Guest guest Posted February 19, 2007 Report Share Posted February 19, 2007 We have recently discussed the education and training of paramedics on these and other lists. I ran across the following mnemonic for heart sounds near S2 that may confuse the Auscultator: P-L-O-P-P-S Paradoxical splitting--The most common cause of paradoxical splitting is left bundle branch block. A delayed A2 (the sound of the aortic valve closing, g.g.) also occurs in flow or volume overload of the left ventricle (e.g., aortic stenosis or insufficiency), though these disorders after present with a single S2. Late systolic clicks--are produced by the pulmonic valve in isolated pulmonary stenosis and idiopathic dilatation of the pulmonary artery. An aortic ejection click is heard in congenital aortic stenosis, truncus arteriosus and, occasionally, coarctation of the aorta and aortic aneurysm. In contrast to these, mitral valve prolapse presents with a mid-systolic click and/or a late systolic murmur. Opening snap-- a loud opening snap associated with mitral stenosis usually means mitral commissurotomy will be possible. A soft opening snap means valve replacement may be necessary and an opening snap louder than a normal S2 should alert one to the possibility of a..... Pericardial knock--the interval between the S2 and a pericardial knock does not change, whereas the S2-opening snap interval widens when the patient assumes the upright posture. Pericardial knock has an S3-like quality but comes earlier than the usual S3. Pulmonary hypertension--delays P2 (the sound of the pulmonary valve closing, g.g.) and increases its intensity. An standing, the A2-P2 interval stays the same or becomes narrow. An A2 opening snap interval becomes wider on standing because of a decrease in venous return and a subsequent drop in left atrial pressure. S3--occurs 0.12 to 0.16 seconds after S2 and is low pitched. A pathologic S3 is usually accompanied by symptoms of congestive heart failure, but may be present without symptoms in patients with a history of myocardial infarction and resultant ventricular aneurysm. Now, I wonder just how many of the members of these groups can follow the foregoing explanations without going to Google more than once or twice. Of course, many will say, " Paramedics don't need to know that. " I leave it up to each of you as to whether or not paramedics need to know it. How many of you believe that paramedic education should teach the evaluation of heart sounds? How many of you were exposed to evaluation of heart sounds during your paramedic education? Your thoughts? Gene Gandy P.S. I had to go to Google twice, and I modified the post with my findings, which you will see in parenthesis followed by my initials, g.g. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2007 Report Share Posted February 19, 2007 Dr Bledsoe, I hope you will consider giving this lecture at the Texas EMS Conference in Houston this year, it sounds interesting. Maxie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2007 Report Share Posted February 19, 2007 I am giving a talk called “Enhancing Your Cardiac Diagnostic Skills” at JEMS and a zillion other conferences this year. It is largely based on heart sounds. I bought a pretty sophisticated heart sounds graphics program to go with it. I will give it for the first time at JEMS. I hope it goes well with all of the shock wave files and sound issues. BEB From: Paramedicine [mailto:Paramedicine ] On Behalf Of wegandy1938@... Sent: Monday, February 19, 2007 8:54 PM To: texasems-l ; Paramedicine Subject: Heart sounds We have recently discussed the education and training of paramedics on these and other lists. I ran across the following mnemonic for heart sounds near S2 that may confuse the Auscultator: P-L-O-P-P-S Paradoxical splitting--The most common cause of paradoxical splitting is left bundle branch block. A delayed A2 (the sound of the aortic valve closing, g.g.) also occurs in flow or volume overload of the left ventricle (e.g., aortic stenosis or insufficiency), though these disorders after present with a single S2. Late systolic clicks--are produced by the pulmonic valve in isolated pulmonary stenosis and idiopathic dilatation of the pulmonary artery. An aortic ejection click is heard in congenital aortic stenosis, truncus arteriosus and, occasionally, coarctation of the aorta and aortic aneurysm. In contrast to these, mitral valve prolapse presents with a mid-systolic click and/or a late systolic murmur. Opening snap-- a loud opening snap associated with mitral stenosis usually means mitral commissurotomy will be possible. A soft opening snap means valve replacement may be necessary and an opening snap louder than a normal S2 should alert one to the possibility of a..... Pericardial knock--the interval between the S2 and a pericardial knock does not change, whereas the S2-opening snap interval widens when the patient assumes the upright posture. Pericardial knock has an S3-like quality but comes earlier than the usual S3. Pulmonary hypertension--delays P2 (the sound of the pulmonary valve closing, g.g.) and increases its intensity. An standing, the A2-P2 interval stays the same or becomes narrow. An A2 opening snap interval