Stethescopes

[corpsmanUP]

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Some 8 years after buying it and on my last day of medical school, I lost my Litmann Master Cardiology so I am going to get something new. Do any of you have a stethescope you consider a better one that I should seriously consider, or should I just get a new Litmann?

 

[BKN]

Some 8 years after buying it and on my last day of medical school, I lost my Litmann Master Cardiology so I am going to get something new. Do any of you have a stethescope you consider a better one that I should seriously consider, or should I just get a new Litmann?

The Welch-Allyn Harvey triple head is the best of the non-electronic ones. Best sounds, almost indestructible. Been using them for 30 years.

 

[corpsmanUP]

The Welch-Allyn Harvey triple head is the best of the non-electronic ones. Best sounds, almost indestructible. Been using them for 30 years.

Awesome...do you know anything about the electronic ones.....or anyone else?

 

[Janders]

The Welch-Allyn Harvey triple head is the best of the non-electronic ones. Best sounds, almost indestructible. Been using them for 30 years.

I just got a Welch-Allen triple head this week (after my Littman cardiology III grew legs and ran away). I've been very impressed with the sound quality so far, and it sure seems to be built like a tank. Plus, it is useful to have a distinctive scope for identification purposes.

BKN, I was wondering if you have any suggestions for head-selection with the triple head. So far I've been using the extra head (the corrugated diaphragm) just for fun, trying to get a hang for it. The "manual" is rather sparse, suggesting it might have amplification powers. I read else where that it has the best mid-range coverage, and thus makes a good first pass choice. After that you can tune in with the normal diaphragm and bell. What is the main utility of the third head for you?

 

[BKN]

Awesome...do you know anything about the electronic ones.....or anyone else?

I also have had several electronic ones, and always gave up and went backto the harvey, until recently. They amplify the sounds you're listening for and also everything else. You have to relearn lungs sounds - a few rales sounds like a watefall.

The latest generation are supposed to have filters for unhelpful frequencies and have electronics allowing you to record and replay the sounds as a phonocardiogram on a PC or a PDA. Theoretically extermely helpful for differentiating heart sounds.

I bought one of the earlier models and am using it- but I made a mistake, I bought one that requires transfering the signal by wire to a pc. that would be fine at a docs office, but is not practical in the ED or on hospital rounds.

Somebody (prob Littman) is making one the beams the signal to a PDA by IR. Seems much more useful.

Anyway about the sounds-much louder than even the Harvey. I don't find the filters have done much- still lots of adventitious sounds, also I hear conversations across the ED. But, you can hear details of breath sounds and heart sound that would be missed by any standard stethoscope. I don't know about sturdiness, better than the old electronics at least. Finally the cost is about three times as much as a Harvey or Master Cardiology.

Cheers, BKN

p.s. I often find things with either scope that the students and residents miss. After I point it out I tell them to buy a real man's (or woman's 🙂 ) scope.

 

[BKN]

I just got a Welch-Allen triple head this week (after my Littman cardiology III grew legs and ran away). I've been very impressed with the sound quality so far, and it sure seems to be built like a tank. Plus, it is useful to have a distinctive scope for identification purposes.

BKN, I was wondering if you have any suggestions for head-selection with the triple head. So far I've been using the extra head (the corrugated diaphragm) just for fun, trying to get a hang for it. The "manual" is rather sparse, suggesting it might have amplification powers. I read else where that it has the best mid-range coverage, and thus makes a good first pass choice. After that you can tune in with the normal diaphragm and bell. What is the main utility of the third head for you?

Oh, the corrugated head is the good one. It's for medium and low sounds and should be considered the bell. The bell is for people who don't have large smooth surfaces (it's a bell for children and audlts with weird shaped chests). The diaphraghm is used for high pitched sounds same as any other.

 

[deleted87716]

Oh, the corrugated head is the good one.

FYI, you can also get the corrugated diaphragm for Welch-Allyn's other stethoscopes (the Harvey DLX and Harvey Elite). I have one on my Elite, and prefer it to the flat diaphragm. YMMV. 🙂

 

[bartleby]

The more money you spend on a stethoscope, the more heartbroken you'll be when it is invevitably lost, stolen, or broken. And remember... by far, most critical component in auscultation is a trained brain.

 

[deleted87716]

The more money you spend on a stethoscope, the more heartbroken you'll be when it is invevitably lost, stolen, or broken.

