MedStudent219

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Hi all, I have a littmann classic III and it came with two tunable diaphragms, a paeds one and an adult one. I have removed the paeds one to get an open bell instead. But I am confused now, how hard do i press down on the diaphragm side to use it as a diaphragm? Because it is still tunable on that side right? if i press to hard, all sounds go away. Conversely, how hard do i press on the bell side? do i just rest it without any pressure on top? Sorry if this is a dumb question im just really confused and would appreciate any help. thank you!
 

longhaul3

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If you're using an open bell you don't really need to press down at all to hear the low-frequency sounds. For the tunable diaphragm side, if you just rest it on the patient it will basically be the same as the bell side, and then when you press gently you will start to hear the higher-pitched sounds more clearly. Maybe about as hard as you would pet a dog or hold a phone to your ear. Think of how your doctor presses on your chest with a stethoscope—probably not very hard at all.
 
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efle

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I think DO students are trained to push until they hear something pop
 
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Depends if I'm doing it correctly (straight on skin) or wrong (through clothes). If I'm going through clothes, I have to put some pressure on it, not too much to cause pain obviously, but the pt. definitely feels me pushing. Mind you, the way I hold it, I'm only going to be generating force with two fingers, so that's not going to be that much, though I do sometimes kinda support their back/shoulder with my other hand so as to not just push the pt. away from me. If I'm doing it on skin, I'm doing little more than placing it on them unless they have really diminished breath sounds/distant heart sounds to the point where I am having difficulty hearing things clearly.
 

LoGo

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Enough to make it seem like I’m doing something and not just waiting for the CXR/echo/ecg/CT to come back with real answers.
 
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deleted957830

This is my exact technique
To get extra bonus points, I close my eyes every time I move the bell and pretend that I'm really getting myself in tune with the rhythm of another person's body.

In reality...I have no idea what I'm listening to. And all the medical students, post-cardio (back in preclinical), who say "So glad this stethoscope just isn't just a prop anymore!"...they have special spots in hell.
 
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takeurmeds02

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The real question is how hard to press down the u/s probe lmao - we had to practice on each other and I didn't realize so many students are trying to punch holes through bodies by pressing down so damn hard
 
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CherryRedDracul

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The real question is how hard to press down the u/s probe lmao - we had to practice on each other and I didn't realize so many students are trying to punch holes through bodies by pressing down so damn hard

I see the opposite when I teach med students how to ultrasound: they don't push hard enough.
 
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aldol16

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Just don't press too hard. If you press too hard with a bell, you're essentially turning it into a diaphragm with the underlying skin.
 
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