My boyfriend’s in the home-stretch of studying for Step 2. So after dinner – just to keep the romance alive – I usually grab a couple beers and make him quiz me. Bonding!
Boyfriend: Okay. Tell me the first thing you should do for this patient: Young male with blunt force trauma to the chest and abdomen. Hypotensive, pale, diaphoretic, JVD. On cardiac auscultation you hear distant heart sounds and h-
Me: PERICARDIOCENTESIS. Bam.
Boyfriend: Whoa, nice! Exactly! Though if I had that patient, I’d probably have to get an echo first.
Me: … Oh, wait – erm. This is real life? …Not a multiple choice question? … Cause I… would probably run for help.
Seriously, since you hear all heart sounds through layers of bone, muscle, and fat, how does anyone recognize a “distant” one? Without insulting/accidentally-mortally-wounding a patient with a few extra layers of adipose tissue?
(“You have distant heart sounds. Here, let me stick a large bore needle in your chest!” = most deathly literal interpretation of “adding insult to injury” ever.)
So while I can confidently answer the call-and-response of“Distant heart sounds” = “cardiac tamponade” on tests – I wouldn’t recognize a distant heart sound if it bit me.
(… What is “distant”? …What is a “heart”? And why is it biting me?)
Action Potential 
Love it!
Hopefully there’s a FAST U/S probe in the ER which will reveal the pericardial clot and, in the distance, a beating heart!
I feel like 1/2 the patients I have have “distant” heart sounds. Maybe it’s that they’re obese. Or that I’m deaf.
haha, great timing. Can I just say, your link to “onsurg” is going to ruin my studying. Last night I spent 2 hours (when I was supposed to be sleeping) going through videos and learning stuff I won’t need to know for years. Even watched a very informative vid about cardiac tamponade!
Chest trauma is so fascinating. Except, ya know, to the patient.
And they say the romantic age-style courtship rituals are dead.
That’s why I like psychiatry – all heart sounds are distant…because I don’t listen to them.
Okay – in actuality it ticks me off! I took a lot of time to REALLY learn the heart, and I bought the Littmann Cardiology 3 stethoscope to be able to REALLY hear heart sounds..and now I never get to use it. Why do we spend 4 years learning EVERYTHING, only to dump 90% of it after we pass Step 3?
OMG So true! It’s partly really depressing. All that wasted effort. And partly a relief that we don’t *actually* need to have all that information at out fingertips. A mentor once told me that choosing a specialty was all about figuring out which parts of medicine you wanted to forget.
That’s an amazing mentor quote. Awesome.
Get a head CT. STAT!