episode_0096

Episode 96. How do you do a stethoscope? (2)

****

Let’s structure the problem.

What is the problem that needs to be solved?

Except for Istina and myself, there is no one in this world who knows how to do a proper auscultation. In fact, there isn’t much you can find out by putting your ear to the chest or back.

When you listen to it, your heart is beating. You can’t just say “I’m amazed.” It’s important to consider how to auscultate it. Listening isn’t everything.

It’s only meaningful if you use a stethoscope and have certain rules, order, and background knowledge.

“Istina. So, do you understand what it is?”

“Yes.”

I took a pen and paper and thought about it for a while.

“I have to make a booklet… … . It’s annoying.”

“I don’t think it’ll take long though!”

It takes a long time, and that’s a problem. Right now, I don’t have many stethoscopes that I need for practice. In fact, if everything went as planned, I wanted to give one to each student taking the class and have them practice with it.

It doesn’t look right.

Right now, I only have two stethoscopes in my possession. The one I made for the palace, and the one I gave to Istina.

“Do you still have your stethoscope?”

“Yes.”

Istina nodded.

“How long will it take to make more?”

“But how many weeks would that be? If you need dozens, if not hundreds.”

I was originally going to ask Istina to do it, but Istina must have gained some internal energy, because she was able to jump over a wall like a snake. It would be difficult to ask her to do it.

If you want to distribute several of them to people working at the hospital, it will take that much time.

First, I’ll hold the next class as scheduled, and as soon as I make the stethoscopes, I’ll distribute them to the people around me. That way, I can have proper conversations and collaborations with other people.

Did you have your auscultation? Did you take your blood pressure?

In my previous life, there was no need to ask about these things. Now, I am in a situation where I have to teach them to my disciples one by one and create new ones.

“Are you ready for class?”

“Yes. I prepared hard.”

Still, we have developed a method to measure blood pressure and are developing methods to make important drugs such as antibiotics.

This time, I’ll teach you how to do auscultation and distribute stethoscopes. We should make it together this time too. There’s someone who can help.

****

The classroom was peaceful today. There were some other professors and graduate students who came to spy on the class, but not many professors came to class.

Anne, a graduate student, was sitting in the front seat.

As soon as I stood at the podium, I began to speak.

“So. Today, I’m going to explain in detail how to do this auscultation. The art of listening to the sounds inside the body.”

I looked around the classroom.

“What are the representative organs that produce audible sounds inside the body?”

This time, a student I hadn’t seen in a long time raised his hand. I looked at him. He seemed to be the student who had recently moved to the front seat.

“What’s your name?”

“This is Lewis.”

“Okay. What do you have?”

“I think the heart is the most important.”

That’s right.

“That’s right. The heart sound is the loudest. The heart beats every second, so it’s easy to hear.”

I roughly drew a human torso on the board and marked it with five dots.

“So, does anyone know how many important structures are inside the heart?”

There are many important structures in the heart. The heart is divided into four chambers, so there are four valves inside the heart. Louis looked around and raised his hand.

“Four. The inside of the heart is divided into four sections.”

“That’s right too.”

I turned my head towards Istina.

“Then. How many points should I auscultate to auscultate the heart?”

“Five Summary.”

“Right, even one of the hearts.”

It is said that aortic regurgitation is heard well at the Erb point. I don’t know the exact reason. Is there a reason why aortic regurgitation and aortic stenosis are heard at different points?

anyway.

So next question.

“Istina. Why do heart sounds occur?”

“My heart is pounding.”

“Moving your arms doesn’t make any special sounds. Do you know where the heartbeat sound comes from?”

No one gave a clear answer.

“Valve sound. The sound made when the heart valves close is the heart sound.”

Although some people know that heart sounds are caused by heartbeats, not many people know that they are the sound of valves closing.

I took out a preserved heart. It had already been cut open on all sides. I held up the heart valves so that the students could see them.

“If you listen closely to the heart sounds, it goes like this: koo-kung, koo-kung, koo-kung. The first sound is the sound of the mitral and tricuspid valves closing at the same time, and the second sound is the sound of the aortic and pulmonary valves closing.”

