S1-S4

Cardiac auscultation is an art that cardiologists only rarely have to care about, having an echo ready at every corner. For us lowliers, it remains perplexing and difficult to learn. But you should try, as it is quite rewarding and also relevant for patient care (think of endocarditis, pulmonary embolism and so forth).

  • We talk about the basic use of the stethoscope, how much it should cost and where you can put it (both on you and on the patient).
  • Also where and how S1 and S2 sound like.
  • Finally, S3 as a sign of distress – it’s differential.
  • S4 as a more prevalent and probably less important sign.

Physical examination of the chest

Since stroke care overlaps a lot with internal medicine we ran through the basics of the physical examination of the chest today, using a case of a patient with deteriorating oxygen saturation and the differential of pleural effusion vs. aspiration pneumonia.

The aim was not so much to repeat all the fascinating details of the chest exam, but to stress the importance of

  • doing regular exams on your stroke patients daily (at least if they are sick or bedridden)
  • of inspection and palpation to judge unilateral chest disease as compared to auscultation (which often yields results that require percussion, fremitus, egophony or bronchophony to intrepret)

With regard to chest x ray: They are important, but much less than the PE. In particular in bedridden patients with dyspnea.

So here is the final question: How do you distinguish the two entities (effusion vs. infiltrate) if it is lobar or bronchopneumonia.