becomes wider on standing because of a decrease in venous return and a subsequent drop in left atrial pressure. S3--occurs 0.12 to 0.16 seconds after S2 and is low pitched. A pathologic S3 is usually accompanied by symptoms of congestive heart failure, but may be present without symptoms in patients with a history of myocardial infarction and resultant ventricular aneurysm. Now, I wonder just how many of the members of these groups can follow the foregoing explanations without going to Google more than once or twice. Of course, many will say, " Paramedics don't need to know that. " I leave it up to each of you as to whether or not paramedics need to know it. How many of you believe that paramedic education should teach the evaluation of heart sounds? How many of you were exposed to evaluation of heart sounds during your paramedic education? Your thoughts? Gene Gandy P.S. I had to go to Google twice, and I modified the post with my findings, which you will see in parenthesis followed by my initials, g.g. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2007 Report Share Posted February 19, 2007 I'll be glad to if agrees. Texas is still 20 conferences away for me (not counting presentations in Australia, France, Germany, and Mexico). We are wanting to do a preconference APLS class of there is enough interest. BEB From: texasems-l [mailto:texasems-l ] On Behalf Of maxifire@... Sent: Monday, February 19, 2007 10:21 PM To: texasems-l Subject: Re: RE: Heart sounds Dr Bledsoe, I hope you will consider giving this lecture at the Texas EMS Conference in Houston this year, it sounds interesting. Maxie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2007 Report Share Posted February 19, 2007 >>Texas is still 20 conferences away for me (not counting presentations in Australia, France, Germany, and Mexico).<< I really, really want to be Bledsoe when I grow up. -- Grayson, CCEMT-P, etc. MEDIC Training Solutions http://www.medictrainingsolutions.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2007 Report Share Posted February 19, 2007 All that glitters is not gold. Long flights, hotels, bad food, bad weather, rental cars.not all it appears to be. From: texasems-l [mailto:texasems-l ] On Behalf Of Grayson Sent: Monday, February 19, 2007 10:33 PM To: texasems-l Subject: Re: RE: Heart sounds >>Texas is still 20 conferences away for me (not counting presentations in Australia, France, Germany, and Mexico).<< I really, really want to be Bledsoe when I grow up. -- Grayson, CCEMT-P, etc. MEDIC Training Solutions http://www.medictrainingsolutions.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2007 Report Share Posted February 19, 2007 Bledsoe writes: >>All that glitters is not gold. Long flights, hotels, bad food, bad weather, >>rental cars.not all it appears to be. Not to mention secret service men on your hotel floor...with guns.<G> jules From: texasems-l [mailto:texasems-l ] On Behalf Of Grayson Sent: Monday, February 19, 2007 10:33 PM To: texasems-l Subject: Re: RE: Heart sounds >>Texas is still 20 conferences away for me (not counting presentations in Australia, France, Germany, and Mexico).<< I really, really want to be Bledsoe when I grow up. -- Grayson, CCEMT-P, etc. MEDIC Training Solutions http://www.medictrainingsolutions.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 20, 2007 Report Share Posted February 20, 2007 Me thinks you may have outgrown even that... Donn ;b Re: RE: Heart sounds >>Texas is still 20 conferences away for me (not counting presentations in Australia, France, Germany, and Mexico).<< I really, really want to be Bledsoe when I grow up. -- Grayson, CCEMT-P, etc. MEDIC Training Solutions http://www.medictrainingsolutions.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 20, 2007 Report Share Posted February 20, 2007 Sounds like you may have bad plug wires. Henry Heart sounds We have recently discussed the education and training of paramedics on these and other lists. I ran across the following mnemonic for heart sounds near S2 that may confuse the Auscultator: P-L-O-P-P-S Paradoxical splitting--The most common cause of paradoxical splitting is left bundle branch block. A delayed A2 (the sound of the aortic valve closing, g.g.) also occurs in flow or volume overload of the left ventricle (e.g., aortic stenosis or insufficiency), though these disorders after present with a single S2. Late systolic clicks--are produced by the pulmonic valve in isolated pulmonary stenosis and idiopathic dilatation of the pulmonary artery. An aortic ejection click is heard in congenital aortic stenosis, truncus arteriosus and, occasionally, coarctation of the aorta and aortic aneurysm. In contrast to these, mitral valve prolapse presents with a mid-systolic click and/or a late systolic murmur. Opening snap-- a loud opening snap associated with mitral stenosis usually means mitral commissurotomy will be possible. A soft opening snap means valve replacement may be necessary and an opening snap louder than a normal S2 should alert one to the possibility of a..... Pericardial knock--the interval between the S2 and a pericardial knock does not change, whereas the S2-opening snap interval widens when the patient assumes the upright