I should draw a heart too. I roughly drew a heart shape on the board, then drew two straight lines to divide the heart into four directions.

“Then. The first thump is the sound of the mitral and tricuspid valves closing as the ventricles contract and blood flows out to the whole body.”

I drew two arrows going up to the heart on the board. These are the blood flowing out to the aorta and pulmonary artery.

This is the moment when the first heartbeat is heard.

“The second thump is the sound of the atrium contracting, filling the ventricle with blood, and the aortic and pulmonary valves closing. Do you understand?”

As expected, only a fierce gaze returned.

“So, when the heart beats in a living person, the first thump is the sound of blood flowing out of the ventricle to the whole body, and the second thump is the sound of blood flowing into the ventricle.”

When in doubt, choose Istina.

“Istina. Do you know what I mean?”

“Oh, yes.”

It wasn’t a very believable reaction, but Istina was smart anyway. Istina even had her own stethoscope.

“Then, the conclusion. Just by listening to the patient’s heart sounds, you can figure out which part of the heart and which function is problematic.”

This time I looked at Oliver.

“Mr. Oliver, do you understand?”

“Yes.”

“So.”

“Yes.”

“If a murmur is heard immediately after the first heart sound, it means that the mitral or tricuspid valve is regurgitating when it should be closing. Can you tell whether the mitral or tricuspid valve is the problem based on the location of the auscultation?”

Oliver frowned here, not seeming to understand what was being said so far.

“I’ll be handing out booklets, so don’t worry too much if you don’t understand right away.”

The lecture room was a bit noisy. Fortunately, the background knowledge required for auscultation of the heart is rather complex. Breath sounds are much easier to hear and understand.

Only Istina’s eyes were sparkling.

****

I erased the messy heart drawn on the board and this time drew a picture of lungs.

“Anyway. Auscultation of the heart is a much more complex process, and auscultation of the lungs is much easier. Amy. Why is auscultation of the lungs easier?”

“The lungs are larger than the heart.”

“And?”

“There are two.”

That’s right. I picked up the chalk again and drew a few lines on the picture of the lungs I had drawn earlier.

“Mr. Lewis, when listening to breath sounds, what is the first thing you should consider?”

“Uh, breathing… … . speed?”

“It is right to look at the speed first. It is normal to rest once every 3 to 6 seconds, and if it goes out of this range, you should consider it a problem.”

There’s one more thing.

“And. As I said earlier, patients have two lungs, right? It is more advantageous to auscultate while comparing the breath sounds on both sides.”

That’s all for the introduction.

It’s time to explain in detail. How to auscultate the respiratory tract. If you’ve ever been to a hospital with a cold, you’ve probably experienced this.

“There are three major types of abnormal breath sounds: rales, wheezes, and stridor. These are the most important.”

I wrote three words on the board.

“In order. Crackles are short, rustling sounds. They are caused by fluid in the lungs, bronchitis, or pulmonary fibrosis.”

“Wheezing is a continuous high-pitched sound when exhaling, and is an abnormal sound caused by air passing through a narrow space. It is often caused by secretions such as runny nose or phlegm, or by inflammation.”

It is also a sound often heard in asthma.

As a side note, rales and wheezing often appear together. They are also sounds often heard in patients with colds. So, you can think of them as symptoms that are often seen in patients.

“Stridor is a high-pitched sound that occurs when you breathe in, and is usually caused by a large obstruction. It indicates an airway obstruction.”

There were many expressions of not knowing. I thought about it for a while and then resumed my explanation.

“Well, breath sounds are different from heart sounds. It’s much more intuitive, so if you hear a strange sound, you can understand that there’s a problem.”

That’s because it makes speaking difficult.

Just listen to the cough of a pneumonia patient and you will understand what this means.

You can immediately feel that this person is very sick and has a dangerous disease.

****

Anne, a graduate student who came to spy on Professor Asterix’s class, was scratching her head.

How can a human be like this? This year, the process by which blood flows from the heart was discovered. It is still a subject of debate in academic circles.

In the span of a few days, you invented an instrument to listen to the sound of the heart, and even developed a technological method to assess the state of blood flow? Does that make sense?

It’s clear that professor is not human.