Need opinions on two stethoscopes

[e30ftw]

I've listened to at least lungs/heart on probably ~5k patients in the ED/ICU over the past three years using first a welch harvey allen elite (med school scope) then a master classic II along with multiple cheaper RN/tech/RT scopes as well as disposable scopes.

imo the hospital setting (ED, ICU, vents running, monitors constantly beeping, etc) drowns out a lot of the appreciable differences between stethoscopes. Most of these scopes were adequate in doing a reasonable physical exam. mainly because I don't routinely rely on chest auscultation to make clinical decisions, although most patients with a complaint more serious than isolated extremity pain will get a chest exam.

the most important parts of your PE are your hands and eyes. Remembering to look at the patient/monitor/lines/access/ett/resp-rate/pulses/abd/pelvic etc are way more important than chest auscultation.

ultimately in sick patients (ie. people who actually need to be in the hospital) your way of working up chest/abd badness is going to start with ekg/plainradiography then progress to biomarkers/CT/CTPA and finally to admission for cardiac monitoring or repeat abd exams. You can usually get everything you need to make these decisions from history and talking/looking at the patient so the intricacies of stethoscope differences becomes less important.

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[IlDestriero]

I like the W-A Harvey Elite.

 

[Psai]

I think the cardio3 is worth it
i can barely hear abnormal heart sounds with it but i guess it's something that improves with more practice and exposure?

 

[notbobtrustme]

I think the cardio3 is worth it
i can barely hear abnormal heart sounds with it but i guess it's something that improves with more practice and exposure?

hearing anything abnormal = excuse for echocardiogram.

 

[Instatewaiter]

hearing anything abnormal = excuse for echocardiogram.

True. Lots use them as a screening tool for an echo. But not every murmur needs an echo.

 

[cbrons]

And miss out on possible abnormalities? No.

I think I might just go with Cardio III unless there's any objections that will convince me otherwise.

I think you should get a portable ultrasound.

 

[deleted87716]

In Europe, Littmann markets the Littmann Traditional Stethoscope, a cardiology stethoscope with a conventional bell and a tunable diaphragm, much like the old (discontinued) Cardiology II S.E. that I used in medical school. You can get these BNIB for around $100 on eBay. A good deal, IMO.

Edit: This model has been discontinued. The bargain-priced ones on eBay are probably the result of retailers blowing out their remaining stock. Get 'em while you can.

http://www.ebay.com/sch/i.html?_odkw=littmann traditional stethoscope&_from=R40&_osacat=0&_from=R40&_trksid=p2045573.m570.l1313.TR0.TRC0.A0.H0.TRS1&_nkw=littmann traditional stethoscope&ghostText=&_sacat=0

 

[Instatewaiter]

I think you should get a portable ultrasound.

That would be a bit more expensive...

 

[Instatewaiter]

In Europe, Littmann markets the Littmann Traditional Stethoscope, a cardiology stethoscope with a conventional bell and a tunable diaphragm, much like the old (discontinued) Cardiology II S.E. that I used in medical school. You can get these BNIB for around $100 on eBay. A good deal, IMO.

http://www.ebay.com/sch/i.html?_odkw=littmann traditional stethoscope&_from=R40&_osacat=0&_from=R40&_trksid=p2045573.m570.l1313.TR0.TRC0.A0.H0.TRS1&_nkw=littmann traditional stethoscope&ghostText=&_sacat=0

Seems like a good deal

 

[MajorBubblez]

Lol get the cardiology III. Don't be a show off.

 

[deleted87716]

Another good value is ADC. The AdScope 602 is a virtual clone of the old Littmann Cardiology II, and is available from online retailers for around $70. It's assembled in the USA and carries a lifetime warranty.

 

[hybrid_s]

I'm going to bump this thread. Yes you do need a good stethoscope and auscultation skills. I've been a lowly critical care RN prior to now, and I have found many life-threatening issues over the years just by routine auscultation. Most nurses buy at least a Cardiology III or Littman Master Cardiology. I actually have a Master Cardiology and a Cardiology II / Omron Sprague as a backup. The Master Cardiology is actually worse than the Cardiology II. The old HPs were much better than current models. The Omron mentioned is not bad, but you will not look professional using it (The main reason to get a Littmann). Ausculation unfortunately is a dying art form, but you should not be one of those to ignore it. You absolutely need to do heart and lungs on every patient no matter what they come in for.