Couldn't you say that about pretty much everything you buy? Fear of loss is a poor excuse for buying shoddy tools, especially something you'll rely on as much as a stethoscope. How are you going to "train your brain" unless you can hear what you're supposed to hear? If you're truly worried about theft, have it engraved or otherwise permanently marked, and don't let it out of your sight.

 

[EM Guy]

I agree. I had my Littman Cardiology Master Auscultator III (blah blah blah) engraved by Littman for $25 several years ago. I've left it, at various times, in about every nook and cranny in my hospital. It's always managed to find its way back to me. Best couple of bucks I ever spent. BTW: It's a simple mail-in to Littman. You can send your current stethoscope. Turn-around time was a couple of weeks so I did it during an elective where I wouldn't need the stethoscope (derm).

 

[deleted87716]

do you know anything about the electronic ones.....or anyone else?

I tried an earlier version of the Philips electronic stethoscope (back when it was the HP Stethos), and was unimpressed. In addition to being more "fidgety" than an acoustic stethoscope (you have to turn it on and press buttons to switch from bell to diaphragm mode, select volume levels, etc.), I found the magnification of ambient noise to be excessively distracting, and it was difficult to grade murmurs since the volume was adjustable. I played with it for a month, and wound up returning it. If you work in a really noisy environment, I can see the advantage. Otherwise, I think you're better off with a good acoustic stethoscope like a Harvey or an HP/Phillips Rappaport-Sprague.

 

[WilcoWorld]

I recently got a Rappaport-Sprague, which I quite like. I listened to a lot of other scopes in the store & found it to be the best balance between cost & quality. Sure, there are better ones out there, but I feel like spending over $250 on a stethoscope for use in the ED is starting to approach diminishing returns.

Since then, I noticed that a number of cardiologists at my hospital carry the same one. They say that it's got good sound quality and that it lasts decades (so long as you don't loose it), so I take that as a sound endorsement (pun unintended). Interestingly, one cardiologist said last week that most auscultation is just for show, and he only does it because patients expect it. Perhaps in these days of extreme reliance on high tech cardiodiagnostic tests a cardiologist can say this. However I suspect that the pulmonologists and the clinicians who still enjoy a good diagnosis would beg to differ.

Lastly, my dad refuses to call it a stethoscope. "You don't see with it" he explains, "You listen with it. So it should be called a stethophone." Y'know what? He's right.

 

[bartleby]

I think that everyone will agree that a cheezy drugstore stethoscope is not going to cut it. I'm not suggesting you buy a $5 stethoscope from Walgreen's.

Having used all the major brands 'scopes on the market at one point or another and having a trained brain at this point, I really don't feel that there's much return beyond buying a Littmann Master Classic-level of stethoscope. It's a triumph of marketing to have people convinced that they're going to hear 4 times more pathology if they buy buy a $400 'scope, and nothing else. One of the old school cardiologists at my med school use to carry the crappiest stethoscope he could lay hands on. We used to tease him that he snagged them out of his grandkid's doctor toy set. But he never missed anything...

I'm not sure what your expectations are, but most of the relevant physical exam findings are not terribly subtle once you learn to recognize them. If you're interested in learning, listen to the sample audio CD that comes with Littmann stethoscopes until you want to vomit. And, for better or worse, testing has supplanted physical diagnosis as the final arbiter of treatment.

And just a reminder, the ED isn't "every nook and cranny of the hospital". If you take your stethoscope off for five minutes while sewing and run out of your room to deal with something else, don't be surprised when some the little urchin snags your 'scope as your thank you. If you want carry a $400 gold plated Master Toughguy Mark IX

 

[EM Guy]

And just a reminder, the ED isn't "every nook and cranny of the hospital". If you take your stethoscope off for five minutes while sewing and run out of your room to deal with something else, don't be surprised when some the little urchin snags your 'scope as your thank you. [/QUOTE]


Dude, if you're stupid enough to leave ANYTHING of value in that situation then you pretty much deserve to have it stolen. Point is that we all know that nice stethoscopes are most likely to be 'borrowed indefinitely" by another health care worker. A cheap, simple procedure can significantly decrease the likelihood of that happening. Further, if you've just misplaced it, people can get it back to you with minimal effort instead of having just another unmarked black stethoscope.
Now, if you're a complete *****, and are in the habit of leaving anything of any potential value unattended around your local hoodrats, you may as well skip the engraving and fork the money over directly to said rodent. For the rest of the world with the vaguest inkling of common sense, simple things like engraving a stethoscope for a couple of bucks potentially saves some heartache.