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?)