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2 Minute EBP Challenge

Monday, January 30, 2012
Scrub the Hub
The Centers for Disease Control (CDC) recommends that central venous catheter (CVC) hubs be scrubbed for how long?

Monday, January 23, 2012
Severe Sepsis and AF Risk
Up to 20% of patients with severe sepsis develop a new onset atrial fibrillation.  Which factor was not associated with increased risk?

Monday, January 16, 2012
Unreported Hospital Errors
In a recent study the Department of Health and Human Service reports that what percentage of hospital errors go unreported?

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  • Get tips, timesavers, and more from
    David W. Woodruff, MSN, RN-BC, CNS, CMSRN, CEN

    Home > 2 Minute EBP Challenge > Heart Sounds

    Heart Sounds

    Monday, January 18, 2010
     

    Stay up-to-date the easy way!

    How would you answer this question?

    The most common cause for the development of a new S3 heart sound is:

    a. Cardiac tamponade
    b. Papillary muscle rupture
    c. Acute heart failure
    d. Myocardial infarction

    The correct answer is "c" acute heart failure.

    The normal "lub" and "dub" sounds of the heart are labeled as S1 and S2 respectfully.  Additional sounds can be a normal variation if they were present before an acute cardiac event, or can signal acute cardiac dysfunction in a patient in acute distress.

    The S3 heart sound is heard after S2 and is lower in pitch and softer than the S2.  The word "Kentucky" is often used to help remember the pattern of an S3.  With "Ken" corresponding with the S1, "Tuc" with the S2, and "Ky" with the sound of the S3.  I prefer the phrase "Sloshing In" to remember the pattern of the S3.  The "Slosh" corresponds to S1, the "Ing" to S2, and "In" to S3.

    An S3 heart sound occurs because the patient is volume overloaded and blood is "sloshing into" the heart.  Specifically, blood oscillates between the walls of the ventricle from blood rushing into the ventricle from the atria.  An S3 is best heard with the bell of the stethoscope at the apex of the heart.

    Although an S3 can be a normal finding in young adults and athletes, the presentation of a new S3 indicates an acute condition of fluid volume overload -- or acute heart failure.  If they told you in report that your patient has an S3, then it probably is not acute; but if the S3 is new assess further for fluid overload and acute heart failure.

    Congratulations to Julia Mason who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly.  Congratulations Julia!   

    Best wishes,
    David W. Woodruff, MSN, RN-BC, CNS, CEN
    President,     Ed4Nurses, Inc.

    PS. Find the answer in this YouTube video...

    (c) 2010 Ed4Nurses, Inc.  Feel free to print this e-mail and share it with your colleagues. Other forms of digital or print reproduction are prohibited without prior written consent from Ed4Nurses, Inc.
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