littmann cardio III conv. small diaphragm to bell

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jcms

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Is it good idea to covert small diaphragm to bell?Does the small diaph. protect the inside of the chestpiece and tube from dust?How about sound quality?

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its designed to be both a bell and a diaphragm based upon the amount of pressure you apply. I know some people like taking it off so i guess thats just personal preferance.
 
Most cardiologists will tell you that a medical student will not be capable of manipulating the tunable diaphragm correctly to produce the bell/diaphram functions, and therefore will be better off just taking the diaphragm off and using it as a true bell. In our small group sessions with a cardiologist for learning heart sounds, he made it sound like you would be laughed out of his clinic if you came in with the diaphragm still on.
 
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I would just convert it to a typical bell. In 1st/2nd year when you are being tested on physical exam skills, SP/SPI's have an easier time telling when you are using bell versus diaphram.
 
Most cardiologists will tell you that a medical student will not be capable of manipulating the tunable diaphragm correctly to produce the bell/diaphram functions, and therefore will be better off just taking the diaphragm off and using it as a true bell. In our small group sessions with a cardiologist for learning heart sounds, he made it sound like you would be laughed out of his clinic if you came in with the diaphragm still on.

I think the cardiologists would laugh at a Littmann III in general.
 
Most cardiologists will tell you that a medical student will not be capable of manipulating the tunable diaphragm correctly to produce the bell/diaphram functions, and therefore will be better off just taking the diaphragm off and using it as a true bell. In our small group sessions with a cardiologist for learning heart sounds, he made it sound like you would be laughed out of his clinic if you came in with the diaphragm still on.

I think this is ******ed. My medicine attending, who is a cardiologist, observed me doing a cardiac exam and pointed out that I was doing an excellent job by alternating pressure, as I was supposed to do on the Littmann. It's really easy, as long as you have a decent hold on the skin: low pressure, low frequency sounds; high pressure, high frequency sounds. My resident and intern couldn't hear the intermittent S3 I had reported, but the attending could as well- and he said that it was because they had Littmanns and weren't using the bell mode properly. The instrument isn't very difficult to use and just because that douchebag cardiologist doesn't get how to use it (or realize that people know how to use it properly), that it should be somehow 'out of bounds'. We're learning how to be physicians, there's no reason we aren't capable of mastering these techniques right now.

Now what I don't get is- is there something I have to do to listen to sounds from the pediatric side? Simply turning it over doesn't work for me, though I just tried that once. I think I have to twist the tubing, maybe?
 
Now what I don't get is- is there something I have to do to listen to sounds from the pediatric side? Simply turning it over doesn't work for me, though I just tried that once. I think I have to twist the tubing, maybe?

Twist the actual diaphragm base around, right by the edge of the tubing. You should feel it lock into place and then you can use the pediatric diaphragm. Just make sure it is locked in place, otherwise you won't hear a darned thing.
 
I think the cardiologists would laugh at a Littmann III in general.

I doubt it considering my uncle is a cardiologist and uses the Cardiology III and recommended it to me, and I highly doubt that any physician will care about something as trivial as what brand of stethoscope you have as long as you use it properly.

Gotta love the things you read on SDN. :laugh:
 
A recent journal article shows data suggesting that, with a tunable diaphragm, the pressure required to simply get a seal against the skin is already too much to get the low freqency sounds. In other words, you physically can not press a tunable diaphragm lightly enough in order to get the low frequency response.

Some diastolic murmurs are very low pitched, you need a good bell to hear them.

Take the pediatric diaphragm off and use the traditional bell. Put the pediatric diaphragm back on for your pediatrics rotation if you want.

For the Step 2 CS, you either have to use a traditional double-sided stethoscope, or verbalize that you are using low or high pressure.

Plenty of clinicians do not like the tunable diaphragm. Some cardiologists may like them. One of the cardiologists at my hospital doesnt have a stethoscope. To each, their own.
 
i just dont get how you change to the bell. is there a video of how to change it somewhere?

Do you still have the materials that came with it? Mine included a little booklet with instructions in like 20 different languages.

Basically, you just pull/roll the rubber rim [on the peds side] off of the metal edge of the chestpiece - toward the center. Once you get it off the metal, you can just slip it back over and off. Lift the diaphragm out, roll on the thicker "nonchill bell sleeve" that should have come with the stethoscope, and you're good to go.
 
Is it good idea to covert small diaphragm to bell?Does the small diaph. protect the inside of the chestpiece and tube from dust?How about sound quality?
Yes, take it off immediately because you look like a dork with the small diaphragm on. The only excuse for having the small diaphragm on is being on your pediatrics rotation (real pediatricians always carry pediatric scopes, but the small diaphragm does work fine on infants and small children while you're on the rotation). If you're not on peds, you look like a medical student who doesn't mind having the bell covered-up because you really don't know how to use your scope yet anyway. The small diaphragm interrupts the acoustic capabilities of the bell - it's only meant for peds.

Just my humble opinion <grin>. And I'm not picking on you - it just amazes me how much more I can hear as each year of my training passes. It's like a part of your brain has to learn to interpret the scope just like your language centers had to develop. I find it hard to remember why it used to be that I couldn't ever hear a murmur - but I remember that time! (FYI, when you have your bell exposed, you'll normally keep your scope turned to the diaphragm side - that will keep the dust out - plus, your scope doesn't hang around your neck right when it's turned to the other side and you won't have that cool 'Grey's Anatomy' look.)

I may well get a Master Cardiology scope someday with the tunable diaphragm - they're great scopes - but I bought the Cardiology-III because: a) it does have the little diaphragm for peds, and b) I do know of a few instructors who severely frown on students using a tunable diaphragm, theory being that you should learn to use a traditional bell first. I'm not sure that's necessary, but I picked bigger issues for deliberately pissing-off instructors.
 
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