Akrit Jaswal-The Seven Year Old Surgeon ????

What is the reality behind this news ?? Anyone knows ???

From Wikipedia 

"
Akrit Pran Jaswal (born April 23, 1993, Nurpur ) is an Indian adult who was a child prodigy as a surgeon. He performed his first surgery at the age of seven.



According to his mother Raksha Kumari Jaswal, Akrit was an early starter, skipped the toddler stage and started walking. He started speaking in his 10th month and was reading Shakespeare at the age of five. Akrit developed a passion for science and anatomy at an early age. Doctors at local hospitals took notice and started allowing him to observe surgeries when he was seven years old. Inspired by what he saw, Akrit read everything he could on the topic. When he was seven years old, an impoverished family unable to pay for regular healthcare heard about his amazing abilities, and asked if he would operate on their daughter. The surgery was successful and was widely celebrated. Akrit hopes to someday continue his studies at Harvard University.
At 12 years old, he is the youngest person to be admitted to a medical university in India (Punjab University).
Akrit Jaswal has an estimated IQ of 146.

At 17 years he is  working on a master's degree in applied chemistry.

Here is the videos about him






.What is the reality behind this news ?? Anyone knows ???

MEDICOS WORLD - www.medicine-students-medical.blogspot.com

Surgeon Wearing Google Glass Live Streams Operation to Colleagues and Medical Students !!!

Dr. Christopher Kaeding, an orthopedic surgeon at The Ohio State University Wexner Medical Center is shown wearing Google Glass while performing surgery.

Dr. Christopher Kaeding, a surgeon at The Ohio State University Wexner Medical Center, is the first in the U.S  to consult with a distant colleague using live, point-of-view video from the operating room via Google Glass, a head-mounted computer and camera device.


Google Glass has a frame similar to traditional glasses, but instead of lenses, there is a small glass block that sits above the right eye.  On that glass is a computer screen that, with a simple voice command, allows users to pull up information as they would on any other computer.  Attached to the front of the device is a camera that offers a point-of-view image and the ability to take both photos and videos while the device is worn.

Dr. Christopher Kaeding, a surgeon at the Ohio State University Wexner Medical Center, was performing a surgery on a 47-year-old patient's injured knee ligament, during this milestone event

During this procedure at the medical center�s University East facility, Kaeding wore the device as he performed ACL surgery on Paula Kobalka, 47, from Westerville, Ohio, who hurt her knee playing softball. As he performed her operation at a facility on the east side of Columbus, Google Glass showed his vantage point via the internet to audiences miles away.

Across town, one of Kaeding�s Ohio State colleagues, Dr. Robert Magnussen, watched the surgery his office, while on the main campus, several students at The Ohio State University College of Medicine watched on their laptops.

�It�s a privilege to be a part of this project as we explore how this exciting new technology might be incorporated into the everyday care of our patients,� said Dr. Christopher Kaeding, the physician who performed the surgery and director of sports medicine at Ohio State.  �To be honest, once we got into the surgery, I often forgot the device was there. It just seemed very intuitive and fit seamlessly.�

Experts have theorized that during surgery doctors could use voice commands to instantly call up x-ray or MRI images of their patient, pathology reports or reference materials.  They could collaborate live and face-to-face with colleagues via the internet, anywhere in the world.

Watch The Video




Read Original Article Point-of-View Surgery Shown Via Google Glass

MEDICOS WORLD - www.medicine-students-medical.blogspot.com

The Man Who Believes He is Dead !!!

The British man, identified only as Graham, woke up nine years ago utterly convinced that he was no longer alive even though he was still breathing.

Doctors diagnosed him with Cotard�s Syndrome, which is also known as �Walking Corpse Syndrome� because it makes people think they have turned into zombies.

Graham did not believe them, however, and insisted that his brain was dead.

The unusual condition emerged after Graham, who suffered from severe depression, tried to commit suicide by taking an electrical appliance with him into the bath.

Eight months later he told doctors that his brain had died or was, at best, missing.

He lost interest in smoking, stopped speaking and refused to eat as there was "no point because I was dead"

He was in the grip of Cotard's syndrome. People with this rare condition believe that they, or parts of their body, no longer exist.

For Graham, it was his brain that was dead, and he believed that he had killed it.

