Questions re stethoscope bell/diaphragm uses

[lemonade90]

For listening to carotid artery, does one use the bell when having the patient hold their breath and then use the diaphragm when they are breathing normally?

What about for the femoral arteries?

For listening to abdominal and respiratory sounds, does one generally use the diaphragm?

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[c4e]

Generally, you listen to vasculature with the bell and everything else with the diaphragm. Exception is the heart where you listen with both the bell and diaphragm, which will allow you hear heart abnormalities.

 

[isoquin]

Careful how you talk about these parts nowadays. If you have a Littmann III then both the large and small side can be used as diaphragm and bell. The smaller side is usually for pediatrics and vasculature like the carotids. The bigger side is better suited for the heart, lungs, belly. You can change between diaphragm and bell functions on a Littmann based on how much pressure you apply, and the audio difference is just whether you're picking up higher or lower toned heart sounds.

 

[Suncrusher]

^ si. I was pressing too hard with the bell and basically turning it into a diaphragm, and I got corrected about it

 

[45408]

the femoral arteries? No need to be listening to them.

 

[newdoc2013]

nice just learned something i always thought it was the diaphragm for the carotids because its a higher pitched sound. i will switch to bell and see if i can hear better. thanks

 

[mishaS]

Perhaps you could use a pediatric diaphragm and hear the carotid, but carotid bruits are low pitched, and so a bell would work much better. Also, if you aren't working with kids, why keep the pediatric diaphragm on the cadio III? I realize that it's a "tuneable" diaphragm, but I've heard repeatedly that an actual bell is far better when you are trying to hear low frequencies specifically.

 

[LoveMyRam]

the femoral arteries? No need to be listening to them.

Unless your both drunk and she's really hot

 

[lemonade90]

Femoral arteries for potential AAA or artherosclerosis.

 

[rocuronium]

Can you still buy the Littmans without the tunable diaphragm on the bell side anywhere?

 

[Rendar5]

Femoral arteries for potential AAA or artherosclerosis.

No.

 

[45408]

Femoral arteries for potential AAA or artherosclerosis.

Yeah, no. You should feel for pulses, check Doppler signals if you can't feel pulses, but you don't need to listen to the femorals. If you can't feel a AAA but you're worried about it, you should get a CT or abd ultrasound. If you're evaluating PVD, you should be looking at ABIs and such.

 

[Instatewaiter]

Careful how you talk about these parts nowadays. If you have a Littmann III then both the large and small side can be used as diaphragm and bell. The smaller side is usually for pediatrics and vasculature like the carotids. The bigger side is better suited for the heart, lungs, belly. You can change between diaphragm and bell functions on a Littmann based on how much pressure you apply, and the audio difference is just whether you're picking up higher or lower toned heart sounds.

On the littmann III, pull off the pediatric diaphragm and replace it with a rubber gasket. Viola- you have a real bell. The tunable diaphragm is no where near as good as a real bell.

Bell- bruits (carotid, renal, AV fistula), S3 and S4, Mitral stenosis and for that matter most diastolic murmurs

Diaphragm- everything else

 

[isoquin]

Can you still buy the Littmans without the tunable diaphragm on the bell side anywhere?

no but the tunable diaphragm is easily removable, so there's not really a benefit to try to find one without it.

 

[xanthomondo]

Yeah, no. You should feel for pulses, check Doppler signals if you can't feel pulses, but you don't need to listen to the femorals. If you can't feel a AAA but you're worried about it, you should get a CT or abd ultrasound. If you're evaluating PVD, you should be looking at ABIs and such.

The attendings on cardio listened to femorals on all post-cath patients.

 

[xanthomondo]

Unless your both drunk and she's really hot

lol

 

[rocuronium]

no but the tunable diaphragm is easily removable, so there's not really a benefit to try to find one without it.

Good to know. Thanks.

 

[MossPoh]

There is a little bit of a debate about the diminished quality with a tunable versus fixed diaphragm. I personally don't think I would notice a dramatic difference, but there are people who swear by fixed diaphragm only.

As far as the femoral thing, that is just a kind of forced physical exam thing they teach you like all the other random tidbits. About the only time I seem to do the full cardio exam with diaphragm and bell, having them roll over, look for PMI, ausculate some more and all that crap is when they force me to for an OSCE. I just don't have the time for that stuff.

 

[FIREitUP]

Yeah, no. You should feel for pulses, check Doppler signals if you can't feel pulses, but you don't need to listen to the femorals. If you can't feel a AAA but you're worried about it, you should get a CT or abd ultrasound. If you're evaluating PVD, you should be looking at ABIs and such.

Haahaha, I just thought of south park when you said that:
http://www.youtube.com/watch?v=5oqgnKgwDsk

 

[45408]

The attendings on cardio listened to femorals on all post-cath patients.

And when they think they have a pseudoaneurysm, they call the vascular surgeon, who doesn't listen to the femoral arteries. Just saying.