"Tinkling Bells"?

[musicemt]

While discussing s/sx of AAA with another medic last night, she mentioned auscultating the abdomen and listening for a sound like bells tinkling. I got the impression that that was a sound you could associate with blood or fluid leaking into the abdominal cavity. Not heard of this or seen it anywhere that I remember, anyone have some guidance or references on this I can look up?

[JenVTemt]

I've never heard of that. With as many sounds as the abdomen makes and the intestines being up against the front wall of the abdomen I imagine it would be quite difficult to pick up such a noise. ...but it would be interesting to know if there is indeed some science behind that.

[GaHazMedic]

First I've heard of it.

[musicemt]

Did a little bit of research, and all I can find is that a AAA MIGHT be associated with a bruit on auscultation, but number one it doesn't occur often enough to really be a diagnostic indicator and number two the bruits I've heard don't sound like tinkling bells at all, more like a swooshing sound.

I'm stumped.

[JenVTemt]

Bruits are characteristically a swooshing sound, but unless the artery is damn near completely blocked they are very difficult to hear in the prehospital setting. ...the "twinkling bells" may be something similar, but I can't imagine it being an easy find either. There are a lot of other more reliable signs of a AAA. Mostly, your patient probably will look like sh!t. haha.

I wonder if there is a recording somewhere of that sound, like they record lung sounds, so we can hear what it is suppose to sound like.

[kjrff23]

Was always taught to palpate it and it would be a pulsating mass.

[GaHazMedic]

Was always taught to palpate it and it would be a pulsating mass.

The latest news is to not palpate. They say it can cause it to rupture. Haven't read all the research on it yet, so I am not fully aware if this has happened or just a precaution.

[scotttt]

Gazhaz, if you could cite a document, that'd be great.

Because no mention here (a review article) about what you say:

"Palpation to detect a widened aorta in the proper clinical
setting appears likely to be quite valuable in raising the clinical
suspicion for abdominal aortic aneurysm and may be considered
diagnostic when positive in the setting of high pretest probability.
Emergency physicians should perform a directed physical
examination to detect a widened aorta when assessing all patients
with abdominal pain who demonstrate risk factors for abdominal
aortic aneurysm (eg, age older than 50 years, hypertension,
vasculopathy) or whose clinical presentation suggests the possibility
of ruptured abdominal aortic aneurysm. When ruptured
abdominal aortic aneurysm is a diagnostic consideration,
confirmation by diagnostic imaging should be rapidly sought."

Carpenter, C R. "Abdominal Palpation for the Diagnosis of Abdominal
Aortic Aneurysm." Ann Emerg Med. 2005;45:556-558.

[GaHazMedic]

Gazhaz, if you could cite a document, that'd be great.

Because no mention here (a review article) about what you say:

"Palpation to detect a widened aorta in the proper clinical
setting appears likely to be quite valuable in raising the clinical
suspicion for abdominal aortic aneurysm and may be considered
diagnostic when positive in the setting of high pretest probability.
Emergency physicians should perform a directed physical
examination to detect a widened aorta when assessing all patients
with abdominal pain who demonstrate risk factors for abdominal
aortic aneurysm (eg, age older than 50 years, hypertension,
vasculopathy) or whose clinical presentation suggests the possibility
of ruptured abdominal aortic aneurysm. When ruptured
abdominal aortic aneurysm is a diagnostic consideration,
confirmation by diagnostic imaging should be rapidly sought."

Carpenter, C R. "Abdominal Palpation for the Diagnosis of Abdominal
Aortic Aneurysm." Ann Emerg Med. 2005;45:556-558.

Ignore my previous post. The study data was corrupt. The idiots doing it apparently knew nothing about research.

[mediccjh]

AAAs run in my family. At least I know how I'm gonna die.

[JenVTemt]

From what Ive heard a AAA is a quick, sudden, painless way of death (most of the time) when they burst. Often many aren't diagnosed or recognized until after death.

[Lord_Balsac]

I did an interfacility transport last shift and when reading the paperwork/history it said he had a AAA amongst other things.

So I said "Hmmm, let me see if I can feel it" :glasses1:

It didnt feel like a mass, but there was definitely a pulse down there when I pushed down.

Too bad it didnt break... this old guy was in bad shape.

[jozak78]

if i remember correctly AAA's have to be pretty big before you can feel them, generally 10-15cm on a somewhat normal size person

[Ditch Doc]

I've never heard of this sound, but then again, in a ruptured AAA, all you will hear is me yelling "drive like you stole it!!"

Your partner doesn't talk to his rice krispies, does he?