In a new study  in Cortex  neuroscientists conducted sophisticated brain imaging (PET) studies on Graham, and discovered that large areas of his brain showed severely reduced activity usually seen only in patients who are anaesthetised or asleep. Graham�s �asleep� brain areas encompassed a network of neurons in parts of the frontal, parietal and temporal lobes on both sides of the brain that have previously been associated in the healthy brain with conscious awareness, or the ability to think about ourselves, and �know� ourselves as an independent being who has control over our own actions. The researchers, who included neurologists, did not believe Graham�s reduced brain function could be accounted for by his depression or by the medications he was taking, although these may have been factors.

Eventually, with psychotherapy and drugs, Graham recovered. Although he says he isn't yet entirely back to normal, he can now live independently. "I'm just lucky to be alive now," he says.

Watch The Video

What is Cotard's syndrome??


The Cotard delusion, Cotard's syndrome, or Walking Corpse Syndrome is a rare mental disorder in which people hold a delusional belief that they are dead (either figuratively or literally), do not exist, are putrefying, or have lost their blood or internal organs. In rare instances, it can include delusions of immortality.


Signs and symptoms

The central symptom in Cotard's syndrome is the delusion of negation. Those who suffer from this illness often deny that they exist or that a certain portion of their body exists. Cotard's syndrome has been found to have three distinct stages. In the first stage � Germination � patients exhibit psychotic depression and hypochondriacal symptoms. The second stage � Blooming � is characterized by the full blown development of the syndrome and the delusions of negation. The third stage � Chronic � is characterized by severe delusions and chronic depression.
People with the Cotard Delusion often become withdrawn from others and they tend to neglect their own hygiene and well-being. The delusion makes it impossible for patients to make sense of reality, which results in an extremely distorted view of the world. This delusion is often found in psychotic patients suffering from schizophrenia. While Cotard's Syndrome doesn't necessitate hallucinations, the strong delusions are comparable to those found in schizophrenic patients.

MEDICOS WORLD - www.medicine-students-medical.blogspot.com

Teen With Progeria, Is The Last Of 6 Siblings Afflicted With Rare Disease .

Ali Hussain Khan from Bihar, India, is only 14 years old, but the condition, called progeria, has given him the body of a 110-year-old.


His parents, who are first cousins, have eight children. Four born with progeria died between ages 12 and 24. Another child, who died shortly after birth, is also thought to have had the disease. Two of their daughters do not have progeria.

There are only about 80 cases of progeria known in the world. According to the Progeria Research Foundation, a nonprofit that seeks to cure the condition and its aging-related disorders , the children with progeria "are born looking healthy... [but] begin to display many characteristics of accelerated aging at around 18-24 months of age."

Watch The Video




What is Progeria ?

Hutchinson-Gilford progeria syndrome (HGPS) is an extremely rare hereditary disease that affects the skin, musculoskeletal system, and vasculature. HGPS is characterized by signs of premature aging. The term progeria is derived from the Greek word geras, meaning old age. Significant morbidity and mortality result from accelerated atherosclerosis of the carotid and coronary arteries, leading to premature death during the first or second decade of life. HGPS is considered a segmental aging syndrome, as affected patients do not manifest all of the typical features of aging, such as increased incidence of cancer and neurocognitive decline.

Clinical Presentation

Evidence of Hutchinson-Gilford progeria syndrome (HGPS) begins within the first 2 years of life. At birth, infants usually appear healthy, although sclerodermatous skin changes have been noted in some patients. Typically, the onset of the disease occurs at age 6-12 months, when skin changes and alopecia are first noted and when the infant fails to gain weight. The following are other suggestive findings :

High-pitched voice
Short stature and low weight for height, with prenatal onset of growth failure
Incomplete sexual maturation
Generalized osteoporosis and pathologic fractures
Feeding difficulties
Delayed dentition, anodontia, hypodontia, or crowding of teeth
Low-frequency conductive hearing loss.
Hypertension
Prolonged prothrombin time, elevated platelet counts, and elevated serum phosphorus levels
Emotionally, patients with HGPS share the same feelings as age-matched healthy persons with regard to expressing proper mood and affect. Patients with HGPS are keenly aware of their different appearance and remain reserved in the company of strangers; in the presence of friends, they display affection and good social interaction.

