rammstein's Americans might say it and my my ears are still ringing from that So long story short, I've got some hearing damage. I've got bad hearing So when I had my first stethoscope the Lipman classic 3 it's an okay stethoscope But it definitely is just not as powerful as a cardiology master, which this is or even a cardiology 4 But cardiology master is definitely top of the line as far as like non-electric Normal stethoscopes go so not like electrically enhanced is what I meant So basically it was actually kind of difficult for me to use a regular stethoscope in school and a lot of times when we were listening for murmurs listening for other stuff a Lot of people seem to get things that I just could not hear I just could not hear faint heart sounds and I think part of that was because I just don't hear as well as some people I also think part of that is because I wasn't really Using the stethoscope Properly and some people may kind of like have the touch they might just get it naturally and some people like me Kind of have to learn how to use it through experience and what I've noticed even with this stethoscope I got this pretty shortly after graduating PA school and starting my medical practice I noticed that it was much better than the cardiology 3 or than the Lipman classic 3 And I definitely noticed things much more loudly and vividly But still as my experience has grown and I've listened to you know Hundreds if not thousands of patients at this point as opposed to a few dozen maybe a couple hundred while in school I've noticed most of I've noticed that I've picked a few things up that I'm gonna share with you that make using the Stethoscope easier and if you were like me as a PA students You know nursing student medical student whatever it may be and you have difficulty hearing the things that you should be hearing that people Around you might be hearing or might be pretending that they are hearing just so they don't look stupid You know things that you should be hearing maybe if you're not hearing them properly Maybe some of these tips can help you out Okay, so with that long introduction the actual content of this video is going to be like a minute or two It's actually pretty quick pretty simple But I feel like this isn't explained nearly enough to new medical providers medical practitioners and you know nurses nursing students PA students medical students So here is what I want to tell you first things first obviously I'm not going to put it in because I got my my AirPods in recording for this video But make sure that your stethoscope is oriented properly Every stethoscope comes like this, you know the little earpieces curve this way and I've actually seen people put it on incorrectly Namely some newer medical assistants that I've seen recently But I'm sure PA students medical students nursing students have done this as well make sure that The earpieces that are curved upward you put them on like this. Okay, so they curve upward They curve forward make sure that they're facing forward in your ears like this. Okay, so not like this Not like this But like this Okay, so if you hold them in front of you you see they're curving upward That is how they should be going into your head your face facing that way so like this Just like that make sure they're facing forward Make sure they're nice and snug and make sure that they have a pretty good fit people talking around you You should barely be able to hear because these earpieces should be very very firmly in your ears Kind of like a noise canceling noise isolating sort of a headphone where they basically cut off all the sound around you So a lot of times when I'm auscultating a patient and they try to talk to me I can't really hear a word it sounds very muffled what they're saying and I actually have to tell them like hey Sorry, I'm auscultating your chest. They can't hear you just hold on a second. I'll listen to you in just a minute So yeah, this should be a very snug fit should really be in your ears good and again This is very important that it's going this way. Okay, so that's the first thing the second thing is no one Oops really dropping my stethoscope here. Good thing. Lippman's got a lifetime warranty Anyway, no what kind of stethoscope you have so if you happen to have a cardiology master like this It actually has multiple settings So it hears different frequencies depending on how tightly you press it against the patient's chest So how much pressure you put on it and then there's also different ways to hold it There's this way. There's this way all of which kind of change how the diaphragm is angled also change how Basically how much sound gets into the diaphragm so it adjusts better for different frequencies and different kinds of sounds So if you're not hearing something properly squeezing really really tight Maybe back off a little then maybe go kind of medium in the middle Just play with it with the pressure because the pressure could really change a lot and also Be very patient. Okay, so maybe squeeze a little bit tighter. Wait a minute Listen Listen for a little while Okay, then maybe back off a little bit again. Give it a while Don't just expect to hear perfect heart sounds like you heard on the uh Like the computer