Cardiac Auscultation for Paramedics 101 

Welcome!

This standalone course facilitates acquisition of heart auscultation skills. As you progress through the course you will gain knowledge of the underlying theories of the skill, as well as an understanding of its application in the field. Performance of the skills will be demonstrated in video presentations, examples of various heart sounds will be presented in audio recordings, and guidance is provided to enable you to gain the necessary practical skills to become competent in cardiac auscultation in the field. 

"The way to the heart is through the ears." ~ Katie Hurley

How to use this course.

•  This course is designed for an audience at the level of qualified Paramedics, or third year Student Paramedics. Presumed knowledge is paramedic science studies to Diploma or Degree level, including 12-lead ECG acquisition and, preferably, interpretation.  
• Learning outcomes for this course are found upon this page below this section. These outcomes identify what is to be learnt, and what you should be able to do following completion of this course and the required practice - they are your learning goals for the course.
• The 'next' links at the bottom of each page of this wiki course lead you through the material in order, and allow you to return to an earlier page to reference that material. A full contents list may be found within the sidebar to the right of this text for navigation to specific pages.
• This online wiki course contains multimedia to demonstrate heart sounds and to facilitate learning of the practical skills. If you are on a slower connection these objects may require longer buffering periods; if streaming media halts due to a slow connection, do not refresh the page but simply allow time for the material to load completely.
• As you work through the course, take time to practice the technique yourself. As with any skill, the more it is practiced, the better you will get - taking the opportunity to auscultate heart sounds on your patients will expose you to both normal and pathological noises in patients of all ages. Practicing upon family and friends will also help - just remember to ask first!
• Assessment tasks for the course are found at the bottom of this page, and explain what is required to successfully complete this course. This involves assessment of your skills and knowledge, as well as a sign-off sheet for practice of cardiac auscultation in the field.
• There is no set time limit for completion of this course. It has been designed for you to undertake in your own time, and you may leave and return to any point in the course for revision or later completion. In fact it is best if you take time from the course during certain stages to practice the auscultatory technique, or listen to patients and volunteers to become familiar with each particular heart sound as you learn about it. This is a hands-on, practical skill, and as such requires actual practice to attain and integrate into your clinical work.

(Wellcome Library, 2012).

Learning outcomes.

When you've completed this course, you should be able to:

1. Identify normal and pathological heart sounds and their places within the cardiac cycle.
2. Explain the common causes of important pathological heart sounds. 
3. Identify the areas of cardiac auscultation and the anatomical landmarks of these.
4. Demonstrate the technique of cardiac auscultation on a variety of patients.
5. Describe the quality of heart sounds and murmurs for patient handover and case documentation.
6.  Discuss the place of cardiac auscultation within overall case management. 
7. Implement cardiac auscultation in your Paramedic practice on-road, and assist your colleagues in their acquisition of the skill.

Assessment.

Assessment has three main parts: 

1. You will undertake self-assessment as you progress through the course by listening to the audio files provided, viewing the videos, and practicing auscultation technique upon patients and volunteers. 
2. Peer or clinical supervisor assessment of your knowledge and technique will occur at the end of the course. This involves successful completion of the final quiz, and demonstration of cardiac auscultation on a volunteer or patient. This section requires sign-off by a peer or clinical supervisor who has already completed the course, or alternately by a doctor.
3. Consolidation of the knowledge and skills you have attained during this course requires consistent practice of the technique upon real patients in the field. The final part of this training programme includes a sign-off sheet for cases you have attended in which you have performed cardiac auscultation upon the patient. The form requires brief details of the patient and presenting condition, the heart sounds observed in the field, your interpretation of these, and your provisional diagnosis of the patient. Upon handover at hospital the receiving doctor is required to perform cardiac auscultation upon the patient and to comment upon your findings. 

Help!

Should you have any questions or require assistance with any aspect of the course, whether regarding the learning material and content, or with the wiki environment or other technical issues, I am contactable by the following means:

Email: My addresses are lisa.hurring@cqumail.edu.au or lisa.hurring@live.vu.edu.au; I aim to respond to all queries within 24 hours.

Skype: Video or voice calls via Skype require installation of the software upon your computer, but both the program and the service itself are free. My Skype status is displayed below; if this does show me as unavailable or offline please send an email on either of the above addresses to advise of your problem, and note if you'd rather I return contact by phone, email, or at an arranged time for Skype call.

Ready?

Click the link below to begin the course. I hope you enjoy learning this new skill, and that it can make a valuable addition to your theoretical knowledge and understanding of the heart, and to your clinical practice as a Paramedic.

~ Lisa Hurring.

Next: Why auscultate?

References

Wellcome Library, London. (n.d.) Doctors or medical students listening to their heartbeats using a multiple stethoscope [Image]. Retrieved from http://images.wellcome.ac.uk/