ABSTRACT
What is the future of physical assessment in general, and the stethoscope in particular? In the acute care setting, clinicians must make important and sometimes life-saving deci sions based on physical examination, even when sophisticated medical devices are readily at hand. Clinicians must sometimes undertake immediate therapy based on physical exami nation and auscultation before diagnostic tests are obtained. Examples include the removal of foreign bodies from the upper airway, providing oxygen to the cyanotic, checking the oxygen supply in oxygen-dependent patients, treating a tension pneumothorax, tapping a large pleural effusion, treating asthma exacerbations with bronchodilators, repositioning a displaced endotracheal tube, patching an open pneumothorax or administering a diuretic to a patient in pulmonary edema. Auscultation can provide important information about chronic diseases, such as asthma or interstitial fibrosis, or in the management of patients with heart failure or COPD. Physical assessment of the chest is likely to remain important despite new technologies. Hopefully, the use of computer-based teaching techniques and tape recordings and the feedback provided by bedside visual acoustic displays will improve the performance of clinicians in this ancient art.
