2009 Sep – My New Stethoscope in the Intensive Care Unit

Dr. KS Tang, Intensive Care Unit, Tuen Mun Hospital, 29 Sep 2009

A Beautiful Array of Stethoscopes in ICU, Kitano Hospital (北野病院), Osaka, Japan (Photo courtesy of Dr Arthur CW Lau)
As chest physicians, it is our second nature to do complete physical examination of the chest. We are also greatly assisted by two common imaging modalities of the chest, namely chest radiography (CXR) and computerized tomography (CT) of thorax. As a chest physician working in ICU now, it appears to me that the three major tools are handicapped to various extents. It is usually quite difficult to listen to the back of ventilated patients. Furthermore, the noises of ventilators and pumps around you make percussion and detection of subtle auscultatory signs difficult if not impossible. For CXR, you can never obtain good quality erect PA films in full inspiration and good penetration. Furthermore, the turnaround time is usually in terms of hours while deteriorating ICU patients demand our decisions in minutes. CT thorax is even worse as transportation of critically ill patients to the CT suite involve substantial risk and may not be available 24 hours a day.


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