Spontaneous Human Combustion ,myth or reality ???

Rahul has been virtually in flames four times since he was born two-and-a-half months ago. Doctors suspected  it's due to a rare condition called spontaneous human combustion (SHC).

Afflicted with the disorder, seen only in 200 people across the world in the past 300 years, the child undergone treatment at Kilpauk Medical College (KMC) Hospital, Chennai, India.


Rahul was nine days old when he first "caught fire" in the presence of his mother Rajeshwari who watched in disbelief as there was no source of fire in the vicinity. She took him to the Villupuram Medical College from where the baby was discharged three days later. After coming home, he suffered burns again. "Doctors say he is a healthy child and his organs are fine. The last time he caught fire was a fortnight ago, and this time it was head to toe," said Rajeshwari

J. Jagan Mohan, head of plastic surgery, who examined the baby, said there was very remote possibility of self-ignition.

�The injuries have healed and the scars are from an older accident that may have occurred less than three weeks ago. We need to explore the possibility of child abuse,� he said.

�How the child sustained burns is still not known. But the injury is due to contact with a hot object or scalding material. As burn injuries do not cause breakage of bones or the rupture of internal organs, the possibility of child abuse is still not ruled out.�

Since the baby does not have any injuries on his back, it is possible the child was hurt when he came in contact with a hot object, he said.


Ordinarily, a child of his age should weigh six kg but Rahul was just 4.5 kg, said doctors. R. Narayana Babu, head of paediatrics intensive care unit where Rahul is being treated, said the baby was being provided supplementary feed for nourishment besides being breastfed.

However all investigation results are  completely normal

Results of a skin biopsy and a test to check for errors in metabolism as well as for genetic karyotyping (to study the composition of cells)  were all normal.

At the time of discharge Hospital dean P. Ramakrishnan said, �We came to know that there is no evidence of spontaneous burns in the child. He has recovered completely.� The parents and Rahul�s maternal grandmother K. Tulasi, were given psychiatric counselling. �A clinical evaluation of the three family members does not reveal any significant psychiatric illness. The possibility of child abuse has to be investigated by the appropriate authority, especially police and child welfare agency,� said Dr. Ramakrishnan

Watch the Video




What is Spontaneous human combustion

Spontaneous human combustion (SHC) describes reported cases of the burning of a living (or very recently deceased) human body without an apparent external source of ignition. As of 1995, proponents claim that there have been about 200 cited cases worldwide over a period of around 300 years.
There are many hypotheses that attempt to explain human spontaneous combustion. 

Natural explanations include those:

1) Based on intestinal conversion of food into methane by methanogens which, when released through the pores of the skin, can catch fire when triggered by various sources (e.g., silk cloth generating static electricity).
2) Based on unknown or otherwise unobserved phenomena (e.g., that the production of abnormally concentrated gas or raised levels of blood alcohol might cause spontaneous ignition)

3) Relating to health and lifestyle factors (e.g. smoking, not consuming adequate levels of water, etc.)

4) That involve an external source of ignition (e.g., the victim was drunk and dropped a cigarette)




MEDICOS WORLD - www.medicine-students-medical.blogspot.com

The girl who cries tears of blood (Haemolacria)

A 20-year-old Chilean woman, Yaritza Oliva, cries tears of blood, and doctors aren't quite sure why.Since June, Oliva has been crying blood tears several times a day, a pain she called "indescribable." 

While doctors have not officially diagnosed the 20-year-old, it's likely that she is one of several people to develop haemolacria, a rare condition marked by bleeding from the eyes.

A simple eye infection and conjunctivitis were ruled out since Oliva continued to shed tears of blood several times per day.

Watch The Video



What is Haemolacria ???

Haemolacria is a physical condition that causes a person to produce tears that are partially composed of blood. It can manifest as tears that are anything from merely red-tinged to appearing to be entirely made of blood.

Haemolacria is a symptom of a number of diseases,and may also be indicative of a tumor in the lacrimal apparatus. It is most often provoked by local factors such as bacterial conjunctivitis, environmental damage or injuries.

Acute haemolacria can occur in fertile women and seems to be induced by hormones, similarly to what happens in endometriosis.

