Stethoscope

[RxBoy]

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So I recently lost my Littman cardiology III (had it for 5+ years). I am doing CCU next month and was considering buying a higher quality stethoscope to hone in on CV and resp exam. I start Anesthesia in June.

I was considering the cardio master:
http://www.allheart.com/2163-65.html

or even the expensive electronic one:
http://www.allheart.com/litt3100.html

Currently using a cheapo that really sucks at picking up minor detail. It can pick up crackles and grade III plus murmurs but not those minor crackles/wheezes or even grade II's. Is it worth it to buy a higher grade stethoscope for anesthesia? Or should I just go with a more basic one?

 

[EternalMD]

get one that will just tell you the diagnosis when you auscultate

all kidding aside, just get another litt. III (dont get the master cuz you'll eventually do peds cases where you'll wish you had the LIII)- we're not pretending to be cardiologists and we sure as hell aren't gonna go around placing people in the right positions to bring out various murmurs either

 

[Licoricestick]

I have some sensorineural hearing loss and looked into the electronic ones a few years ago as a med student (parents offered to buy one for me if it's what I needed) - the big problem I found with all the different ones on the market then was that they amplified all the little noises of your hand on the stethoscope, fabric brushing over the top, movement of stethoscope on skin etc etc. Shame really, I could have conned 5 grand out of my parents 😉.

I ended up going for a good quality "cardiology" (ie dual tubes, decent diaphragm + bell but not the overly fancy stuff) stethoscope. But I happen to need that level of quality to do useful stuff like take a BP (can't hear a thing with the cheapo ones that hang off our machines).

For anaesthesia purposes you really only need to be able to identify BS equal bilaterally, presence/absence of wheeze, presence/absence of loud murmur. Afterall functional status is more important that what grade murmur they have.

Get the cheapest stethoscope that will allow you to do the above (and the absence of the word "littman" on it will probably make it cheaper).

I survived being a cardiothoracic intern, medical intern and medical resident/registrar without being able to hear stuff my consultants heard. And what I can or can't hear with a stethoscope has never been an issue in anaesthesia.

And yes a bell/paeds diaphragm will come in handy.

 

[Bertelman]

Get something like the master classic II. Easily slides down shirts, drapes, etc.

You'll diagnose valvular disorders with echo, not a steth.

 

[Prof Moriarty]

One of my colleague MS-3's on a surgical rotation was called to a consult in the ED last week. I finished up what I was doing and stopped by about midway through the H&P. Middle aged guy, came in for hand pain, which turned out to be nothing of note. Incidentally, a large soft mass was discovered in the left testicle. Imaging was equivocal... mass lesion vs hernia. Surgical consult was called. Of course, I didn't know any of this when I walked in... I just knew we had a surgical consult and I thought I'd check in on my colleague.

I walk in and the first thing that I notice is that the patient is really malodorous. Not the kind of smell you get from not taking a shower for a couple of days, more like a couple of weeks. No problem. Seen it (smelt it) before. My classmate pats his white coat, checks his shoulders, looks to me.

"Do you have a stethoscope on you?"

I don't think twice. I just hand mine straight over to him. The fancy one that I was convinced I'd need back in first year when the rep came to speak to our class. Right around the time I also picked up my PanOptic Ophthalmoscope.

So I hand it over and my friend goes to work. Checks the lungs, heart sounds, listens for murmurs, carotids, abdomen, etc., the whole 9 yards. As he's doing this I'm thinking, "Man, I'm gonna really have to spray down my stethoscope after this one."

He finishes up the abdomen and pulls the sheets down. It smells even worse than before. I'm starting to wonder what we're here for right about now. For some reason he's still got my stethoscope in his ears...

He points to the guy's left testicle. It's big. On closer examination, it looks like he's got 2 testes in there.

My colleague finally informs me: "So the reason we're here is there might be a hernia."

And slowly, but surely, he begins to move the diaphragm of the scope down there. For a second, I think he's joking. Then he looks at me again, guiltily, and it dawns on me that he's seriously going to place my stethoscope right on this guy's malodorous balls.

I give him a look that says "Noooooooo!!!!"

