Questions re stethoscope bell/diaphragm uses

Discussion in 'Medical Students - MD' started by lemonade90, Oct 12, 2011.

  1. SDN is made possible through member donations, sponsorships, and our volunteers. Learn about SDN's nonprofit mission.
  1. lemonade90

    lemonade90 2+ Year Member

    192
    4
    Jun 14, 2010
    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?
     
  2. SDN Members don't see this ad. About the ads.
  3. c4e

    c4e 7+ Year Member

    59
    0
    Sep 29, 2009
    MDApps:
    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.
     
  4. isoquin

    isoquin Allopathetic 5+ Year Member

    468
    2
    Jun 17, 2007
    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.
     
  5. Suncrusher

    Suncrusher ☣ ☣ ☣ ☣ ☣ Lifetime Donor 5+ Year Member

    6,399
    10
    Jun 28, 2010
    Florida
    ^ si. I was pressing too hard with the bell and basically turning it into a diaphragm, and I got corrected about it
     
  6. 45408

    45408 aw buddy 7+ Year Member

    16,982
    35
    Jun 13, 2004
    the femoral arteries? No need to be listening to them.
     
  7. newdoc2013

    newdoc2013 7+ Year Member

    164
    6
    Apr 30, 2009
    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
     
  8. mishaS

    mishaS 2+ Year Member

    476
    17
    Aug 13, 2009
    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.
     
  9. LoveMyRam

    LoveMyRam 7+ Year Member

    203
    2
    Sep 24, 2006
    DC
    Unless your both drunk and she's really hot
     
  10. lemonade90

    lemonade90 2+ Year Member

    192
    4
    Jun 14, 2010
    Femoral arteries for potential AAA or artherosclerosis.
     
  11. rocuronium

    rocuronium 7+ Year Member

    311
    14
    May 11, 2008
    Canada
    Canadian Forces
    Can you still buy the Littmans without the tunable diaphragm on the bell side anywhere?
     
  12. Rendar5

    Rendar5 10+ Year Member

    6,823
    353
    Nov 12, 2003
    Florida
    No.
     
  13. 45408

    45408 aw buddy 7+ Year Member

    16,982
    35
    Jun 13, 2004
    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.
     
  14. Instatewaiter

    Instatewaiter But... there's a troponin 10+ Year Member

    5,776
    1,589
    Apr 28, 2006
    Washington
    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
     
  15. isoquin

    isoquin Allopathetic 5+ Year Member

    468
    2
    Jun 17, 2007
    no but the tunable diaphragm is easily removable, so there's not really a benefit to try to find one without it.
     
  16. xanthomondo

    xanthomondo nom nom nom Banned 10+ Year Member

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

    xanthomondo nom nom nom Banned 10+ Year Member

    lol
     
  18. rocuronium

    rocuronium 7+ Year Member

    311
    14
    May 11, 2008
    Canada
    Canadian Forces
    Good to know. Thanks.
     
  19. MossPoh

    MossPoh Textures intrigue me 7+ Year Member

    7,995
    38
    Apr 24, 2006
    Tally/Willkillya County
    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.
     
  20. FIREitUP

    FIREitUP 10+ Year Member

    2,872
    506
    Jul 31, 2007
    TBL
    Haahaha, I just thought of south park when you said that:
    http://www.youtube.com/watch?v=5oqgnKgwDsk
     
  21. 45408

    45408 aw buddy 7+ Year Member

    16,982
    35
    Jun 13, 2004
    And when they think they have a pseudoaneurysm, they call the vascular surgeon, who doesn't listen to the femoral arteries. Just saying.
     

Share This Page