hey everyone it's s with register nurse rn.com and in this video I'm going to be going over how to osculate heart sounds what I want to be doing is I'm going to show you how to listen to Heart sounds on a real person I'm going to show you the anatomical sites how to identify S1 S2 talk about those S3 S4 and heart murmur those extra sounds you may hear but first let's cover the basics okay why do we listen to Heart sounds what is the purpose well one thing we want to make sure the rhythm is regular we want to count the rate but we're also one of the big things is that we're assessing how those heart valves are closing because whenever you are hearing S1 S2 those are valve valves closing S1 are your tricuspid and mitro valves closing and S2 is the sound of your aortic and P pulmonic valves closing and while you're listening to heart sound you'll be trying to distinguish am I hearing S1 S2 and then you're going to be positioning the patient in a little bit different positions and you're going to be listening for those extra heart sounds like S3 S4 and heart murmurs so first let's go over the anatomical sides here in a second you're going to see what it actually looks like whenever um you're looking at the anatomical sites on the chest but let me cover them real fast if you want you can write this down so you can remember it the key to help you identify these anat comical sites is to find the clavicle on the patient and then go down and find the angle of Lewis it's a joint little area and the second rib comes out from there and right below that we're going to start on the right side is the intercostal space and right there left I mean right of that border is the aortic valve and the aortic valve represents when it closes the sound of S2 that and the pulmonic valve normally close together so when they close together they're semi lunar valves you will hear S2 then right over on the left side in the same space second intercostal space you will find the pulmonic valve then down in the third space you will find herbs point and this is just an area where um you're separating the base from the Apex it's just the Midway point between those two areas and then you have the fourth intercostal space which right next to the border of that is the tricuspid valve you'll find that on the left side as well and the tricuspid and mitro valves when they close together simultaneously you will hear S1 and they are found in the base then you go down a little bit in the fifth intercostal space but midclavicular which is the Midway point of your clavicle and you will find the M mitro valve also called by cuspid valve and these are your Avo ventricular valves your AV valves and this is also where you you will hear the point of maximal impulse and also it's important to know the bottom part of the heart down in this area is the Apex the top part of this area is called the base you want to remember that now let's look and osculate these areas and see what they look like on a real person okay first I wanted to start out just showing you on the chest what where you're going to actually place your chest piece whenever you're listening to the what I like to do whenever I'm first starting out is either have the patient set up or lie down and I like to start in the aortic and work my way down remember the pneumonic all patients take medicine and herbs point is in between the pulmonic and the tricuspid and whenever your semi lunar valves are your aortic and pulmonic and when they close you hear S2 and so you're going to hear S2 the most at the base of the heart and then whenever you're hearing the tricuspid and mital which are your o ventricular valves which are AV valves you're hearing S1 whenever they close so let's use the chest piece and osculate okay whenever I'm beginning oscilation of the heart what I like to do is remove the clothing and um I like to have the patient set up you can also have them lay down and I listen with the diaphragm of my stethoscope first and then I'll switch to the bell and redo all the anatomical sites but I like to listen to diaphragm because you can hear S2 and S1 the best with this along on with your aortic and P pulmonic regurgitation murmurs so um I start at the aortic remember the pneumonic all patients take medicine and what I'm going to do is I'm listening for S1 and S2 I'm distinguishing them and I'm also listening for S1 splits or or S2 splits and this is just where the valves are not closing at the same time so you may hear a little bit of an extra noise so we're going to start in the aortic over here and what I'm hearing is love dub love dub and dub is louder because dub represents S2 and in the base of the heart you're going to hear S2 louder than how you would hear it down there then I'm just going to inch over here to the pulmonic and I hear the same thing I don't know any splitting S1 and S2 are closing at the same time no extra heart sounds then I'm going to inch down to herbs point this is just the halfway point between the base and the apex of the heart now I'm going to inch down to the tricuspid and this time I'm hearing love dub and love is louder because this is signifying more where you're going to hear S1 and love is represented by S1 and I hear that louder in this area and then I'm going to go over to the mital area midclavicular and this hearing the same thing love dub nice good Rhythm and what I'm going to do is I'm just going to switch over to my bell and I'm just going to repeat and what I'm really paying attention to is I'm listening for any type of murmur or those low pitch sounds you really can't hear S3 and S4 that great in this position that's why here in a second we're going to get on our left side and you hear that in the Apex but what I'm listening for is maybe any murmurs blowing swishing noise and I'm not hearing anything now one thing you may find hard whenever you are osculating is distinguishing S1 from S2 and some tips to help you with that again S2 is going to be louder here at the base and S1 is going to be louder here at the Apex so that can help you with that or if you're still having trouble you don't can't really differentiate um you can fill on the cored artery and listen at the apex of the heart and whenever you feel a pulsation and you feel you hear that noise you've identified S1 because the cowed pulsation and the sound signify S1 or if you have a patient on a bedside monitor you can look at your QRS complex in the r way the big spike whenever you see that that Spike and you hear the noise that is S1 so those are just some little tips on how you can differentiate between S1 and S2 now we've assisted the patient onto their left side and the whole purpose of doing this is majority of your heart is on your left side so whenever you turn them have them go there it pushes the heart over a little bit more just so you can hear those anatomical sites a little bit better and what we are interested in is the apex of the heart and we're going to be listening with the bell of our stethoscope because we're listening for low pitch noises and if the patient was going to have an S3 S4 or a mro stenosis murmur this is where we most likely hear it so what we're going to do is just find the midclavicular the fifth intercostal space we're going to just listen over there and we're listening for S3 or S4 and mmers and S3 is heard after S2 so again that's why you have to distinguish between S1 and S2 and S3 is going to sound like a love dub t love du T because it's heard after S2 S4 is going to be heard before S1 and it's going to sound like this t t t and a murmur of course is just that blowing swishing noise okay last what I like to do is I like to have the patient set up and lean forward and then have them exhale and I'm going to listen for what I'm looking for is murmur aortic and pulmonic murmur and I'm going to be listening at the aortic and the pulmonic SES with the diaphragm because it's good at picking up those murmur and what's happening is that the chest the heart behind the STM is just moving a little bit forward so we can hear those anatomical positions a little bit better and I'm listening for like a blowing a swishing noise and if one's present you'll want to grade that and here on your screen you'll see what the grading scale is for that one a grade one is hard to hear and it goes all the way up to six and this is the loudest you could literally lift your chest piece off the patient's chest like this and you could hear just the blowing and swishing noise you could also feel on the chest a thrill which is like a vibration on the skin okay so that is how you osculate heart sounds now be sure to check out my other video where I go in depth about these heart sounds I talk in great detail about them a card should be popping up so you can access that video so you can familiarize yourself with these heart sounds thank you so much for watching and please consider subscribing to this YouTube 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