Though a sanguineous discharge is relatively frequent in conditions of acute conjunctival hyperaemia and inflammation, occurrence of bleeding from conjunctiva as an isolated phenomenon is exceptionally rare. 

Duke Elder  outlined the differential diagnosis of bloody tears; severe anaemia, jaundice, vascular tumours, Osler-Weber-Rendu disease (hereditary haemorrhagic telangiectasia) haemophilia and other coagulopathies.

Other causes reported are vicarious menstruation, conjunctival manipulation for follicle expression in trachoma, clinical treatment of conjunctiva with silver nitrate and epistaxis with retrograde blood stream into conjunctiva through puncta lacrimalia .

Recently Bona-volanta and Sammaritino  attributed orbital varix as a cause of bloody tears. In another interesting case Richard and Eifermam  blamed secondary giant papillary conjunctivitis for bloody tears.


Read more scientific journals about Haemolacria at Google Scholar

New HIV Vaccine Proves Safe In Phase 1 Trial !!!

Phase I Clinical Trial (SAV CT 01) of the first and only preventative HIV vaccine based on a genetically modified killed whole virus (SAV001-H) has been successfully completed with no adverse effects in all patients, Western and Sumagen Canada Inc. announced .

Developed by Dr. Chil-Yong Kang and his team at the Schulich School of Medicine & Dentistry, with the support of Sumagen Canada, the vaccine (SAV001-H) holds tremendous promise for success in the final phases of clinical testing now that the first hurdle has been accomplished. It is the only HIV vaccine developed in Canada currently in clinical trial, and one of only a few in the world.




This vaccine is the first genetically modified killed whole virus vaccine (SAV001-H) in human clinical trial to evaluate its safety, tolerability and immune responses. The human clinical trial was initiated in March 2012 and completed in August 2013. This trial was a randomized, observer-blinded, placebo-controlled study of killed whole HIV-1 vaccine (SAV001-H) following intramuscular (IM) administration. HIV-infected, asymptomatic men and women, 18-50 years of age, have been enrolled in this study and randomized into two treatment groups to administer killed whole HIV-1 vaccine (SAV001-H) or placebo.


The adverse effects after vaccination were recorded on a volunteer diary card by the volunteers seven days after vaccination. Thereafter, the volunteers visited the test sites on Weeks 4, 6, 12, 18, 26 and 52 after vaccination and were analyzed for hematology, clinical chemistry, urinalysis and physical examination by principal investigators. No serious adverse event was observed in any volunteer vaccines throughout the observation periods.


In addition to safety evaluation, HIV-1 specific antibody detections have been performed throughout the follow up period. The antibody against p24 capsid antigen increased as much as 64-fold in some vaccines and antibody against gp120 surface antigen increased up to eight-fold after vaccination. The increased antibody titers were maintained during the 52 week study period. The boost antibody production in HIV-positive volunteer vaccines is highly encouraging, since it forecasts a success of the Phase 2 human clinical trial, which will measure the immune responses.


In particular, the antibody against gp120 surface antigen is considered to be very important, since some of these antibodies may represent the broadly neutralizing antibodies, which seem to be the most important parameter of an effective HIV vaccine for prevention of HIV-infection.


SAV001-H is the first genetically modified killed whole virus vaccine (SAV001-H) in human clinical trial and proving its safety was the major concern for going forward for next steps. With these  encouraging results from the Phase I Clinical Trial, Sumagen is confident  in developing SAV001-H as the first preventative HIV vaccine for saving millions of lives and is now preparing for the next phases of trials to show the immunogenicity and efficacy.


�Even though Sumagen has struggled and spent a much longer time to overcome manufacturing difficulties and to meet the USFDA�s requirements, we have accomplished successfully Phase I Clinical Trial of SA001-H and proven that there is no safety concern of SAV001-H in human administration,� said Jung-Gee Cho, Sumagen CEO. �We are now prepared to take the next steps towards Phase II and Phase III clinical trials. We are opening the gate to pharmaceutical companies, government, and charity organization for collaboration to be one step closer to the first commercialized HIV vaccine.�

Watch the Video About This Vaccine



Read More at  communications.uwo.ca


MEDICOS WORLD - www.medicine-students-medical.blogspot.com

How Much Do Doctors Make?

