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

p9142

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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.
 

jbrice1639

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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).
 
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Gimlet

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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.

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.
 
D

deleted77919

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.
 

Winged Scapula

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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?
I did...

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.

Is that a problem?:D
 

H_Caulfield

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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.

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...
 
Jan 21, 2006
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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.

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

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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.
 

jcms

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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)?
 
D

deleted77919

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)?

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).
 

smq123

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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)?

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.
 

kylek044

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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)?

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?
 

smq123

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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?

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.

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

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.
 

smq123

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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

I think, actually, that some diaphragms have holes in them to prevent the formation of a vacuum against the skin??? Maybe??
 
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Jan 21, 2006
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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! ;)
 

jcms

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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! ;)

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.
 

OncoCaP

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

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:
 

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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.
 

Jasoos

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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!
 

alwaysaangel

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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.

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).
 

p9142

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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?
 

smq123

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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?

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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