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Littman Cadiology III, is it supposed to have a hole in the diaphragm?

Discussion in 'Allopathic' started by p9142, Mar 5, 2007.

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  1. p9142

    p9142 UR out of your element!

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    I just got a new Littman Cardiology III stethoscope as a birthday gift, and I noticed something strange. The pediatric side has a small pinhole in the center of the diaphragm. Is this normal? I am just a pre-med and have no idea how to use this thing, but I would like to know if I should send it back. I can hear things if I use the adult side, but the pediatric side doesn't seem to do anything.
  2. jbrice1639

    jbrice1639 Cub Fan, Bud Man

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    yes, it's supposed to have a hole. that allows it to function as a traditional bell. in order to hear things out of that side, you have to rotate the head 180 degrees (twist it around the axis of the tubing - read the directions if this isn't clear).
  3. p9142

    p9142 UR out of your element!

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    Hey, many thanks. I appreciate you resisting the urge to blast me for being a premed idiot.

    /p
  4. Winged Scapula

    Winged Scapula Cougariffic! Administrator SDN Senior Moderator Lifetime Donor

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    Mine does (its also got crumbs in it frm the bottom of my pocket).

    As noted, above you have to twist it to hear things with the pediatric side.
  5. Blue Dog

    Blue Dog Avec caféine. Gold Donor SDN Advisor

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    I guess that explains all those pleural friction rubs you keep hearing. ;)
  6. TheMightyAngus

    TheMightyAngus

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    Is it possible to convert the pediatric diaphragm to a bell? Or do I have to buy another head?

    Edit: My pediatric diaphragm aint got no hole.
  7. Gimlet

    Gimlet Cardiac Anesthesiologist

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    Yes, it's possible (and recommended by some attendings). You should be able to peel back the plastic ring that holds the pediatric diaphragm on by pushing on it with both thumbs (push back toward the adult diaphragm side, not off the pediatric side, if that makes sense). Your stethoscope should have come with a rubber non-chill ring to attach to the bell side once the pediatric diaphragm is off.
  8. Dakota

    Dakota Senior Member

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    I was just about to pose this as a question. How many leave the pediatric "tuneable" diaphragm on and how many convert it to a bell?

    Personally I like having the traditional bell on one side, but at the same time I'm afraid of actually getting little crumbs in the steth from having an exposed bell in my coat pocket.
  9. Winged Scapula

    Winged Scapula Cougariffic! Administrator SDN Senior Moderator Lifetime Donor

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    You presume I actually use (and remember how) to use the thing! :D


    Hmmm...chocolatey chip friction rubs...
  10. Winged Scapula

    Winged Scapula Cougariffic! Administrator SDN Senior Moderator Lifetime Donor

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    I did...

    Is that a problem?:D
  11. H_Caulfield

    H_Caulfield Junior Member

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    My friend, nobody blasted you for being a pre-med idiot because everybody feels too bad for you...being the type to ask for a Littman Cardiology III stethoscope for your birthday. Weren't there any video games you wanted? Good Lord...
  12. Blue Dog

    Blue Dog Avec caféine. Gold Donor SDN Advisor

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    Actually, that little "emergency snack" could come handy when you're on-call late at night after the hospital cafeteria is closed. ;)
  13. OncoCaP

    OncoCaP

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    Another premed here. As long as you don't make the mistake of wearing it to class on the first day, you should be fine ... ;)
  14. Kazema

    Kazema In a kingdom by the sea

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    I remember last year during the second semester, I remarked to a friend that I could never hear anything using my bell. First they were saying stuff like, "Oh yeah, i have trouble too, you have to be in a quiet room" and all that jazz.

    After I told them I couldn't hear anything in even a quiet room, and I could tap on it with my finger and still didn't hear anything, they asked if I rotated it to switch to the bell.

    Yeah I felt pretty dumb.
  15. jcms

    jcms New Member

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    jbrice1639 wrote that the small diaphragm has a hole and that allows it to function as a traditional bell - how about a big diaphragm?Doesn't it work as the traditional bell when a little pressure applied to the chestpiece (it's tunable as the small one is and doesn't hava a hole)?
  16. Dakota

    Dakota Senior Member

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    The trick is you have to apply firm even pressure, and few patients have perfectly flat surfaces onto which you can apply said firm even pressure (esp trying to hit anything around the rib cage).
  17. Anastasis

    Anastasis caffeinated for safety Moderator Emeritus

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    Awww... that's how I was planning to pick you out of the crowd the first day of classes :smuggrin: ;)
  18. Critical Mass

    Critical Mass Guest

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    You're not an idiot until you put the stethoscope on backwards and wonder why you can't hear very well. :thumbup:
  19. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    I think the answer to your question is technically yes. I was told that the diaphragm will act like a bell if little-to-no pressure is applied. Conversely, the bell will act like a diaphragm if a lot of pressure is applied (pressing down on the bell will tighten the skin under it, making it, functionally, like a diaphragm).