Somebody asked: "You're a Doctor? How much do 

you make?"

I replied: "HOW MUCH DO I MAKE?" ...
I can make holding your hand seem like the most
important thing in the world when you're scared...

I can make your child breathe when they stop..

I can help your father survive a heart attack... 

I can make myself get up at 4AM to make sure
your mother has the medicine she needs to
live...and I will work straight
through until 4am to keep her alive and start the
day all over again!
I work all day to save the lives of strangers...

I will drop everything and run a code blue for
hours trying to keep you alive!!!

I make my family wait for dinner until
I know your
family member is taken care of...

I make myself skip lunch so that
I can make sure that everything I did for your wife today was
correct...
I work weekends and holidays and all through the
night because people don't just get sick Monday
though Saturday and during normal working
hours.

Today, I might save your life.

How much do I make?

All I know is, I make a difference.

MEDICOS WORLD - www.medicine-students-medical.blogspot.com

How to find a difficult vein for Venipuncture !!

Whether drawing blood specimens or starting IVs, venipuncture is the most commonly performed invasive medical procedure. It is also one that frequently requires additional time and multiple attempts to be successful. In fact, establishing IV access in difficult patients can take up to 10 minutes.



Of all invasive medical procedures, venipuncture is the most common and these venipuncture attempts can fail. As a result:
Blood tests that facilitate diagnosis and patient management may be delayed;
Intravenous therapy may not begin promptly;
Physician intervention to access a difficult vein can erode productivity;
Patients may endure unnecessary needlesticks and additional discomfort;
Stress may increase for both patients and staff.

But by using vein illumination with AccuVein�s breakthrough device, many veins that might be otherwise undetectable without a vein locator, can be located and mapped on the patient�s skin.

How Does It Work?
Hemoglobin in the blood absorbs infrared light. When the device is held above the skin, veins appear noticeably different than the surrounding tissue. The vasculature shows up clearly on the skin�s surface, aiding in vein location to collect a blood sample or administer IV medications.



Features of vein illumination with AccuVein�s breakthrough device:
Easy to learn and use � No pre-use calibration or adjustments are necessary- it can be used immediately.
Small size �The device fits in your hand and weighs only 10 ounces.
Hands-free option �In situations that require hands-free use, the device can be placed in a wheeled hands-free accessory or one that quickly attaches to a chair or bedrail.
No patient contact �Because the device has been designed to be non-contact, it may not have to be sterilized after every use.
Works in light or dark �Use the device in light or darkly lit environments.
Rechargeable battery �The device doesn�t need to be plugged into an electrical outlet.
Real world ruggedness � Designed to take the wear and tear of hospital and field applications.
Movement tolerant �Because the device shows the veins in real time, when operated properly, the device can accommodate patient movement.




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Indian Drugs Brand Names Free Android Mobile Application -edT (E Drug Today)

The Wait is Over !!!! The most wanted Application by Indian Doctors and Medical students is here.

EDT (E Drug Today Android Application ), an offline mobile application with Class of the molecule,Mechanism of action ,Indication along with dosage ,Adverse drug reactions (ADR) ,Contraindications and special precautions ,Drug interactions.Most important is there is search option Generic wise and Brand wise.
It is Absolutely Free NOW !!!


Download from Google play 


EDT (E Drug Today Android Application ),is  for healthcare professionals to access all important drug information without connecting to internet from Dynoble Edusoft Pvt LTD.


EDT Android Application  does not require internet connection after first database download  and hence the information is always on your fingertips even in hospitals wherein the network may be poor (NB:Initial database download took about 7-10 mins however after that the app is running very smoothly).

With EDT Android Application , you can access the following information anytime and anywhere


Brand Related Information


Indian brand names

Composition of each brand
MRP of Indian brands
Information about pharmaceutical companies
Top Indian brands
Brands for Each Molecule available in India

Molecule Related Information

Class of the molecule
Mechanism of action
Indication along with dosage
Adverse drug reactions (ADR)

Contraindications and special precautions
Drug interactions


How to Install it in Your Android Phone ?

1) First Download software  from Google play   Store app on your device.

2)Search for " edT Drug information " in the search bar.

