00:01
Now let's talk here for a second
about the heart and what
you're going to hear.
00:05
Now, anytime you
listen to the heart,
take your stethoscope
get your ears
placed into your heart,
you always hear that lub
dub, lub dub.
00:14
So a lub dub is
one, lub dub is two,
that's how you're going to count you're
listening to your heart or auscultate.
00:21
So this is what we call
your S1 and S2 heart sounds.
00:25
Now this is going to correlate with the
blood pumping out of the ventricles,
and then you're going to
hear the closing of valves.
00:32
So the first sound that you
hear, that lub,
this is what we call our S1.
00:37
Now, at the bottom of
this image of the heart,
the ventricles are
really important here.
00:42
Here's where they can tract
and they're going to pump
blood out of the body.
00:46
And we're going to hear
that little bit of closing
of that tricuspid and
that mitral valve.
00:51
Now that's where we're going to hear
the S1 from the closing of these valves.
00:55
So there's our lub.
00:57
Now for moving on to our
S2, which is our dub.
01:00
This is after we've
received that blood,
and then we start hearing
the diastole phase.
01:06
So this is where we hear the aortic
and that pulmonic valve close,
causing a little bit of that
vibration causing the S2.
01:14
So don't forget,
you hear a lub dub
S1, S2, and that is 1B.
01:20
Now just know the increase
in intensity of the sound
can main mean that there's
certain conditions.
01:25
And again,
there's various of sound
such as clicks or something
else that you may hear whooshes.
01:32
Just note these and make sure
you talk to your patient
and also make sure that you check
with your health care provider.
01:42
Now let's take a
little bit deeper look
of how we perform a
cardiovascular assessment
and some key considerations.
01:49
Now we're going to use our
diaphragm of our stethoscope here
and we're going to
auscultate or listen.
01:55
For 30 beats three
really big things.
01:58
So we need to number one
see, is the rhythm regular?
So if you recall,
we're going to listen to that lub dub, S1,
and it should be very
regular and on time.
02:08
So it may sound like lub dub,
lub dub, lub dub, lub dub,
and as you can hear very
regular and on time.
02:17
Now sometimes you may
hear some irregularity.
02:20
Now this could be mean that the
patient has a irregular rhythm
such as atrial fibrillation,
and that's important to know.
02:27
So it may sound like lub
dub, lub dub,
lub dub,
lub dub,
lub dub lub dub,
so you can see
that's not regular
and that's important to know and
communicate with the healthcare provider.
02:40
And of course, don't forget about
the heart rate of your patient.
02:43
As you recall,
60 to 100 is what we consider normal,
but
your patient's resting heart rate
may be a little bit different.
02:50
So it's important for you to
assess it and note that first.
02:54
You may listen to the heart
rate, and it may be really fast,
like tachycardia,
or really slow.
03:00
So this is important to
know based on medications
and other treatments that
the patient may have.
03:06
And of course,
if you hear any whooshes or clicks,
you want to note these as well.
03:11
You might hear something like
an artificial heart valve
when you're listening
to your patient.
03:16
An important note as well,
if you're given some
certain cardiac medications
like digoxin, for example.
03:22
It's really important that you
listen to the heart or auscultate
for one full minute
and get a true apical pulse.
03:30
Now this is important for
that particular med because
with digoxin,
if the patient's heart rate is less
than 60, we will hold that med.
03:39
So here to get the truest
and most accurate assessment,
we listen for an apical pulse.
03:46
So when we're talking about auscultation
with a cardiovascular assessment,
if you take a look
at these images,
and you see all these little
red circles or hotspots,
these are all different areas
of the thorax or the chest
that you can listen to,
to auscultate the heart.
04:02
However, the erbs point that
you see pointed out here
is the auscultation
location for heart sounds
and heart murmurs and
this is really preferred.
04:13
Now as you can see,
this is located between about
the third intercostal space
in the left lower
sternal border.
04:20
And now here at this erbs point,
you should be listening
for the S1 and S2 here.
04:26
Now again,
nice thing if you think about
you put your stethoscope
to the patient's chest
at any of these points,
even maybe down to the apex,
that horde is going to radiate
and that sound can radiate.
04:39
So you want to make sure
you listen to the spot
that you can pick up and
listen to that lub dub.
04:44
But again,
for heart sounds
or heart murmurs,
that erbs point is
definitely preferred.