Auscultation in the Time of COVID-19

We thought we'd share this newsletter from Thinklabs with the latest info on using the Thinklabs One for safe distance auscultation:

By the time summer came to Belgium this year, Covid-19 had left the country ravaged. With 9,726 dead out of 61,007 cases of infection, it was one of the hardest hit places in the world.

How an ICU team used Thinklabs One for Safe Distance Auscultation™ amidst the crisis

In the town of Vilvoorde, just outside of Brussels, Helmut Molzahn, a critical care doctor at Jan Portaels Hospital, was taking long walks and reading late into the night to forget about the horrors of the ward. With patients ranging in age from 36 to 76, the mortality rate was hovering around 40 percent.
“It takes its toll,” Molzahn says. “I tried very hard to leave everything at work, for the sake of my partner and my health.” He admits he also has become quite neurotic about handwashing, cleaning his smartphone, and constantly cleaning surfaces. His ICU unit, one of two, has six beds, and was converted into an all-COVID unit in early March. The Vilvoorde area, with a population of about 200,000, is served by two university-hospitals, which took the main brunt of the COVID patient load; Jan Portaels Hospital took the overflow.
After trying, unsuccessfully, to listen to patients with a regular stethoscope while donned in PPE, some of his colleagues argued for omitting auscultation altogether. But that’s not a viable option for Molzahn. He says auscultation is critical, especially when you have patients on ventilators.

With patients ranging in age from 36 to 70, the mortality rate was hovering around 40 percent. "It really takes its toll," Molzahn says.

“If you have a lung collapse in a patient who is mechanically ventilated, that often leads to cardiac arrest and desaturation,” he explained. Breath sounds can be absent in these circumstances, making auscultation even more important, according to Melzahn.
His team tried jerry-rigging solutions with a conventional stethoscope, using everything including duct tape and cables to create their own “hands-free” auscultation methods, but each time they ended up worse-off. Molzahn, who’s in charge of infectious disease protocols at the hospital, decided to do some online research to find a better solution. That’s when he found the Thinklabs One, and ordered it immediately for his critical care unit, using his own private funds.
“The hospital had rightly prioritized the purchase of PPE,” he explained via email. But then they found the One and, he added, “We used the Thinklabs One to protect ourselves. It makes us all feel safe.” His team tried two methods of Safe Distance Auscultation™ with the Thinklabs One: first, they listened with disposable earbuds donated by Brussels Airlines. This method proved only partially successful.
“Lung auscultation was OK, but heart auscultation was impaired by the low strength of the bass,” Molzahn explained, noting that Thinklabs One works well with higher-quality earbuds. “The earpieces also made communication with the nursing staff pretty difficult.”

"We use Thinklabs One in the Covid wards to protect ourselves. It makes us all feel safer."

But, while working with a cardiologist one day, Molzahn’s colleague not only purchased the One for himself, he also had the idea to use it with a JBL portable loudspeaker, and voila, the ideal listening solution was born.
“The cable is long enough to avoid feed-back. We still use the JBL speaker attached to an extension cable with maximum extension,” Molzahn says. “It makes it so you can hear the nurse and auscultate perfectly at the same time.”
After treating 20 COVID patients this spring, his COVID case load is down to two. Molzahn is now preparing for a second wave, hopefully with a lower mortality rate than he had last spring. As the hospital stockpiles PPE, Molzahn builds his library with books in six languages that hopefully will once again help him leave the stresses of work well behind him each day when he leaves the ward.

To find out more about using Thinklabs One for Safe Distance Auscultation™, visit our COVID-19 page.