more stethoscope questions..Masters II

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APACHE3 said:
What about the Littman Masters II w/ no bell? I'll be an IM intern! 😀
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I assume you mean the Master Classic II? I don't recommend it for physicians. It's a general exam 'scope with single-lumen tubing and the infamous "tunable diaphragm", which is guaranteed to turn subtle heart sounds into mush. It's OK for nursing or other fields where you're not interested in the finer points of auscultation, but physicians (particularly IM) should use a good-quality dual-lumen cardiology stethoscope with a true bell and diaphragm. Check out the Welch-Allyn Harvey Elite, an older Littmann Cardiology II (not S.E.), or HP/Philips Rappaport-Sprague. The latter two are discontinued, but can be found on eBay.

Also, check out this thread and this thread. Lots of good info there.

Hope this helps,
Kent
 
You saved me $85 bucks and some embarrassment! thanks! 😀
 
APACHE3 said:
You saved me $85 bucks and some embarrassment! thanks! 😀
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I am a believer in the old addage that it is not what you put in your ears that matters, rather it is what is in between the ears that is important. Use any steth you like. One of my best attendings uses that rinky-dink not even good enough for nurses littman Classic II SE and still waxes all philisophical on S3, S4, clicks, opening snaps. That having been said, I use the Master Classic II and wish I had something nicer. Alas, an intern's salary has kept my urge to buy anew at bay.
 
Well, I have the Littman II SE and as a student it was great, but I was never terribly pimped on my auscultations anyway, so it was fine, but now I see the finer points of audiometry (hz), dual tubing, etc. being discussed and I'm like..whooa. I saw some good deals on ebay. The Welch-Allyn Harvey Elite sounds nice, but its only 25" whereby the Littman cardiology is 27". I'm tall and I'm sure by the end of the day that extra 2" makes a difference!! 😀 But the Welch is $60 cheaper!! 😕
 
Are you sure you want longer tubing? When I started med school I got the longest tubing I could find, on the basis that I didn't want to start frenching my patients (or smelling them) when I was auscultating. After repeatedly borrowing various stethoscopes from others with shorter tubing, I'm convinced that my super-cool long tube is dampening anything more subtle than, say, a jet plane taking off inside the patient's chest. I'm definitely going for a shorter 'scope when I replace this one.
 
ok so size doesn't matter..? 😀 I'll try to borrow a Welch just to check it out. Thanks
 
sacrament said:
I'm convinced that my super-cool long tube is dampening anything more subtle than, say, a jet plane taking off inside the patient's chest.
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So, tell us...how long is it? 😉

Seriously, a couple of inches shouldn't matter (we're still talking stethoscopes here). Here's some info from Littmann:

What Is The Optimal Tubing Length For Stethoscopes?

Quite often health care workers raise questions regarding tubing length based on early publications claiming shorter tubing length provides better acoustic response. Some instructors have recommended their students buy the shortest tubing possible. In an attempt to clarify many of the myths surrounding tubing length, 3M Littmann has tested their stethoscope product line to offer the following information about tubing length.

To explain our test results, it will be helpful to compare the tubing of the stethoscope to a garden hose. For example, an increase in the length of a garden hose will decrease the pressure at the end of the hose as a result of frictional and other internal forces. The same effect occurs when the tubing length of a stethoscope is increased. However, in the case of stethoscope tubing, change in length is relatively small; this decrease in acoustic pressure is not detectable by the human ear.

Additionally, as tubing length increases, resonant frequency decreases. Considering this fact, an increase in tubing length provides a better response to the lower frequency sound (an advantage in auscultation). Many heart sounds fall below 150 Hz and are considered low frequency. Because it has been shown that the human ear is least sensitive to low frequency sounds, improved low frequency response is an advantage.

Taking these two factors into account, there is no detectable difference in acoustical performance between stethoscope with shorter tubing vs. that with longer tubing. In fact, there may be some enhancements to low frequency sounds.

When purchasing a stethoscope, the customer needs to consider their own needs and practices. Longer tubing might be more appropriate for people wearing the stethoscope around their neck as it drapes better. The customer's height and arm length should also be a factor to determine optimal tubing length. Many practitioners would like a little more distance from sicker patients while auscultating. Longer tubing also reduces the amount needed to bend over the supine patient which can stress the health care provider's lower back.

Source: http://www.steeles.com/catalog/length.html
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APACHE3 said:
Well, I have the Littman II SE and as a student it was great, but I was never terribly pimped on my auscultations anyway, so it was fine, but now I see the finer points of audiometry (hz), dual tubing, etc. being discussed and I'm like..whooa. I saw some good deals on ebay. The Welch-Allyn Harvey Elite sounds nice, but its only 25" whereby the Littman cardiology is 27". I'm tall and I'm sure by the end of the day that extra 2" makes a difference!! 😀 But the Welch is $60 cheaper!! 😕
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I'm 6'6" at the extra length of my Littman Cardiologymaster III has saved my back.
 
