more stethoscope questions..Masters II

Dr Firefly said:

The company that was meant to be selling me the harvey elite messed up, ran out of stock and generally messed me around for two weeks. Now I've just had a refund from them, and was about to order another harvey elite from a different supplier.

But I've just seen a Rappaport-Sprague for $450 in an antique shop near me. Original Hewlett Packard. Works perfectly. Should I get it? Is it too much for an old stethoscope?

Also would I look silly on the wards?

I'm torn, and advice would be appreciated.

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that actually sounds like a good price for the HP Rappaport. I've seen them upwards of $1000 frequently on ebay. If you want the Rappaport and can afford it, I don't see what the problem is. Just keep in mind stethoscopes do have a habit of walking off on the wards

Yeah, get it. They go for a grand on ebay.

I bought it! It wasn't in a local shop - I actually bought it off the internet but didn't want anyone to search for it and snap it up before me. Should be here in the next week. I hope it's worth the money and the wait.

Should I notice a difference compared to my Littmann classic II SE? Will be gutted if the only difference is more artefacts from the tubes rubbing together!

Thanks,
Ian

Dr Firefly said:

I bought it! It wasn't in a local shop - I actually bought it off the internet but didn't want anyone to search for it and snap it up before me. Should be here in the next week. I hope it's worth the money and the weight.

Should I notice a difference compared to my Littmann classic II SE? Will be gutted if the only difference is more artefacts from the tubes rubbing together!

Thanks,
Ian

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No, you wont notice any difference. You'll only hear the tubes rubbing together, so you should take some duct tape and wrap it around the entire length of the tubing. Better yet, just send it to me.

you nitwit.

howelljolly said:

No, you wont notice any difference. You'll only hear the tubes rubbing together, so you should take some duct tape and wrap it around the entire length of the tubing. Better yet, just send it to me.

you nitwit.

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Ok will do both those things. I'll send you my old steth too so you can compare

Does anyone know where I can order a pair of medium soft eartips for the Harvey Elite? The large ones that comes with it doesn't fit properly in my ear so using the medium one in the accessory kit...would like a back up.

It's definitely not as booming and muffled as the littmann. It's not as loud though...maybe I damaged the flat diaphragm when I replaced it. Those with poor hearing might notice a significant difference.

http://www.allheart.com/ty5079cset.html

or

http://www.miami-med.com/welch_allyn_harvey_elite.htm

or, visit your friendly neighborhood medical bookstore.



One thing Ive found when using the WA-Elite... slight changes in position make a difference. The angle of detection seems to be more narrow (think of an echo transducer). Actually palpate the PMI, and listen over it. Search around a bit for the other locations. A few centemeters seems to make a difference between hearing something vs. not.

Also, having the patient twist to the left, or lean forward really does help.

But yes, you sacrifice intensity for resolution.

Thanks! So the small "Comfort Sealing Eartip" = medium from Welch Allyn?

You are definitely right about the changes in position affecting the sound. I was not expecting that as I was using the Classic II SE where you can approximate each spot and hear the same quality of sound. I wished I started with this when I first learned to auscultate...time to get rid of some bad habits.

It arrived! Looks used but generally in great condition. Very distinctive looking - I think I'll have to get it engraved pretty quickly.

Nowhere near as loud as my littmann classic SE, but somehow that doesn't matter - I can hear everything better. Pretty cool! Less artefacts than the Littmann - hardly hear those tubes rubbing that everyone goes on about.

Here's a photo

If its nowhere near as loud as the littmann classic, you should check it for an air leak somewhere.

pump air through the earpieces, and submerge the whole damn thing in water, then search for air bubbles.

Seriously, look for a crack in the tubing, or a loose connection.

What a difference!

Used it for the first time on my on-call shift today - medical cover - nightmare - 3 junior doctors, 1 registrar and 500 patients to cover. We just basically firefight over the weekend - keep everyone going till the day teams return on Monday. But it's great to increase your experience as you end up making all kinds of decisions you would normally never make on your own during the week.

The stethoscope's amazing. I'm hearing so much more - not heart sounds particularly, but listening to lungs is crazy - I'm having to be careful not to diagnose everyone with heart failure because I can hear so many minor bits and bobs. Lots of stat IV frusemide given today - I'll have to wait till their chest X-rays come back during the night to see if I was right or not. One guy I found inspiratory creps, coarse expiratory crackles, polyphonic expiratory wheeze, and broncial breathing, along with areas of reduced air entry. I've never been able to get that much info with my Littmann classic - makes me realise where all these old-fashioned clinical textbooks get their words from. There's so much to hear

Anyway, it was a good purchase (unless there's a lot of totally clear chest X-rays and a lot of patients in ARF when I return tomorrow morning - we'll see!)

