Heart Arrhythmias

[croaker260]

To answer the original question (though I am a NERD myself...)

I will illustrate a real word example why listening to the heart is useful.

Many years ago I rolled out on a very simple sounding flu lie s/s patient. Sweet Old School Country lady, ambulatory, positive Samsonite sign. Her only complaint was she felt dehydrated and run down, and the last time she had this she had to be admitted with the flu. She wanted to "get ahead of this damn thing". BTW, this was right in the middle of "flu season" in the south.

She ambulated (at her insistence) to the ambuilance and only with some southern charm did I get her on the cot and allow a set of vitals. She was a touch SOB from the walk but that really wasn't surprising. Vitals were text book perfect with a HR at the radius and on the SPO2 of 98-100, and her SPO2 was in the mid 90's on RA. Her skin turgor was poor but not bad (typical old people skin), she was rather perky, and she looked, tasted and smelled like a typical (very stable) elderly dehydration patient. As a part of a routine physical exam I listened to her lungs and noticed something odd. Instead of the thump thump at 100 beats a minute, I hjeart a very rapid tap-tap-tap-tap-tap-tap-tap-tap-tap-tap-tap-tap-tap at about 200!

Sure enough, hooked up the monitor and there she was in a little SVT at about 200/minute. Given a number of factors I may have never had put the monitor on had I not heard the rate. 6 of adenocard later she felt 100% better and wanted me to take her back home!

Anyway, THAT is why I always listen to lung sounds and heart sounds when ever I can remember it. THAT is why listening for arrhythmias is useful. You probably wont be able to tell WHAT the rhythm is, but it may keep you from making a STUPID mistake.

Imagine the bad karma to bring in that patient BLS/ILS and the look on your face when they do the routine 12 lead 90% of patients seem to get today.

Hope my lil war story is useful.

Edited August 1, 2011 by croaker260