There is an article on pubmed regarding this; you should check it out, search for "acoustics and stethoscope."
 
KentW said:
So, tell us...how long is it? 😉

Seriously, a couple of inches shouldn't matter (we're still talking stethoscopes here). Here's some info from Littmann:
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I suppose I've never rigorously controlled for other contribuing factors which may have influenced my anecdotal results. Still, I would desperately like a different stethoscope... I thought maybe it was just me, but I've had other people try to use mine and they always agree that it's a POS. It's a Littman Cardiology III, which lots of people use without difficulty, so I wonder if I just got a bum scope.
 
A cardiologist at my school makes all of the fellows in cardiology and pulmonary care/critical care cut their stethoscopes if they are long. If you talk to cardiologists many of them don't like Littmans either and say that they are just the best advertised and marketed brand. Further, Littman "tested" the lengths but did not publish anything when there are publications that tested this premise and found shorter to be better. If you are just going to believe what they say about the evidence and their products then do yourself a favor and stay away from drug reps.
 
u_r_my_serenity said:
If you are just going to believe what they say about the evidence and their products then do yourself a favor and stay away from drug reps.
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BLASHPHEMY!!!!!! 😡 😡 😡

Drug reps speak only the truth!!!!

Don't you read the little booklets they hand out about certain disease conditions and how their drugs perfectly fit with rational care??? 😕

And the holy ones come bearing offerings of cheap food/pens/books. As my belly be full, my critical reasoning be asleep .....

OK, sorry, I just saw Kingdom of Heaven.

On a serious note, I had one cards attending who had this wicked three bell stethoscope. None of us know what it does (including my cards fellow), but it looks SOOOO COOL!!! 😀
 
retroviridae said:
I had one cards attending who had this wicked three bell stethoscope. None of us know what it does (including my cards fellow)
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It's a Welch-Allyn Harvey Triple Head . The third head has a corrugated diaphragm, which is designed to detect mid-range and lower frequencies...useful for "surveying" the precordium prior to tuning in with the bell or conventional diaphragm.
 
sacrament said:
I thought maybe it was just me, but I've had other people try to use mine and they always agree that it's a POS. It's a Littman Cardiology III
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Try a stethoscope with a true bell and diaphragm rather than Littmann's "tunable" diaphragm, like the Welch-Allyn Harvey Elite. I'd almost guarantee that you'll be able to tell a huge difference.
 
Sacrament, a "bum scope" is something entirely different. No wonder you can't hear heart sounds with it. 🙂

We got Harvey DLXs from our school when we started and the corrugated diaphragm is better than the regular one, but it's horrid in comparison with my Phillips Rappaport-Sprague with a Craddock/Pelham bell.
 
I have the Littmann Master Cardiology, which I love very much. I have been using this for 2 years now, since moving up from the cheap Littmann. I do no think i could ever go back to another scope. Having one head makes life easy for different exams.

I know 2 years ago, the Master Cardiology was top of the line. Is there a new one that has replaced this scope?
 
Mumpu said:
We got Harvey DLXs from our school when we started and the corrugated diaphragm is better than the regular one, but it's horrid in comparison with my Phillips Rappaport-Sprague with a Craddock/Pelham bell.
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Note that the Harvey DLX and Harvey Elite are two different 'scopes.

The HP/Philips stethoscope has been discontinued, unfortunately. BTW...what the heck is a "Craddock/Pelham bell?" I can't find any other references to that anywhere.
 
It's a very good big-arse bell (as big as the diaphragm in diameter) that can be bought for the R-S.
 
Mumpu said:
It's a very good big-arse bell (as big as the diaphragm in diameter) that can be bought for the R-S.
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Bought where? I'm interested.

The adult-sized bell on my HP, the one it came with, is about 30mm in diameter; the diaphragm is about 40mm. Is the one you're talking about larger than that?
 
Hm, it may be a Colorado-only thing (one of the cards attendings here invented it eons ago). It's a machined aluminum bell with a sharp edge and it's the same diameter as a diaphragm.
 
Mumpu said:
Hm, it may be a Colorado-only thing (one of the cards attendings here invented it eons ago). It's a machined aluminum bell with a sharp edge and it's the same diameter as a diaphragm.
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Interesting. Well, if you know where I can get one, PM me. I'd like to try it out.
 