Thanks guys for the info and help and advice on here as regards steths - would never have known this one existed otherwise.
Ian

I'm going to be entering medical school this August and I stumbled across this thread (assuming it's mostly dead...but I'll post nonetheless). I was wondering if you all had any stethoscope suggestions for a med student.

Also, if anyone here is still looking for the HP steth, I found a few cheaper ones on Ebay - assuming I've stumbled across the correct one. I don't think I really want to spend $300 on a scope...yet.

http://shop.ebay.com/?_from=R40&_trksid=m570&_nkw=HP+Hewlett+Packard+Rappaport+Sprague+Stethoscope

Thanks for the reply. I did some more researching last night (before I read your post) and had all but decided on the Welch-Allyn Harvey Elite DLX...thank you for reaffirming my decision. Is there much difference between the DLX and Elite?

Also, has anyone bought from steeles.com? They seem to be very cheap and I was wondering how reputable they are.

Thanks for the advice! I wasn't planning on the 3 head one...I haven't even learned what I should be doing with the first 2.

GoIrish2010 said:

Thanks for the advice! I wasn't planning on the 3 head one...I haven't even learned what I should be doing with the first 2.

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I purchase both of my harvey's from steeled without issue. Personally I carry the three headed Harvey as I use the flat and corrugated diaphragm more than the bell.

I'll vouch for Steele's. I ordered my Harvey DLX from them in medical school and had it laser engraved. The warranty from Welch-Allyn is great, I've had to get new tubing after the first set cracked (lesson: don't use the nasty cleaning wipes) and they Fedexed me a new set no questions asked. The sound quality from the scope is the best I've found.

Just got my Harvey DLX today! Thank you all for the advice...now I just need to learn how to use it haha

vaiar said:

Congratulations. A nice website to help you with your auscultation skills is http://www.blaufuss.org/tutorial/index1.html. Click on contents in the upper left corner to surf through the different murmurs and the explanations of their origins.

The "Cardiac Exam Virtual Trainer" on the Littmann's USA website is also recommended: http://www.3m.com/healthcare/littmann

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Thanks...I'll definitely check these out!

I own a Harvey Elite and it is pretty amazing. It comes with a holographic flat diaphragm. I purchased an extra diaphragm assembly to interchange with the ribbed diaphragm if I chose, and it came with instead a white, semi opaque diaphragm. This is superior to the original one. Sounds seem clearer and tighter. If you look closely the holographic it is slightly convex. Perhaps this has something to do with it. You can feel the white one and it is certainly tighter. Anyone who owns this scope should look into obtaining this white diaphragm; you are missing out. (IMHO)

Also, I have not had the opportunity to ever try a Cardiology II. I was wondering how it compares to the Elite. I think the Cardiology III looks better and is more comfortable to use and handle, but the Elite outperforms it hands down. Stethoscopes are sort of my hobby and I thinking of buying a Cardiology II. I'm sure "Blue Dog" can answer, lol. Thanks.

gutonc said:

I am still using the Welch-Allyn Harvey DLX that I bought as an MS1 (1997 for the record). I've replaced the tubing once ($25) and the soft eartips twice ($15 each time...now using the hard plastic ones that came with it 13 years ago). The sound quality and isolation is excellent. It costs about the same as the Littman Cardio Master (the only scope besides the HP that even comes close to it...but still not as good) and has user replaceable parts (you have to send Littmans back to the company for repair). Plus, the head unit is heavy enough to use as a pretty serviceable reflex hammer, or a blackjack if you happen to need some muscle before security gets there.

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Qft

Blue Dog said:

Already did: http://forums.studentdoctor.net/showpost.php?p=7899619&postcount=70

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Oh ok. Right. I know it's a great scope, but I was wondering specifically how it compares to the WA ELite? I'm not such a fan of the Cardiology III but if the II is similar in performance to the Elite it may be worth owning one of these.

Blue Dog said:

If you follow the link in the post that I referenced, you'll find an excellent head-to-head comparison.

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Oh ok, yeah I saw that. But I was asking about the cardiology II which that article doesn't reference. Also the study uses the ribbed diaphragm not the flat one, which may not be practical for everyday use.

jcoffin1981 said:

Also the study uses the ribbed diaphragm not the flat one, which may not be practical for everyday use.

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why not? i carry the three headed version with the corrugated and flat diaphragm without any issues.