3) Select Edt drug information software .The application picture look like this

4) Click on Install, and then the application gets installed on your device

5) Open The application

4) Enter Your Name, Email, Mobile No: , Left the space for activation key blank and activate the application. Initial Data download takes 1 to 2 minutes in 3g or wifi.If you are using GPRS it will take 15 minutes.After initial data download no internet connection needed further.

5 ) Now enjoy the world of drugs !!!




EDT Android Application  works across various other  mobile platforms also like

Blackberry

iOS (iPhone, iPad)

Java Based Mobiles

Visit http://edt.co.in/download.php  for more details.


They have taken every step to ensure that the drug information is correct. Still if you notice any error, please let them know. Your feedback will help them to improve! 


A user review about this application


Vikram Kumar says 

 "Most needed apps for everyone Really I was waiting for such apps from long time,its just perfect as i wished... :-) Its very helpful and updated.. Thumb up for u people....well done...Thanks... "

Application Review by  medicos world www.medicine-students-medical.blogspot.com

Also visit my other post How To Download  CIMS in Your Mobile Completely free !!

Instant Anatomy-online resource for anatomy

Instant Anatomy

Today I found an amazing website by Robert Whitaker instantanatomy.net, which contains note and diagrams .There are tips, mnemonics and lists of questions to bring out the relevance and basic principles.  There are even some anatomical crosswords for enthusiasts.

Main content of this site are :-

•           Instant Anatomy Audio Visual Lectures
• �         Instant Anatomy iPhone/iPad Android Apps
• �        1800 MCQs on the Arm, the Leg, the Thorax, the Adbomen, Embryology 
• �         Instant Anatomy Video Podcasts
• �        The Instant Anatomy CD-ROM 
• �         MCQ iPhone app

Here is  Instant anatomy youtube page

Instant Anatomy  has loads of diagrams, podcasts and revision quizzes and is a great place to go if you're revising for exams, or need to brush up on your knowledge. Since retiring 20 years ago Robert Whitaker now teaches clinically applied topographical anatomy to first-year medical students at Cambridge University, in the UK. He also teaches clinically applied anatomy to surgical, radiological and other speciality trainees and is an examiner for the MRCS at the English and Edinburgh Colleges of Surgeons.

The free diagrams on Instant Anatomy are clear, colourful and give you the key points, without the unnecessary detail. The lectures that are available are also extremely well done and easy to followNot all of the podcasts and quiz questions are available on the site, if you're after more content you can purchase and download the Instant Anatomy CD ROM or one of the flash card, quiz or lecture apps available for iPhone or Android

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Anaesthesia resource - AnaesthesiaUK

AnaesthesiaUK (frca.co.uk ) is an anesthesia portal with training resources for anaesthetic professionals and students. It provides interactive practice questions, journal abstracts ,software,image library,exam preparation resources and  reference articles for the Primary FRCA, Final FRCA, Irish FCARCSI, European Diploma of Anaesthesiology, American Board examinations.AnaesthesiaUK is endorsed by The Royal College of Anaesthetists, The Irish College of Anaesthetists and The Intensive Care Society for its role in education.


Highlights of this site are :

Journal section - provides summaries of selected recent papers in anesthesia . It may help you to keep up-to-date without having to read through all the medical literature.

Exams section  - contains  examination papers of FRCA I and II, FCARCSI examination and American Board Examination I and II as well as OSCE and viva examination. This section will help for other anesthesia exams conducted world wide.

Forum   - Here discussions on different important topics are initiated by the users and it can be accessed after validation from the web administrators..

image library  - Users may download as well upload clinical and professional images here.

Tutorial of the week  -a weekly web-based tutorial run by the World Anaesthesia Society.

Resources   - Topics related to basics like anatomy, pharmacology and physics as well as related to clinical anaesthesia e.g. ECG interpretation, acute and chronic pain, coagulation, clinical governance, fluid management, obstetric and regional anaesthesia etc are covered in great detail. 

Intensive Care-   here you will find recent literature on respiratory, nutritional, renal and haematological therapy. It also includes articles on sepsis and cardiology and a special topic on ethics in intensive care.

Software  - Provides Link to download Apps for Mobiles/Handhelds. It also include link to downloadable RCoA electronic logbook.