KentW said:
Try a stethoscope with a true bell and diaphragm rather than Littmann's "tunable" diaphragm, like the Welch-Allyn Harvey Elite. I'd almost guarantee that you'll be able to tell a huge difference.
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So I did it, I bought a Harvey Elite off Ebay. Best fifty bucks I've ever spent. Definitely a noticeable difference.
 
sacrament said:
So I did it, I bought a Harvey Elite off Ebay. Best fifty bucks I've ever spent. Definitely a noticeable difference.
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Glad you like it. Don't forget that it has a 10-year warranty. If anything breaks, Welch-Allyn will send you a replacement part for free, even the big-ticket items like tubing and binaurals. You can't do that with a Littmann. 🙂
 
You are freaking kidding me. Is it gold-plated?

LOL by the way, the seller has an FDA email address. I heard basic data interpretation skills, rudimentary knowledge, and personal integrity were already sold last week.
 
KentW said:
Try a stethoscope with a true bell and diaphragm rather than Littmann's "tunable" diaphragm, like the Welch-Allyn Harvey Elite. I'd almost guarantee that you'll be able to tell a huge difference.
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Every Littman with the combo peds/adult diaphragm comes with a rubber gasket that replaces the peds diaphragm turning it into a bell. In fact if you look you'll notice that most IM docs with a Littman III have converted their peds diaphragm to a bell. The tubable thing works ok on a thin person but most of our patients are fat.
 
Just to put this post to rest, as the op, I bought a Cardiology III. Dont know how to use it, but boy, I LOOK good! 😀
 
The rubber gasket makes for a largely worthless bell. You need a thin sharp edge on the bell to for it to work correctly which means almost none of the modern stethoscopes have a real one.
 
Why do people spend so much for the Phillips stethoscope? For that price you could get a digital scope and hear things amplified 20x better. That's a big difference in hearing when there are people in the room talking and making noise. I still don't get the Phillips stethoscope obsession. You could get a $20 dollar similar "Phillips-design" with the dual tubing, etc from many reputable places online. Same parts. No difference.
 
BlondeCookie said:
Why do people spend so much for the Phillips stethoscope? ... You could get a $20 dollar similar "Phillips-design" with the dual tubing, etc from many reputable places online. Same parts. No difference.
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Huge difference, actually. If you ever have the opportunity to use an HP/Philips Rappaport-Sprague, you'll notice it in an instant. Despite its humble appearance and many inferior copies, it's one of the best stethoscopes ever made. Too bad it's been discontinued. 🙁
 
Furrball2 said:
Every Littman with the combo peds/adult diaphragm comes with a rubber gasket that replaces the peds diaphragm turning it into a bell.
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That still doesn't fix the tunable diaphragm, although you can always pull it off too, and put on one of these instead. At that point, the Cardiology III might actually be usable. 😉
 
Digital stethoscopes are a joke. Making a diagnosis based on cardiac auscultation is much more about the pitch and character of the sounds than about their loudness. Digitals amplify the sound but in the process totally destroy all the diagnostic features.
 
Yeah, but digital scopes DO offer incredible distinction in high and low pitched sounds merely for the fact that you can actually hear what's going on. I think about it like this. You are sitting in a room watching TV with the volume turned down a little low. Some people walk into the room, start talking and now you can't hear. Turn up the volume and it's all good. Same principle applied to digital scopes. I know this isn't a traditional thing to use a digitial scope, but the technology is superior and it's going to be the upcoming trend once people start seeing how much better they are. Even Phillips makes a new digital scope that is THE thing.

And what's not to like about the exact same designs as the Phillips, but with the different brand name for like 20-30 bucks? Don't get me wrong. I HAVE tried the Phillips from an older physician. They are fantastic! However, Phillips doesn't hold the patent to the design, at least they don't anymore. So, what's wrong with spending not a whole lot and getting a whole lot. I'm serious. It's the exact same parts. Same quality sound and everything. Just try one. That's all I'm saying. And if you don't know a person that has one, buy one. If it sucks, return it.
 
BlondeCookie said:
Phillips makes a new digital scope that is THE thing.
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The electronic stethoscope marketed by Philips is actually manufactured by a Canadian company, AndroMed. An earlier model was marketed by Hewlett-Packard before they sold their medical division to Philips. It's been around for several years now. I used one on a 30-day free trial, and wound up returning it.

I HAVE tried the Phillips from an older physician. They are fantastic! However, Phillips doesn't hold the patent to the design, at least they don't anymore. So, what's wrong with spending not a whole lot and getting a whole lot. I'm serious. It's the exact same parts. Same quality sound and everything.
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Well, I'm in no position to say that your ears are wrong. However, I have never encountered a non-HP/Philips Rappaport-Sprague that offered anything even remotely close to the sound quality of the original. I used an ADC Rappaport-Sprague back when I was an EMT, and there's no comparison. If you examine them side-by-side, there are obvious differences in quality and construction that invalidate the "same parts" argument.

Since the HP/Philips Rappaport-Sprague is no longer made, I suspect we'll see inflated prices for any that come up for sale on eBay and elsewhere. There are a lot of people out there who really like that stethoscope.
 