[URL=http://www.allheart.com/omhsamd50.html said:

these[/URL] instead. At that point, the Cardiology III might actually be usable.

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I use a Master Cardiology III and I have no complaints. I have worked with a lot of highly regarded cardiologists, most of whom used Littmans. I bought mine because it was the easiest to obtain through my school, and it has a smaller diaphragm for kiddos so you aren't listening to their entire chest at the same time.

I have also heard very soft murmurs with nurse's station POS scopes. Being in a quiet room and using proper positioning and technique is a lot more important for auscultation than the type of scope you have. Unless you take into account electronic, volume-amplifying scopes, there is just not a lot of technology involved to matter that much.

In the end it is mostly a style thing, sort of like using a Cross ballpoint pen instead of a Bic disposable. You can't look at a written note and tell which type of pen was used, just like you can't look at someone's cardiac exam notes and tell what type of scope they used to hear a I/VI diastolic murmur.

In short, buy a scope in your budget that you are comfortable using, and practice.

Blue Dog said:

The Cardiology I and II are acoustically identical. The major difference is that the I uses a metal screw-on diaphragm retaining ring, while the II uses a slip-on plastic one.

You'll hear more with the flat diaphragm than the corrugated one on the Harvey Elite. I wouldn't recommend the corrugated one unless you have a triple-headed scope like Hernandez.

I have all three (Cardiology I, II, and Harvey Elite) and find the acoustic quality to be very comparable between them all. I tend to use the Littmanns most of the time simply because I find them more comfortable.

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Ahhh, ok. Thanks, you've answered my question. I meant the corrugated diaphragm isn't practical if it is the only one you use. That's why I bought an extra head to interchange easily with the flat one if I choose, but I have not found a big advantage with the ribbed one. Yes I have to agree that the Littmanns are more comfortable than the WA. They are lighter, more comfortable on the ears, and the rubber on the bell rim is so much more comfortable to hold. The hard plastic on the WA abrades my fingers after a while.

I know the debate on the length of steth tubing has been addressed, but has anyone here used the same stethoscope model in different lengths and perceived a change in sound quality? For example a WA Harvey ELite in 22" and in 28?" I have just purchased a Cardiology II and in comparison, sounds on the WA just seem, well, "distant." (The Littmann is only 21", the WA is 28") I am debating cutting the tubing on my WA or replacing it with shorter. I fear that 22" length may be just too darn short to be practical, but I may gain advantage by reducing to 25." Does anyone have experience or opinions on this? Thanks

I've purchased two Cardiology II steths on Ebay with the intent of refurbishing one of them. There are some slight differences where the diaphragm snaps on. It is possible that there were some slight design changes, or that one of these is not genuine. Perhaps someone who is knowledgeable in Littmann scopes can look and give me their opinion. Thank you.

http://img339.imageshack.us/i/togetherp.jpg/

http://img3.imageshack.us/i/deskzi.jpg/

Blue Dog said:

I've used stethoscopes in all three lengths. 22" is pretty short, and 28" is a little long-ish. I find that 25" is "just right." I honestly can't tell any difference in terms of acoustic quality. It's more of an ergonomic preference.

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I have taken a chest piece and attached it to different lengths of tubing. You may hear a difference this way. Shorter sounds better to me.

It is perfectly flush; there is no metal extending above the snap on rim. You are probably correct, it is most likely an earlier version. It is also 24." I didn't know that it was ever available in that length. I thought only 21" Unless the tubing is aftermarket or fake. I'm trying to decide if I'm going to refurbish one of these and use it, or just get rid of them and keep my Welch Allyn. I really enjoy auscultation and want to develop my skills as much as possible. Stethoscopes have turned into kind of a hobby for me. Maybe it's time for a girlfriend, lol!

on the topic of stethoscopes, I've always wondered if any of those wipes at hospitals has been shown to degrade the material on stethoscopes over time. I go to town with those cavi-wipes and bleachwipes at times not just on the diaphragm, but along the entire tubing and earpiece as well.

So I'm going to be starting residency this July and was also wondering about my steth. I've used a Littmann Classic II SE throughout all 4 years of med school and always thought it worked fine (but really, what do I know). All the attendings/residents etc seemed to have some version of a Littman so I always thought it was okay.

Having read though this thread and other stethoscope threads I'm thinking I need to switch it up. Would any of you guys actually recommend me getting a knew one or should I just stick with the one I've got since it's in perfect working order?

Appreciate any replys

Post deleted so that I'm allowed to start it as a new thread. Thanks for the friendly welcome back to the forums