Advice: Don’t stop breathing!
Bread and butter work for a Nurse Practitioner, and lots of other health care professionals, chest examination….and yes I know there is lots of different aspects to it. But at the most basic, it is a case of grabbing a stethoscope and getting the patient to breathe.
How easy must it be?
Well actually it is sometimes incredibly difficult. A strange phenomenon occurs the second your stethoscope touches someones flesh. It is invariably not too problematic in babies, but for the rest of the population it is a major factor that makes me grin/grimace.
What is this phenomenon??? – The patient forgets how to breathe.
This breaks down into several categories:
1: “The Hyperventilater”
Sub divided into 2 section:
1a: “The quickly assessed”…Everytime I move my stethescope the patient responds by rapidly taking another breath in. So I have to move quickly on to the next spot I’m listening to. Consequently the patient feels dizzy, but I’ve finished listening to the whole chest in about 5.343 seconds!
1b: “The classic hyperventilater”: The moment the stethoscope makes skin contact, this patient starts panting like a porn star or Meg Ryan over dinner!
I often feel as if my stethoscopes innocents has been stolen, perhaps I should put a condom over it!!
2: “The Throaty rhino”: although perfectly capable of normal breathing during the initial chat with you, this patient will suddenly develop a striddor when the stethoscope makes contact. This can also vary between inspiratory or expiratory or alternate between them.
3: “The mock respiratory arrest”: a well perfused patient, often but not exclusively a child, who actually stops breathing the very moment you start to listen for lung sounds. Category 3 can normally be resolved with a quick chat, (Something along the lines of: “It doesn’t matter what anybody says to you, never stop breathing – it isn’t good for your health”)
Category 3 can sometimes be an early sign of the 4th category…
4: “The need exact instruction”: In this case you end up trying to listen to the chest at the same time as ignoring your own voice saying: “Breathe in…..and out…..and in again……and out”
(I have to confess that with patients in this latter category I have on occasion taken advantage of these patients by saying: “and now put one hand on your hip, and the other in the air, and now say “I’m a little teapot, short and stout!”)
5: “The sputumiser”: This is typically seen in elderly heavy smokers, and has nothing to do with stethoscope contact. This group of patients sit nicely chatting to you, with no evidence of respiratory problems, then as soon as you say; “Well lets take a listen to your chest”, they start viciously hacking up the tiniest amount of sputum, in an attempt to prove something (God alone knows what!) and “no I really don’t need to look!”
OK then…I’m off to sit in a darkened room and take some deep slow breathes (in and out).