Most of the site resources are available without registration; however, registration is required if you wish to participate in the online examination section. Since the registration process requires that one submit one�s "GMC number," viewers outside the UK who wish to explore this feature should contact the site via the e-mail feedback section and access will be organized. 

In short  AnaesthesiaUK is Free, up to date, peer reviewed, and well organized  anaesthesia resource.  Very highly recommended !!


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Heart sounds auscultation basics.

Today while searching internet I came to notice a reply by  ipizzy in  studentdoctor.net  about auscultating heart sounds.I feel it must be shared with my blog readers .

He writes " You  can google 'heart sounds' and find plenty of websites that offer audio clips of heart sounds. Listen to these sounds repeatedly. Do NOT try to memorize what the sounds sound like; rather, just identify the *patterns*. Identify S1 and S2 for every audio clip, identify systole and diastole, listen for the presence or absence of extra murmur sounds " .  How to I identify all these things?? 

Basics of auscultating heart sounds

1. S1 and S2 identification. 

A big clue as to which is which is the fact that diastole is longer than systole. Tap your fingers out to the heart rhythm along with S1 and S2 (I find this to be helpful when there are other sounds like gallops or clicks or opening snaps, which can sometimes confuse you into thinking they are S1 or S2). When you tap your fingers along with S1 and S2, you'll be able to tell if the extra gallop/click/snaps are occurring in diastole vs systole depending on when the extra sounds occur in relation to your taps.

-More advanced: If you can't tell which sounds are S1 and S2 based on the length of systole and diastole, revert to the first rule of heart sounds. First rule of heart sounds = heart sounds are loudest closest to where they originate. S1 will be louder at the apex (bottom) of the heart because this sound is created by the closure of the mitral and tricuspid valves, which are 'closer' to the bottom of the heart. S2 will be louder at the base (top) of the heart because it is created by the closure of the aortic and pulmonic valves, which are closer to the top of the heart. You can use this topology to help you identify S1 and S2. For example, put your virtual stethoscope near the top of the heart. The louder of the two beats is S2, and the softer one (which you may not even be able to hear) is S1. The opposite is true for the apex/bottom of the heart.

2. Stick it to the man 

Even if you can't tell what is S1 and S2 from all that hard work in step 1, you can still easily figure out if the heart murmur is occurring in systole or diastole on the exam because they give you a way to cheat.The virtual patient has a very visible carotid pulse. If you hear the murmur while you see the carotid bulging, you know it is systolic. If the murmur occurs while the carotid is flat, it's a diastolic murmur. This essentially renders all of the advice given in #1 as useless for the purposes of step 1, but alas, I had already written it up...so...yeah.

3. Which valve is involved? 

This brings me to my second made-up rule of heart sounds: topology is key. Memorize the sh*t out of the APTM mnemonic for remembering where the heart valves are located in the chest. It doesn't matter if you memorize what murmurs go with the valves' locations; you can figure this out if you don't memorize it. But you should damn well know that most sounds over the aortic valve are heard best in the 2nd intercostal space on the right sternal border. You can memorize 4 location facts. I just know you can.

Combine this with first rule of heart sounds! Murmurs coming from the tricuspid or mitral valves are heard best at the apex (bottom) of the heart, and thus are loudest in the 4th and 5th intercostal spaces.

Murmurs coming from the aortic and pulmonic valves are heard best at the base (top) of the heart, and are thus loudest in the 2nd intercostal spaces on the left and right, respectively.

On the exam, if you can figure out if the heart sound is in systole or diastole, and then figure out which valve is generating the sound, you essentially have solved the puzzle. A diastolic murmur that is loudest in the mitral valve area? That must be mitral stenosis! 10 points to Gryffindor!

(Extra credit). Extra sounds: S3 and S4 are the big ones. These will always be heard best at the apex/bottom of the heart. They say these sounds when combined with S1 and S2 are like the rhythm of "Kentucky" (S3) or "Tennessee" (S4) but this relies on you saying the names of these great states in an unnatural way. If you've identified S1 and S2 by now, just figure out which one your extra sound is closer to. S4 comes just before S1, while S3 comes just after S2.

Also watch a video about heart sounds made easy!!


Don't forget to visit my other best posts in Cardiology section.

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