programs or videos that we used in school real people are not robots. They're not programs. They're not videos They're not perfect You know, so just wait a minute be patient So that's another thing be very very patient and listen for much longer than you think you need to Might be a little bit awkward at first, you know, but I promise you the patients understand what you're doing And if they don't explain it to them, hey, look, I really need a minute to listen to your chest I'm just listening for something. It doesn't mean anything's wrong. Don't worry I just have bad hearing and I want to make sure that I'm hearing this correctly And that's it. Just listen. Okay tip number one put it on correctly That's very important tip number two if you happen to have one like this that has adjustable pressure Uh, definitely make sure you try various kinds of pressure before you get one That just kind of feels just right like goldilocks not too tight not too loose just just right And also tip number three make sure you listen for a while be patient Be patient listen for much longer than you think you need to and then you'll hear things Okay tip number four This one is a little bit odd But honestly when I learned this one a lot of it just kind of clicked You know, this was like an epiphany moment where I realized, okay My hearing might be bad, but I can use a stethoscope Properly and uh really get it use it as a the kind of diagnostic tool that it needs to be used as And this one is a little bit weird, but if you've been practicing for a while, you know exactly what I'm talking about Don't worry so much tip number four is don't worry so much about listening for sounds So much as you worry about Feeling the sounds Okay, you're not going to feel them in your fingertips You're not going to feel them in your chest or in your head You are going to feel them on your eardrum But you won't necessarily hear them. It may not be a sound. It may not be like a click Click or a boom boom It might not be that but you might if you're quiet and you're paying attention to your body to the sound very much Paying attention to your ears. You might just feel your eardrums pulsing. Okay, and that's what you actually Interpret as the heart sound It's not necessarily a sound that you hear coming out of the speakers on your computer when you're training You might be more of a sensation more of a pulsing more of a feeling. Okay, that's something that I realized I want to say in the last couple of months and I've been practicing for close to a year Okay, so I just maybe I've known this all along and I haven't been able to put this into words But when I realized this it wasn't a epiphany moment. I'm not necessarily listening for a perfect sound I'm just listening for a feeling. So again, I know this is hard to explain a little bit But I hope you get it. I hope this is helping somebody you're not necessarily waiting for a sound You might be waiting just to feel your eardrums pulse All right, I'm going to say it again because this one is critically important. I think you're not always listening for a sound You might just be waiting for your eardrums to pulse and that's how you can interpret sounds All right, so especially on kind of bigger people or people who have very faint Blood pressure when you're doing it manually this one. I feel like is the most important thing here It's good with heart sounds too. Don't get me wrong But this is where I've really found it the most useful You're waiting for your eardrums to kind of pulse to feel less than an actual sound And that could be your blood pressure heart sound or sorry And that could be your blood pressure sound when you're listening for the manual blood pressure That could be your heart sounds when you're ausculting the heart when you're doing breath sounds Obviously, that's going to be sounds, you know, are they is it good air movement? Is there anything in the way is there, you know rails ronkai? Is there wheezes? Is there anything like that? So breath, you know heart or Breath lung sounds you're usually just kind of going by sound bowels sounds. Yeah, you're basically just going by the gurgles Is it hyperactive hypoactive? Is it basically uniform throughout the four quadrants? You're kind of going for sounds here But for the heart and for the blood pressure from blood vessels. So heart and blood pressure I found that that feeling, you know, sometimes it's very faint But if you pay attention you could feel your eardrums actually move More than an actual sound because it could be very faint But even a guy like me who doesn't have very good hearing Can still feel it and use the stethoscope as a diagnostic tool as it should be used All right guys, so I really hope that's helpful to somebody who's out there just frustrated that you know I got the stethoscope. I even paid money for a good one. I didn't get a cheap one You know, I paid a lot of money for a great stethoscope And I just still am just not getting the heart sounds that a lot of people in school Are telling me that they're getting I just I something's wrong with me I just can't get the stethoscope to work for me. Try that. Okay, try these four tips. Let me know if it helps All right guys, I'll see you in the next video