Bedside Physical Examination

(i) The most careful points to perform Auscultation

Auscultation is a most important clinical skill to examine the cardiology patient at the bedside, and physicians as well as nurses or paramedical personnel should master this technique. Auscultation is the most important technique to examine the elderly and during visits.
  • Choose a quiet room. The examiner as well as the patient should be relaxed. Stop breathing while the auscultation is going on.
  • Select the tube of proper length (about 20 - 22 inches).
  • You should be familiar with the auscultation sites. Apply the ear-piece tightly- plugged into the ear-canal.
  • Know the auscultation sites correctly.
  • Know the timing of heart sounds or murmurs (in systole or diastole).
  • Know the intensity of heart sounds or murmur (Levine's classification I/VI - VI/VI).
  • Apply "breath holding test" or "changing of body position."
  • Write down the auscultatory findings in your chart.
The loudness of heart murmur
  • Levine's classification of the loudness of heart murmur is widely used throughout the world. (grade I/VI - VI/VI)
  • Ⅰ/Ⅳ  :very faint to recognize the murmur even after listening for a while.
  • Ⅱ/Ⅳ  :faint, but easy to recognize the murmur right after the stethoscope is placed on the chest.
  • Ⅲ/Ⅳ  :intermediate loudness between II/VI -IV/VI.
  • Ⅳ/Ⅳ  :with loud murmur (palpable thrill) .
  • Ⅴ/Ⅳ  :very loud, but you can not hear the murmur, if the stethoscope is away from the chest wall.
  • Ⅵ/Ⅳ  :the loudest murmur you can hear, even if the stethoscope is off the chest wall's Various Positions in Auscultation.