Stethoscope Question--NOT about which one to get!

[Kahlan]

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Hi, I am finishing my first year in medical school, and am most likely going into a Peds subspecialty. I need a new stethoscope, but I'd rather not buy one now and then again right before residency. My question is whether a Peds stethoscope will work well on adults or if I should just get a normal one now and a good Peds one later.

 

[RandomKai]

I know people who use peds steths on adults and it works fine but I'd get an adult steth. You never know what changes might happen over the next 3 years. You might not do Peds anyway.

 

[weightyheart]

how is this not a question of which one to get?
littmann cardio 3 has both pediatric and adult, diaphragm and bell i believe.

 

[Kahlan]

I knew someone would point out that I may not do Peds anyway 🙂 I suppose I meant "Not another endless and redundant post about whether Littman, etc are the best". I just want to know if Peds stethoscopes work on adults.

 

[penguin24]

I would just spend a couple bucks and get an adult one now, for like $50 bucks. Then if you in fact end up doing Peds, then spring for a peds one.

Realistically, you could get by all your M2/M3/M4 rotations w/ a Peds stethescope, but they are so cheap that you won't be saving that much money by doing this.

I had an adult stethescope, and when I was on Peds, I would just use the bell on small kids. It works just fine. All the intricacies about bell vs diaphragm really don't make much difference in your assessment of the patient. Either their heart is beating or not, either they have a murmer or not, etc.

 

[zenlike]

If you want to get a good one now that does both, you can get a Harvey Elite here: http://www.steeles.com/catalog/harveystudent.html ($147).

It comes with the peds accessories for free (~$60 if you buy them seperately).

 

[albe]

An attending I had worked with (a pediatric pulmonologist) recommended using the regular adult-sized diaphragm on kids, even for newborns. He noted that the acoustics coming from the larger diaphragm are better than the smaller peds-sized ones. I'm not sure exactly how large of a difference it makes, but it's something to consider.

 

[TexasPhysician]

If you want to get a good one now that does both, you can get a Harvey Elite here: http://www.steeles.com/catalog/harveystudent.html ($147).

It comes with the peds accessories for free (~$60 if you buy them seperately).

This is the Harvey Elite Cardio. You can get the regular Harvey Elite which also comes with everything needed for peds for $80 or so. You can switch it in about 30 seconds. I have it and I love it for both adults and peds.

 

[TexasPhysician]

An attending I had worked with (a pediatric pulmonologist) recommended using the regular adult-sized diaphragm on kids, even for newborns. He noted that the acoustics coming from the larger diaphragm are better than the smaller peds-sized ones. I'm not sure exactly how large of a difference it makes, but it's something to consider.

The peds cardiologists would throw a FIT to hear this. An adult diaphragm is almost the size of a newborn's heart. You can not adequately localize pediatric murmurs in a timely fashion with an adult diaphragm. I can see it now:
Cardiologist: Where is the murmur coming from?
Med Student: Somewhere underneath the left chest wall?

If you are just looking for wheezing in a young child, an adult diaphragm will work fine.

 

[Laryngophed]

I can see it now:
Cardiologist: Where is the murmur coming from?
Med Student: Somewhere underneath the left chest wall?

 

[Bacchus]

The Cardio III is peds/adult with a rotational head. If you go into adult specialties and don't want to use the bell/diaphragm by pressure differences, you can pop the plastic off the peds side for a bell.

 

[smq123]

I knew someone would point out that I may not do Peds anyway 🙂 I suppose I meant "Not another endless and redundant post about whether Littman, etc are the best". I just want to know if Peds stethoscopes work on adults.

Generally, peds stethescopes don't work very well on adults. It's a pain to use such a tiny diaphragm on an obese adult. Plus, the peds stethoscopes are often not heavy enough to double as a reflex hammer.

 

[Kahlan]

Plus, the peds stethoscopes are often not heavy enough to double as a reflex hammer.

I have never heard of this trick before.

 

[TexasPhysician]

I have never heard of this trick before.

Oh to be young again.

 

[smq123]

I have never heard of this trick before.

You hold the tubing so that the diaphragm dangles sort of loosely. And then you just swing it, letting the weight of the diaphragm and the momentum hit the joint - at least, this is how I do it, although everyone does it differently. It's easier than carrying a reflex hammer around with you.

 

[TexasPhysician]

You hold the tubing so that the diaphragm dangles sort of loosely. And then you just swing it, letting the weight of the diaphragm and the momentum hit the joint - at least, this is how I do it, although everyone does it differently. It's easier than carrying a reflex hammer around with you.

you can even use your hand and it will work.....

 

[OnDemond]

Generally, peds stethescopes don't work very well on adults. It's a pain to use such a tiny diaphragm on an obese adult. Plus, the peds stethoscopes are often not heavy enough to double as a reflex hammer.

Heh...anyone who uses a steth to elicit reflexes is missing out on the best toy in the physician/med student's arsenal - the reflex hammer. Seriously, I would consider neurology just for the fun of banging people's tendons for a living

 

[Guile]

Heh...anyone who uses a steth to elicit reflexes is missing out on the best toy in the physician/med student's arsenal - the reflex hammer. Seriously, I would consider neurology just for the fun of banging people's tendons for a living

Oh man, do they bang the HELL out of those tendons. Jeez...

To address the OP's question: get an adult stethoscope or one that has rotational heads for a pedi diaphragm. I like the Welch-Allyn scopes. Check out the Harvey Elite in particular. There's a really good chance you WON'T be going into peds at this point, so don't bank on it. Also the IM guys would give you a lot of grief for listening to the 300 lb CHF patient with a pediatric stethoscope. It would probably affect your evaluations. So, no, don't get a pediatric scope.

 

[Kahlan]

Thanks everyone. I kinda figured I should get an adult one, but a few of my friends had said that the Peds ones worked just as well. I ended up getting a Harvey Elite, and I really like it.

 

[J-Rad]

The peds cardiologists would throw a FIT to hear this. An adult diaphragm is almost the size of a newborn's heart. You can not adequately localize pediatric murmurs in a timely fashion with an adult diaphragm. I can see it now:
Cardiologist: Where is the murmur coming from?
Med Student: Somewhere underneath the left chest wall?

If you are just looking for wheezing in a young child, an adult diaphragm will work fine.

A little OT here, but quite a few of my staff pediatric cardiologists have the old (original) HP Sprague-Rappaport steths. They use them to listen to anyone, including babies. It actually isn't that hard to localize, even with a larger diaphragm as the chest wall in a baby is round and there is a limited touch-point. I've been using a Cardiology III since med school and find both the large and pediatric diaphragms perfectly adequate for auscultation (and I consider myself to have above average listening skills). My stethoscope snobbery only extends as far as recommending some version of a dual lumen as I believe there is a noticable improvement in sound quality over a single lumen steth. Other than that, get whatever one you like.