![]() Start high and listen to lung sounds as you work your way down the patient’s back. If you are too low or below the posterior rib cage, you are more likely to hear bowel sounds than the whoosh of air moving in and out of the lungs. The lungs are underneath and protected by the ribs. You’ll hear best if you place the stethoscope diaphragm directly against the patient’s bare skin. Clothing, even light layers, can dampen the sounds you are attempting to hear. But don’t spend so much on a stethoscope that you’ll be financially and emotionally crushed if you leave it behind on scene or forget to take it out of the ambulance at shift change. The beginner stethoscope you bought at the start of EMT class might be great for the relative calm and quiet of the classroom, but you’ll probably be better served by a higher-quality stethoscope in the ambulance, on the street or in a patient’s bedroom. When buying a stethoscope, like anything, you’ll get what you pay for. In general, use hearing protection anytime you are operating light- or heavy machinery, including your lawnmower, leaf blower and chainsaw. While riding in the ambulance or fire apparatus, keep the windows up when running with the siren (and lights) and use employer-provided hearing protection. When you are not using your stethoscope, take good care of your hearing by keeping the volume down on music, videos and games, especially while using AirPods or headphones. I have also added additional tips from other EMS educators, so read all the way to the end of the article and submit your own tips to be added to the list. If you are having a hard time hearing through your stethoscope, here are a few things to try. Bystanders and partners talking, dogs barking, idling vehicle engines and more can make it difficult to hear the transmission of audio waves from the patient’s lungs, heart, bowels or arteries through the stethoscope tubing and into your ears. But hearing through a stethoscope in the chaotic prehospital environment is a constant challenge. In some situations, paramedics might auscultate a patient’s heart sounds or a long bone to assess for a fracture. ![]() ![]() At a minimum, EMTs and paramedics are expected to auscultate a patient’s blood pressure and listen to lung sounds as part of a respiratory illness physical exam. Auscultation, which is to listen, with a stethoscope is part of every patient assessment.
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