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Questions re stethoscope bell/diaphragm uses

Discussion in 'Allopathic' started by lemonade90, Oct 12, 2011.

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  1. lemonade90

    lemonade90

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    For listening to carotid artery, does one use the bell when having the patient hold their breath and then use the diaphragm when they are breathing normally?

    What about for the femoral arteries?

    For listening to abdominal and respiratory sounds, does one generally use the diaphragm?
  2. c4e

    c4e Avoiding Death on Ice

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    Generally, you listen to vasculature with the bell and everything else with the diaphragm. Exception is the heart where you listen with both the bell and diaphragm, which will allow you hear heart abnormalities.
  3. isoquin

    isoquin Allopathetic

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    Careful how you talk about these parts nowadays. If you have a Littmann III then both the large and small side can be used as diaphragm and bell. The smaller side is usually for pediatrics and vasculature like the carotids. The bigger side is better suited for the heart, lungs, belly. You can change between diaphragm and bell functions on a Littmann based on how much pressure you apply, and the audio difference is just whether you're picking up higher or lower toned heart sounds.
  4. Suncrusher

    Suncrusher ☣ ☣ ☣ ☣ ☣ Lifetime Donor

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    ^ si. I was pressing too hard with the bell and basically turning it into a diaphragm, and I got corrected about it
  5. 45408

    45408 aw buddy

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    the femoral arteries? No need to be listening to them.
  6. newdoc2013

    newdoc2013

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    nice just learned something i always thought it was the diaphragm for the carotids because its a higher pitched sound. i will switch to bell and see if i can hear better. thanks
  7. mishaS

    mishaS

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    Perhaps you could use a pediatric diaphragm and hear the carotid, but carotid bruits are low pitched, and so a bell would work much better. Also, if you aren't working with kids, why keep the pediatric diaphragm on the cadio III? I realize that it's a "tuneable" diaphragm, but I've heard repeatedly that an actual bell is far better when you are trying to hear low frequencies specifically.
  8. LoveMyRam

    LoveMyRam

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    Unless your both drunk and she's really hot
  9. lemonade90

    lemonade90

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    Femoral arteries for potential AAA or artherosclerosis.
  10. rocuronium

    rocuronium

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    Can you still buy the Littmans without the tunable diaphragm on the bell side anywhere?
  11. Rendar5

    Rendar5

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    No.
  12. 45408

    45408 aw buddy

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    Yeah, no. You should feel for pulses, check Doppler signals if you can't feel pulses, but you don't need to listen to the femorals. If you can't feel a AAA but you're worried about it, you should get a CT or abd ultrasound. If you're evaluating PVD, you should be looking at ABIs and such.
  13. Instatewaiter

    Instatewaiter Octogenarian with a Cr of 3... send a troponin

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    On the littmann III, pull off the pediatric diaphragm and replace it with a rubber gasket. Viola- you have a real bell. The tunable diaphragm is no where near as good as a real bell.

    Bell- bruits (carotid, renal, AV fistula), S3 and S4, Mitral stenosis and for that matter most diastolic murmurs

    Diaphragm- everything else
  14. isoquin

    isoquin Allopathetic

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    no but the tunable diaphragm is easily removable, so there's not really a benefit to try to find one without it.
  15. xanthomondo

    xanthomondo nom nom nom

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    The attendings on cardio listened to femorals on all post-cath patients.
  16. xanthomondo

    xanthomondo nom nom nom

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    lol
  17. rocuronium

    rocuronium

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    Good to know. Thanks.
  18. MossPoh

    MossPoh Textures intrigue me

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    There is a little bit of a debate about the diminished quality with a tunable versus fixed diaphragm. I personally don't think I would notice a dramatic difference, but there are people who swear by fixed diaphragm only.

    As far as the femoral thing, that is just a kind of forced physical exam thing they teach you like all the other random tidbits. About the only time I seem to do the full cardio exam with diaphragm and bell, having them roll over, look for PMI, ausculate some more and all that crap is when they force me to for an OSCE. I just don't have the time for that stuff.
  19. FIREitUP

    FIREitUP

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    Haahaha, I just thought of south park when you said that:
    http://www.youtube.com/watch?v=5oqgnKgwDsk
  20. 45408

    45408 aw buddy

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    And when they think they have a pseudoaneurysm, they call the vascular surgeon, who doesn't listen to the femoral arteries. Just saying.

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