Digitals cannot reproduce low-pitched sounds unless you've got one with a big subwoofer on it. Low-pitched sounds simply get transposed to a higher pitch which ruins their diagnostic value. Besides that, how can you grade a murmur if you keep turning up volume?

To say that anything with two tubes is R-S is like claiming that anything with four wheels is a Ferrari. I suppose you could try to convert one into a good stethoscope by substituting better tubing, diaphragm, and bell.

The only "digital" thing you need on the wards is the one that runs on hemoccult cards.
 
Mumpu said:
The rubber gasket makes for a largely worthless bell. You need a thin sharp edge on the bell to for it to work correctly which means almost none of the modern stethoscopes have a real one.
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So leave the original retainer ring for the diaphragm on instead. Although you want a good seal without applying any pressure for a bell. Any applied pressure would turn the skin under the bell into a diaphragm. Eh, whatever it works for me.
 
Furrball2 said:
So leave the original retainer ring for the diaphragm on instead. Although you want a good seal without applying any pressure for a bell. Any applied pressure would turn the skin under the bell into a diaphragm. Eh, whatever it works for me.
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What's the purpose of the retainer ring anyway? Is it all superficial, so the patient doesn't get the cold chill of a metal thing touching their body?
 
BlondeCookie said:
What's the purpose of the retainer ring anyway? Is it all superficial, so the patient doesn't get the cold chill of a metal thing touching their body?
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The original purpose is to retain the diaphragm, but yes it will prevent your patient from jumping away from you. My thought is that it also allows for obtaining a seal with out pressing down on the stethoscope head, which would turn your bell into a diaphragm. But the very cool English stethoscope that some of the physical exam meisters had at my medical school had nothing except the steel edge of the bell.
 
KentW, you and someone else on this forum talked about a Craddock/Pelham bell...... where are these obtainable????

Im verry interrested in buying one of them
 
The bell was designed by a U of Colorado faculty member for the HP/Phillips Sprague-Rappaport and as far as I know the only place to buy it is the CU bookstore. I don't know if they ship them, but try contacting Kelly Wilson 303-315-0343 or email [email protected].
 
FANTASTIC!!!!!!!!!!!

The fastest answer ever.
👍 👍 👍 👍 👍

Its not only a question if the ship, its if they ship internationally.......im in sweden 🙂
 
If the craddock-bell diaphragm is so good, then why don't they just make it for sale for other stethoscopes? Certainly, it's not advertised. I've never seen it before.
 
It's a bell, not a bell-diaphragm.

Consider the number of people happily running around with dual-diaphragm Littmans, furrowing their brow ever so professionally as they carefully auscultate with both diaphragms. Auscultation skill is largely d-e-a-d, replaced by a "RRR 2/6 systolic murmur" in the chart, so I doubt there is a market for a stethoscope doodad that cannot claim to instantly turn one from a dunce to a deity the way the electronic devices do.

I'm not claiming it to be the awesomest thing eVaR but it is much better than the stock R-S bell. Like I said, it was designed by a CU faculty member and they probably never bothered to do a huge marketing campaign. I can always tell a CU grad because the hardcore ones always have the R-S with that bell. 😛
 
Mumpu said:
I'm not claiming it to be the awesomest thing eVaR but it is much better than the stock R-S bell. Like I said, it was designed by a CU faculty member and they probably never bothered to do a huge marketing campaign. I can always tell a CU grad because the hardcore ones always have the R-S with that bell. 😛
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It had better be awesome, dude...or I'm holding you responsible!

(Kidding! 😉 )

Actually, I am ordering one from Kelly at the CU bookstore as we speak. Thanks for the info. 🙂
 
OK, I finally got the Craddock-Pelham bell. It's actually pretty cool, although a little pricey for a hunk of machined anodized aluminum. Fits the HP like it was made for it, though. Definitely provides improved definition of low-pitched sounds, noticeably better than the stock bell. I'm looking forward to using this in the office.

Craddock-PelhamBell1.jpg


Craddock-PelhamBell2.jpg
 
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Bike on a Trek said:
Just make sure you practice, and occasionally validate your colleague's "ears" against your own

http://archinte.ama-assn.org/cgi/co...el&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
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I don't subscribe to the Archives of Internal Medicine. What is it you were trying to tell me by posting that link?

Related to any of these?

http://casesblog.blogspot.com/2006/03/is-physical-examination-useless.html

http://www.medpagetoday.com/Cardiology/Arrhythmias/tb/2944?pfc=101&spc=230
 
Kent, yes it is pricey. 😛

Yours is all nice and shiny -- the sharp contact surface on mine is worn down to bare aluminum. I never use the diaphragm for cardiac auscultation anymore, unless the pt is cachectic and the bell won't seal on the protruding ribs.
 
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