Flipped Classroom - stethoscopes Flashcards
1.) What are the uses of precordial and esophageal stethoscopes (Select all that apply)
a. To confirm placement of endotracheal intubation
b. To identify ventilator circuit disconnections
c. To gain visuals of the pharynx
d. To auscultate heart and lung sounds
Answer: A, B, D
Rationale: The three main uses of precordial and esophageal stethoscopes are confirming placement of endotracheal intubation, identifying ventilator circuit disconnections, and auscultating heart and lung sounds. While the esophageal stethoscope can be used as a carrier for various devices, a camera for pharynx visualization is not one of them.
2.) In what scenario is the esophageal stethoscope superior to a regular binaural external stethoscope
a. Anesthesia provider would like to know the quality of breath sounds in an intubated patient with COPD, but auscultation proves difficult through external stethoscope due to elevated BMI
b. Anesthesia provider is unsure if the endotracheal tube entered the right mainstem bronchus
c. The anesthesia provider wants a clearer auscultation of a heart murmur on a non-intubated patient.
d. Provider needs to assess for return of bowel sounds after surgery
Answer: A
Rationale: An esophageal stethoscope can provide clearer auscultation of breath sound quality, especially for patients with elevated BMI. These devices are centrally located and, therefore, cannot determine bilateral breath sounds. They can only be used on intubated patients and are unable to assess bowel sounds from their position.
3.) Which patient is a candidate for placement of an esophageal stethoscope
a. 45-year-old male with esophageal varices
b. 78-year-old female receiving general anesthesia for an ex-lap
c. 63-year-old female with a history of esophageal stricture
d. 15-year-old male receiving conscious sedation for a re-alignment of a dislocated shoulder
Answer: B
Rationale: The 78-year-old female can receive an esophageal stethoscope as she has no stated contraindications and will be intubated for surgery. The 15-year-old male will not be intubated. Placement of an esophageal probe in those with a history of strictures or esophageal varices may result in perforation and/or bleeding.
4.) What are the steps included in placing a precordial stethoscope (Select all that apply)
a. Place metallic bell onto the patient’s chest at the sternal notch
b. Ensure the adhesive side is facing away from the patient so that it does not adhere to skin
c. Place earpiece in ear
d. Cleanse device between uses
Answer: A, C, D
Rationale: The adhesive side of the metallic bell on a precordial stethoscope must be applied to the patient’s skin to prevent the device from moving
5.) What are the steps included in placing an esophageal stethoscope?
a. Wash hands and apply gloves
b. Apply lubricant to the balloon tip of the esophageal stethoscope catheter
c. slide catheter through the pharynx and into the esophagus
d. Clean thoroughly before applying to next patient
Answer: A, B, C
Rationale: Esophageal stethoscopes are disposable and are only used on one patient per stethoscope to prevent hospital-acquired infections.
6.) With what devices can the esophageal stethoscope pair?
a. Electrodes
b. temperature probes
c. Atrial pacemaker electrodes
d. Endoscopes
Answer: A, B, C
Rationale: The esophageal stethoscope can pair with various devices such as electrodes, temperature probes, atrial pacemaker electrodes, and ultrasound probes
What is a precordial stethoscope?
A device used for auscultating heart and breath sounds, consisting of a metallic bell-shaped head positioned on the suprasternal notch or elsewhere on the patient’s chest.
How is the precordial stethoscope secured to the patient?
It uses double sided adhesive to keep the weighted piece of metal secured.
What connects the metal piece of the precordial stethoscope to the earpiece?
A rubber tube extends from the metal piece, sending sound to a single earpiece.
What is an esophageal stethoscope?
A long, plastic 18-24F catheter with a balloon covering its distal tip, placed in the esophagus after intubation for high quality heart and breath sounds.
What additional monitoring devices can be used with esophageal stethoscopes?
Temperature probes, electrocardiogram leads, atrial pacemaker electrodes, and ultrasound probes can be placed in conjunction.
How is a precordial stethoscope placed?
The precordial stethoscope is placed by applying the adhesive side of the metallic bell onto the patient’s chest and the earpiece into the ear of the provider.
Child-sized chest piece works on the majority of patients (Butterworth, et al., 2022).
What is the procedure to insert an esophageal stethoscope?
First, dip the ballooned tip in lubricant. Next, insert the catheter, balloon first, into the mouth or nose and through the pharynx into the esophagus. Provider should listen through earpieces as catheter is inserted to obtain optimal positioning retrocardially.
Who can use esophageal stethoscopes?
Esophageal stethoscopes can only be used on ventilator patients.
What should be used to confirm bilateral chest sounds?
A binaural stethoscope should be used to confirm bilateral chest sounds in the event of mainstem bronchus intubation.
Auscultation of grunting or audible inspiration or expiration may indicate partial airway obstruction
What are the benefits of esophageal stethoscopes?
- The esophageal stethoscope provides higher quality detection of turbulent breath sounds that are not identifiable with electric monitoring (wheezing, stridor, etc.).
- It can confirm regularity and quality of heart sounds and identify murmurs and muffling.
(Butterworth, et al., 2022; Nagelhout, et al., 2023).
What should be avoided when using an esophageal stethoscope?
The esophageal stethoscope should be avoided in patients with esophageal strictures or varices as insertion can cause trauma and bleeding.
(Butterworth, et al., 2022)
What can happen if the esophageal stethoscope is misplaced?
Misplacement of the esophageal stethoscope into the trachea rather than the esophagus can create a cuff leak.
(Butterworth, et al., 2022)
What is a potential issue caused by esophageal stethoscopes?
Esophageal stethoscopes can compress the posterior tongue, decreasing lymphatic drainage.
(Nagelhout, et al., 2023)
What are the benefits of using esophageal stethoscopes?
They provide high quality heart and lung auscultation, detecting heart tone quality and turbulent respirations that electronic monitoring cannot detect.
(Nagelhout, et al., 2023)
What devices can the esophageal probe pair with?
The esophageal probe can pair with various devices such as electrodes, temperature probes, atrial pacemaker electrodes, and ultrasound probes.
(Butterworth, et al., 2022)
What is a risk of using esophageal stethoscopes?
They can cause trauma to the airway or decreased lymphatic drainage.
(Butterworth, et al., 2022)
What methods are definitive for endotracheal intubation placement confirmation?
CO2 waveforms and bilateral chest auscultation remain the definitive methods for endotracheal intubation placement confirmation.
(Butterworth, et al., 2022)
Are esophageal stethoscopes necessary alongside modern monitoring?
While electronic monitors can accurately identify respiratory rates and apnea, manual auscultation devices can help students learn to closely monitor the respiratory system.
(Nagelhout, et al., 2023)
Why are precordial and esophageal stethoscopes still used?
They are still depended on as reliable tools in the event of technology failure.
(Butterworth, et al., 2022)