    The only problem, as Dakota said, is that the big diaphragm will make it hard to achieve good surface contact with the patient's chest, especially on the anterior surface.
  20. kylek044

    kylek044

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    Do you really want to be pushing down "firmly" on a kid? It's probably for that reason; adults have more meat on 'em.


    Oh BTW, does it really matter if you convert it to a bell? Can you use the adult side on a ped. patient given that they're not too small?
  21. jcms

    jcms New Member

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    master cardiology has hole in adult diaphragm so why cardio III doesn't?Both have tunable diaphragms which work as diaphragm and bell
  22. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    The pressure that you apply to your stethoscope doesn't always increase the loudness of what you hear. The pressure can change which frequencies you pick up. The bell (= light pressure) will pick up low frequency sounds like murmurs. The diaphragm (= firm pressure) will pick up high frequency sounds. The amount of body mass the patient has isn't always that relevant.

    Again, converting it to a bell doesn't have anything to do with the size of your patient. It has more to do with what type of sounds you want to pick up.

    I was confused by this, because I had always thought that the hole in the diaphragm doesn't allow the diaphragm to become tunable. I thought that there's a special ring/gasket behind the diaphragm in the Littman that makes it a tunable diaphragm.
  23. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    I think, actually, that some diaphragms have holes in them to prevent the formation of a vacuum against the skin??? Maybe??
  24. Blue Dog

    Blue Dog Avec caféine. Gold Donor SDN Advisor

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    My guess is that the hole in the diaphragm prevents the creation of a vacuum behind the diaphragm when the eartips are properly sealed against the ear canal. Because of the mobility of the tunable diaphragm, a vacuum could affect the mobility of the tympanic membrane (similar to pneumatic otoscopy), which could be uncomfortable as well as impair auscultation.

    Edit: smq123 and I appear to have posted at almost exactly the same time. Great minds think alike! ;)
  25. jcms

    jcms New Member

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    maybe you're right but why only the pediatric diaphragm has a hole?Big diaphragm is tunable too so?Why?Master Classic II doesn't have a hole in diaphragm which is tunable too and the stethoscope is single-sided as Master Cardiology is.
  26. jcms

    jcms New Member

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    any new idea?
  27. Blue Dog

    Blue Dog Avec caféine. Gold Donor SDN Advisor

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  28. Critical Mass

    Critical Mass Guest

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    Not all diaphragms work as well with holes poked in them, just those on stethoscopes. Keep this in mind.
  29. kylek044

    kylek044

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    Hahahaha. Hey, you must be a doctor...or at least a student doctor.
  30. 45408

    45408 aw buddy

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    Then my class has a lot of idiots. :D

    It's just fun to point out to the people who put their scopes in backwards and then say they can't hear anything.
  31. OncoCaP

    OncoCaP

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    Don't worry. I'll already be sticking out like a sore thumb because I'll probably be the oldest person in the class. There is no way I can hide, so I might as well wear the steth on the first day. I remember on one of my med school interview days, all the candidates and several med students went to a nice restaurant and the waitress handed me the check because she thought I was the professor.:laugh:
  32. afr0dite01

    afr0dite01 Member

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    I change mine small diaphragm to bell depending on where I am. If Im in peds, Ill leave the diaphragm on and maybe fam med. But other things, I use the bell because youll most like be using it to listen to extra heart sounds on adults. I think its going to depend on your attending and the rotation your on.
  33. Jasoos

    Jasoos Speculumating

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    I have a Litmann Classic III. Is it any good? Will I need another one for ped?

    BTW: I found something pointless to do with my steth today:
    A stereo headphone, when auscultated with the bell, gives more bass than one can ever imagine coming from a headphone!
  34. alwaysaangel

    alwaysaangel

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    Yeah, I think almost anyone would do this.

    I have been a volunteer MA for years and have trained probably like 20 people how to do manual blood pressure.

    Every damn one put the stethoscope in their ears backwards (including myself when I was taught).
  35. p9142

    p9142 UR out of your element!

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    Sweet! I can't believe this post got so many replies. OK, it is on the right way, but it freaking hurts if you keep it in your ears for any more than 20 seconds. Do I just have sensitive ears or something?
  36. kylek044

    kylek044

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    I just got a Littman, and it is awful tight... supposedly, with use, it will stretch a little.
  37. Critical Mass

    Critical Mass Guest

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    Is it a Classic II or a Cardiology III?

    Never mind. Doesn't matter either way.
  38. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    I don't think the stethoscope is supposed to be painful to wear for an extended period of time. You can wait for it to loosen naturally, as you keep using it, but you can also gently (GENTLY) pull the eartubes apart to make it more comfortable. If you pull them too much, then cross them over to tighten it up.

    http://solutions.3m.com/wps/portal/3M/en_GB/Littmann/stethoscope/education/stethoscope-anatomy/

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