posture. Pericardial knock has an S3-like quality but comes earlier than the usual S3. Pulmonary hypertension--delays P2 (the sound of the pulmonary valve closing, g.g.) and increases its intensity. An standing, the A2-P2 interval stays the same or becomes narrow. An A2 opening snap interval becomes wider on standing because of a decrease in venous return and a subsequent drop in left atrial pressure. S3--occurs 0.12 to 0.16 seconds after S2 and is low pitched. A pathologic S3 is usually accompanied by symptoms of congestive heart failure, but may be present without symptoms in patients with a history of myocardial infarction and resultant ventricular aneurysm. Now, I wonder just how many of the members of these groups can follow the foregoing explanations without going to Google more than once or twice. Of course, many will say, " Paramedics don't need to know that. " I leave it up to each of you as to whether or not paramedics need to know it. How many of you believe that paramedic education should teach the evaluation of heart sounds? How many of you were exposed to evaluation of heart sounds during your paramedic education? Your thoughts? Gene Gandy P.S. I had to go to Google twice, and I modified the post with my findings, which you will see in parenthesis followed by my initials, g.g. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 20, 2007 Report Share Posted February 20, 2007 We definitely need better training in regards to heart sound AND lung sounds. I'll be honest, I could stand a little heart sounds refresher myself. When are you teaching the new class close to home, ? Barry E. McClung, FF/EMT-P _____ From: texasems-l [mailto:texasems-l ] On Behalf Of wegandy1938@... Sent: Monday, 19 February, 2007 20:54 To: texasems-l ; Paramedicine Subject: Heart sounds We have recently discussed the education and training of paramedics on these and other lists. I ran across the following mnemonic for heart sounds near S2 that may confuse the Auscultator: P-L-O-P-P-S Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 20, 2007 Report Share Posted February 20, 2007 We teach heart tones. We have CDs to teach major sounds. However, the best way is to have one student hold a stethoscope bell in their hand and the other simulate sounds by moving a card along the forearm by cadence and inflection of the heart tone and listen. Works well in split sounds as well as murmurs. -MH >>> 2/19/2007 8:54 pm >>> We have recently discussed the education and training of paramedics on these and other lists. I ran across the following mnemonic for heart sounds near S2 that may confuse the Auscultator: P-L-O-P-P-S Paradoxical splitting--The most common cause of paradoxical splitting is left bundle branch block. A delayed A2 (the sound of the aortic valve closing, g.g.) also occurs in flow or volume overload of the left ventricle (e.g., aortic stenosis or insufficiency), though these disorders after present with a single S2. Late systolic clicks--are produced by the pulmonic valve in isolated pulmonary stenosis and idiopathic dilatation of the pulmonary artery. An aortic ejection click is heard in congenital aortic stenosis, truncus arteriosus and, occasionally, coarctation of the aorta and aortic aneurysm. In contrast to these, mitral valve prolapse presents with a mid-systolic click and/or a late systolic murmur. Opening snap-- a loud opening snap associated with mitral stenosis usually means mitral commissurotomy will be possible. A soft opening snap means valve replacement may be necessary and an opening snap louder than a normal S2 should alert one to the possibility of a..... Pericardial knock--the interval between the S2 and a pericardial knock does not change, whereas the S2-opening snap interval widens when the patient assumes the upright posture. Pericardial knock has an S3-like quality but comes earlier than the usual S3. Pulmonary hypertension--delays P2 (the sound of the pulmonary valve closing, g.g.) and increases its intensity. An standing, the A2-P2 interval stays the same or becomes narrow. An A2 opening snap interval becomes wider on standing because of a decrease in venous return and a subsequent drop in left atrial pressure. S3--occurs 0.12 to 0.16 seconds after S2 and is low pitched. A pathologic S3 is usually accompanied by symptoms of congestive heart failure, but may be present without symptoms in patients with a history of myocardial infarction and resultant ventricular aneurysm. Now, I wonder just how many of the members of these groups can follow the foregoing explanations without going to Google more than once or twice. Of course, many will say, " Paramedics don't need to know that. " I leave it up to each of you as to whether or not paramedics need to know it. How many of you believe that paramedic education should teach the evaluation of heart sounds? How many of you were exposed to evaluation of heart sounds during your paramedic education? Your thoughts? Gene Gandy P.S. I had to go to Google twice, and I modified the post with my findings, which you will see in parenthesis followed by my initials, g.g. Quote Link to comment Share on other sites More sharing options...
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