 

[Kaustikos]

I'm going to bump this thread. Yes you do need a good stethoscope and auscultation skills. I've been a lowly critical care RN prior to now, and I have found many life-threatening issues over the years just by routine auscultation. Most nurses buy at least a Cardiology III or Littman Master Cardiology. I actually have a Master Cardiology and a Cardiology II / Omron Sprague as a backup. The Master Cardiology is actually worse than the Cardiology II. The old HPs were much better than current models. The Omron mentioned is not bad, but you will not look professional using it (The main reason to get a Littmann). Ausculation unfortunately is a dying art form, but you should not be one of those to ignore it. You absolutely need to do heart and lungs on every patient no matter what they come in for.

Until I'm experienced enough to differentiate things, I won't spend an exorbitant amount of money for a stethoscope. I regret doing that first year. It was a waste. Went and bought one for half the price and I haven't had issues listening to the pertinent findings. I can hear pulmonary or cardiac issues just fine.
Medical students don't need expensive stethoscopes. They need a decent one that's reliable.

 

[Traumahawk]

Has anyone else had trouble with tubing artifact on the Harvey Elite? I picked one up off eBay after my old Cards III got stolen (on the basis of a plethora of "Littmann sucks, get WA" reviews), and frankly I can barely hear anything over all the tubing artifact. Even just the pressure of my fingers holding the diaphragm down - and hence the side of my hand contacting the tube ever-so-slightly - generates horrible, LOUD scratchy artifact noise, never mind if the tubing or binaural spring bumps against my clothing while I'm moving from point to point. Never had this problem with the Littmann. Something about the Harvey tubing seems really brilliant at amplifying artifact noise.

Is there a hack or workaround for this? I've been considering building a "Littvey" with the Harvey chestpiece and replacement Littmann tubing, but am concerned that this will compromise the acoustics even more than they already are. Thoughts?

 

[DrYoda]

I have a cardiology III, IMO it is noticeably better than the cardiology II. I've had several of both, other brands I will leave the commentary to others. Most of our student's seem to have a cardio II, I'm assuming because it's cheaper. electronic stethoscopes are IMO not worth it unless you have a hearing issue at baseline.

 

[Traumahawk]

Hmm. The Cardiology II has been off the market for some time - one of my nursing school CIs spoke of hers as a "relic" seven years ago. I'm not even sure you can still get replacement parts. Based on that alone, Cardiology III would be an upgrade. I only know two people with electronic stethoscopes - one has major hearing deficits and the other takes an awful lot of guff. (Of course, this is Emergency, where everyone says "lol digital ears" and then half the crowd goes back to auscultation with tin cans, while the other half are busy trying to diagnose influenza with bedside ultrasound... )


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[Spriteling]

Just to jump in on this thread, does anyone have experience with stethoscopes for those with hearing loss? I have moderate sensorineural hearing loss in both ears, mainly in the lower frequencies. I'm worried that I'm going to struggle with a normal stethoscope.

 

[Sailing Bob]

The finest Scope ever made is the HP Rappaport Sprague Stethoscope.
If you are a serious practioneer and need to hear all levels of cardio ...low, med and high pitched murmurs, and the S3, S4, gallops of the heart, the Gold standard is H-P. This world famous stethoscope will make a come back soon by a company that made all the components for over 45years for H-P, Agilent, and Phillips Medical.
*I understand Re-Placements parts will soon be available from R.J. Mansour,Inc. of Providence, RI

 

[Peach Newport]

IMO best value for money is a Classic III. Good sound, durable, looks pretty. The cardiology series is for people with more money than sense. I don't even think most cardiologists use the cardiology series.

1st years put way too much value on the quality of the stethoscope. Every practicing physician I've ever met says that their's is mostly for show nowadays anyway.

 

[mistafab]

That's sad man.

IMO best value for money is a Classic III. Good sound, durable, looks pretty. The cardiology series is for people with more money than sense. I don't even think most cardiologists use the cardiology series.

1st years put way too much value on the quality of the stethoscope. Every practicing physician I've ever met says that their's is mostly for show nowadays anyway.

 

[Crayola227]

such bull****

I saved a life my second month of internship directly due to the 3 following things:

I USED MY STETHOSCOPE
read the nursing notes (gasp!)
stood up to my senior and attending (double gasp for a gal whose SDN byline used to be "Boot Licker")

do I sound ****ing proud?

yeah, cuz they were going to take an action that would have killed the patient, and I did my job, which includes basic physical exam skills and reading ****e that could have been written better by a 6th grader (ouch, slam on nursing notes for spelling/grammar!)

smfh for this attitude about the physical exam

try this: take it the **** seriously and see what difference it makes
if you're any good you'll see that it does
if you come to the conclusion it doesn't make a difference, well hell, nothing probably can with clinicians with this attitude

yeah, not every specialty really needs their steth much for what they do, but it's not for ****ing show