Problematic

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?)

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8 thoughts on “Problematic

  1. 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.

  2. 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.

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