A qualitative exploration of current paramedic cardiac auscultation practices

The aim of this exploratory study was to gain an understanding of the current knowledge base and clinical practice of UK paramedics in relation to the clinical skill of cardiac auscultation (CA). The primary areas of interest were to explore the current frequency of CA undertaken by UK paramedics, and paramedic exposure to abnormal heart sounds in clinical practice.

Free-text responses were invited to allow respondents to voice other concerns and opinions regarding the skill of CA. This study provides original knowledge in the area of pre-hospital patient assessment and highlights the variability in current practice. It also provides an insight into the perceived barriers and restraints involved in pre-hospital CA and advanced patient assessment more widely.

CA is a skill using both the bell and diaphragm of a stethoscope on the praecordium to identify both normal and abnormal sounds emanating from the heart. This is part of a complete examination of the cardiac system and is often performed after examining the patient for other signs of cardiac disease, and inspecting and palpating the praecordium. Most commonly, auscultation is performed over the four valve locations (Table 1). The patient may be asked to move position, commonly to lean forward or roll onto their left side, or to hold their breath. Findings may include the normal heart sounds of S1 and S2, splitting of these sounds, a third heart sound (S3), a fourth heart sound (S4), murmurs caused by turbulent blood flow, or extra sounds such as clicks, plops and rubs. A cardiac examination is then completed with examination of the lung bases, abdomen and legs for peripheral oedema and vascular disease.