Presented by Dr. Satish Kumar, Bokaro General Hospital. B. S. City.

Learning from the history of Medicine: 2 centuries ago; René Laënnec, France, 1819:

The doctor’s iconic Stethoscope is one of the essential tools for the clinician while dealing with a patient presenting with symptoms like cough & shortness of breath (like in COVID-19). But this device is also recognised as one of the worst FOMITES (non-living carriers of infections), particularly viruses and thus pose a great risk, both for the care-giver and the care-seeker.

My Observations: (Novel CORONA, Novel Situations, novel Solutions!)

1. It goes without saying that the safety of the healthcare worker is of utmost importance. [SAVE THE SAVIOUR.]
2. The increasing number of morbidity and mortality of doctors involved in COVID-19 patient care globally warrants more stringent precautionary measures.
3. Chest Auscultation of such patients in particular, poses an enormous challenge before the clinicians, as far as their safety is concerned.
4. Those clinicians who are wearing Personal Protective Equipments (PPEs) have an additional practical difficulty in the sense that their ears are covered and exposing them for putting the ear-piece of the stethoscope may jeopardise the asepsis.
5. Special alternative equipment, like tubeless electronic stethoscopes using Bluetooth, as shown in this YouTube clip (https://m.youtube.com/watch?v=Z3xGZ3AvsjI) are not available readily during the lockout period.
6. Also, alternative approaches, like hand held/ portable ultrasound for assessment of lung conditions, though preferable (https://youtu.be/HolLNa_Zypg), are also scarce as well as observer dependent.
7. For COVID-19 patients with suspected Severe Acute Respiratory Illness (SARI), it is always considered preferable to do Chest X-Ray/ CT rather than just rely on auscultation, as it has been observed that the auscultatory findings may not be very reliable, may have a subjective bias and most importantly, do not seem to correlate well with the radiological status of the lungs.
8. Hence, in such a resource – challenged scenario, one may:

• A. Perform conventional auscultation, only if it is too essential.
• B. The patient must have his/her mask properly placed on the face.
• C. The patient should be looking away from the examiner.
• D. He/she should breathe normally. (Don’t ask the patient to do deep breathing, to minimize aerosolization).
• E. If using a conventional stethoscope, one should use:

• – Stetho with a long tubing
• – A dedicated stethoscope
• – Preferably a disposable cheap device
• – Sanitize it very meticulously with Lysol or Sod. Hypochlorite soln. after each use.
• – Handwash after each procedure is a must.

9. When wearing a full PPE in the Isolation ward, it is proposed to use the following device, borrowed straight from the History of Medicine, exactly 200 years ago. [René Laënnec, 1819]

• – We may use the cylindrical caskets made of cardboard for shuttlecocks (or some whiskey brands), as shown.
• – It measures about 13.5 long x 2.5″ dia.
• – It gives a reasonably good acoustics in a quite environment.

Your comments are welcome.

René Laennec:

Laennec’s first stethoscope kept in the Museum of London, made of a single hollow tube of wood and brass. He first invented this in 1816 and later published his observations in 1819.

A better way of doing auscultation with this AYU LYNK Bluetooth device.

IIT Mumbai cradled ‘Ayu Lynk’ Start-up has started manufacturing digital stethoscope. A conventional stetho can be converted to digital with Bluetooth connectivity to doctor’s stethoscope for remote recording and listening of Chest and Heart sounds. Ayu Lynk on Amazon.

Taking ECG in COVID patients

Nursing the COVID-19 patients in prone position, particularly those with respiratory distress has been shown to be rewarding. Even results of Ventilation is better in prone position.

Now, even we may perform ECG in such position. This is routinely done for patients undergoing thoracostomy who have their anterior chest strapped. The minor deviation from a standard 12-lead ECG is that they have low voltage complexes. This may also reduce the chances of aerosol generated transmission to the ECG Technician.

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