Don't Trust The Ambulance Stethoscope!

Don’t trust the ambulance stethoscope!


I don’t know about where y’all work but where I work the service provides stethoscopes for the jump bag and in the box. They are not good stethoscopes and I learned the hard way of why I always carry my own, quality stethoscope. (I carry a Littman Cardiology)

I was dispatched to a nausea/vomiting patient alongside a roadway in a vehicle.  We arrived on scene and the patient was vomiting profusely and did not look good.  We got the patient loaded on the stretcher and in the patient compartment.  The spouse stated that the patient had mitral valve regurgitation and that they hadn’t been feeling well the night before.

We immediately started obtained vitals and beginning interventions. Patient refused to accept anything other than a NRB and O2 saturation was not looking good. IV access obtained but the pt was obtunded and was agitated.  I asked my partner to listen to lung sounds, they said they were good. 

I was at a loss at was what was wrong but knew that it was not good.  I started us out emergency traffic to a Level 3 and within 1 minute I was told something we all know isn’t good. My partner yelled for me to pull over and get back in the box. 

I hopped in the back and the patient was unresponsive, pulseless with foam coming from their nose and mouth. Flash Pulmonary Edema! We called CPR in progress and for first responders to come to our location. We worked the code and within 10 minutes had ROSC. When I checked lung sounds to verify the tube placement, I heard a significant amount of crackles and rales. 

The patient was transported to the Level 3 and made it a couple more days in the ICU until the family ceased interventions.  I think about this call often and wonder if we had used a real stethoscope, rather than the junk services provide, would our outcome have been different.  

I researched mitral valve regurgitation and found that if left untreated it can cause pulmonary edema but would we have heard the crackles earlier? Could we have RSI’d him? Could we CPAP and use nitroglycerin to help clear out some fluid? I wish we would’ve used a quality stethoscope and since then, have used my quality stethoscope and hope that you will too!

- Jason