How do you imagine the auscultation?

How do you imagine auscultating your patient? Try to describe the place and how it is done ... Lying down, in sitting position, with the patient clothed, or naked, how you place the stethoscope, I'm interested in your ideas ....

Luca

She starts out wearing athletic wear, coming to see me for a sports physical. I check her weight, eyes, ears, etc, fully dressed, but after the blood pressure, I have her strip to her waist for auscultation, very thorough auscultation, that leads to ......hehe

I love to imagine my wife in a gown, tied in the back.. the Dr. undoes the ties to listen to her back, and then lowering the gown so as to listen to her chest.. she has rather full, heavy breasts which rise and fall so sweetly as he asks her to breathe deeply..

The patient is a slender and shy girl who comes for a routine check-up, dressed in jeans or shorts and a t-shirt. She has small or medium Breasts. First we'll talk to her,then I'll measure her height, weight, then I'll prepare my own several different stethoscopes and say: "Lift your t-shirt a little, I need to listen to you carefully"

He's shirtless sitting on an exam table. If he had a gown on, it's down in his lap now so I have full access to his chest. He's slender with just a little bit of muscle definition -- generally fit but no body builder. I start by palpating his chest, looking for thrills and heaves and not finding any, just feeling the contours of his bones and muscle under my hand. I let my stethoscope linger on each auscultation point as I listen in to his slow, steady heart. I have him lie back on the table and listen again; after taking in each auscultation point, I continue my exploration lower and listen to his abdomen. I finish off with a thorough abdominal palpation, almost a massage, that is relaxing and gratifying for both of us.

Male patient, slender but with defined chest muscles. Check the radial pulse for one minute, then tell him to remove his shirt. While sitting on the exam table I inspect his chest, then palpate for the apical impulse. I auscultate with the diaphragm at the mitral, tricuspid, pulmonic and aortic sites, then repeat, asking the patient to breath in deeply, hold, breath out and hold. Repeat at each site with the bell. Have the patient lay back (supine) and repeat the auscultation with diaphragm and bell. Inspect the jugular pulse. Then have the patient roll onto their left side, palpate the apical impulse and auscultate with the bell.

Then proceed with the rest of the examination, starting with auscultation of the abdomen.....

I imagine stething a female in just underwear first sitting then laying down. I start by listening to lungs from the back, moving from side to side to be sure they are clear.

After that I would have the patient lay flat, and steth the chest area thoroughly, moving the breasts if necessary. I'd ask them to take some deep breaths over their lower rib cage and to cough a little.

After that I'd move to the abdominal auscultation, asking the patient about bowel movements before thoroughly listening to them to the top of her panties.

The patient hopefully is feeling the anticipation of taking their panties down for the doctor soon by the time we are done stething and palpating the abdomen.

I would have my patient standing in front of me stripped down to her underwear. I start off by listening to her lungs, both on the back and the front all over. I then move onto listening to her heart and then onto peripheral pulses - neck, abdominal aorta just above her bellybutton, femoral pulses either side and popliteal pulses behind both knees. I'll then finally listen to all four quadrants of her belly and the gurgling sounds inside.

Female patient, petite athletic build, probably a bit shy and nervous. Ideally she'd be wearing jeans or jean shorts, and a t-shirt. Start with her seated, pull up her shirt to listen to her back, unhook her bra to ensure I can listen everywhere I need to… then instruct her to remove her top and lie down. Gentle but firm assurances that I'm the doctor and I know best, have her raise her arms over her head. A very thorough auscultation of the chest, checking lungs and heartbeat, lingering perhaps just a bit too long around those perky nipples. Then slowly sliding the stethoscope down across her tummy… lower and lower, unbuttoning her jeans and nudging them down slightly, not fully exposing her, but giving me enough room to check her lower abdomen and femoral pulse… Where it goes next, of course, you can probably guess.

We think the same way in many ways :-)