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Friday, March 30, 2012

Why do we listen to lungsounds?

If you thought this was going to be a thought provoking post about why we listen to lungsounds you better stop reading now.  The theme of this post is more of a why-do-we-bother theme.

How many times have you seen a doctor exam a patient without even touching his stethoscope, then walk out of the room and order breathing treatments?  If I had a dollar for every time that's happened I'd be rich. 

A nurse paged me to examine a patient on the medical/surgical floor, and I heard crackles in the patient's lung bases.  I provided my expert advice to the nurse that the patient sounded wet and probably needed a diuretic rather than a bronchodilator.

Since I was concerned about the patient I stayed at the patient's side.  Even thought the patient was dyspneic we had a nice discussion.  In a way, it was my job to allay the patient's fears by getting her to think about other things.  I sat by the patient's bedside for thirty minutes before the nurse came back in with an order for a breathing treatment of 0.5cc Albuterol.

To me this was a slap in the face. Here I'm called for my professional assessment skills and my recommendation is completely ignored.  And the doctor orders a bronchodilator without even using his stethoscope. 

So this brings me to my quesiton:  Why do we listen to lungsounds?  It doesn't matter what the person sounds like.  The person could be wheezing, have rhonchi, crackles, rubs, coarseness in the throat, stridor, clear, or ribbits and all generally result in a bronchodilator with assessment or sans assessment.

If all annoying lungsounds result in a bronchodilator, then why bother to listen to lungsounds at all?  If a doctor can decide a bronchodilator is indicated by a simple phone conversation with a nurse, then why are respiratory services recommended? 

I'm not saying you shouldn't listen to lungsounds, because you should.  Please share your similar stories.


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