But it's too late. The diaphragm is on the skin.

I don't know if the tears in my eyes are from the feelings of loss or the thick haze permeating the air. I cycle through the first 4 stages of grief in a flash... Denial, anger, bargaining, depression. Acceptance would come much later.

I'm staring at my colleague in disbelief. He hands me the scope and says, "Take a listen."

So I do.

Bowel sounds.

Turns out the guy has an large incarcerated loop of bowel in his scrotum.

We call our attending, admit the guy, and book the OR. Needless to say, my colleague spent the next 15 minutes scrubbing down my stethoscope.

Quick tip if you find yourself borrowing someone's stethoscope in a similar situation: slide a latex glove over the chest piece and you will avoid the ire of your colleagues.

Maybe I still haven't hit acceptance yet.

All that is to say: I'd go with a basic one.

 

[lushmd]

I used to have a Littman Cardiology III stethoscope that I wasn't very satisfied with. It was replaced with a Welch-Allyn Harvey Elite stethoscope which I find to be superior. Of course, this is all just personal/anecdotal experience so try a few out and see what you like. Also, check out this post from KentW/Blue Dog.

 

[Intensivist]

l found that it doesn't matter that much what kind of stethoscope do you have, as long as you are used to it, and of course have to practice your auscultation skills. l would say that it's pure waste of money to go and buy a fancy ones, unless you have some hearing problems, and in fact it up to some point makes you neglect your physical exam skills. l went through most of my med school with really cheap one, Riester classic, and now l have cardiology one, but nevertheless, after getting used to my cheap stethoscope (by practicing) l got to hear all murmurs my attendings heard, and often even before they did (of course b/c l got to do 1st exam on patients)

just my 2 cents

cheers

 

[jennyboo]

The stethoscope I use in the OR is whatever disposable one I find hanging on the anesthesia machine.

I lost my real Littman months and months ago. There is one in my locker which I never bother to take to the OR -- after I lost my Littman, I went to the anesthesia workroom and grabbed whichever sparebie some other poor loser had left behind, since obviously someone walked with mine.

 

[IlDestriero]

... after I lost my Littman, I went to the anesthesia workroom and grabbed whichever sparebie some other poor loser had left behind, since obviously someone walked with mine.

Seriously?
Way to look out for eachother...

 

[Surfer]

One of my colleague MS-3's on a surgical rotation was called to a consult in the ED last week. I finished up what I was doing and stopped by about midway through the H&P. Middle aged guy, came in for hand pain, which turned out to be nothing of note. Incidentally, a large soft mass was discovered in the left testicle. Imaging was equivocal... mass lesion vs hernia. Surgical consult was called. Of course, I didn't know any of this when I walked in... I just knew we had a surgical consult and I thought I'd check in on my colleague.

I walk in and the first thing that I notice is that the patient is really malodorous. Not the kind of smell you get from not taking a shower for a couple of days, more like a couple of weeks. No problem. Seen it (smelt it) before. My classmate pats his white coat, checks his shoulders, looks to me.

"Do you have a stethoscope on you?"

I don't think twice. I just hand mine straight over to him. The fancy one that I was convinced I'd need back in first year when the rep came to speak to our class. Right around the time I also picked up my PanOptic Ophthalmoscope.

So I hand it over and my friend goes to work. Checks the lungs, heart sounds, listens for murmurs, carotids, abdomen, etc., the whole 9 yards. As he's doing this I'm thinking, "Man, I'm gonna really have to spray down my stethoscope after this one."

He finishes up the abdomen and pulls the sheets down. It smells even worse than before. I'm starting to wonder what we're here for right about now. For some reason he's still got my stethoscope in his ears...

He points to the guy's left testicle. It's big. On closer examination, it looks like he's got 2 testes in there.

My colleague finally informs me: "So the reason we're here is there might be a hernia."

And slowly, but surely, he begins to move the diaphragm of the scope down there. For a second, I think he's joking. Then he looks at me again, guiltily, and it dawns on me that he's seriously going to place my stethoscope right on this guy's malodorous balls.

I give him a look that says "Noooooooo!!!!"

But it's too late. The diaphragm is on the skin.

I don't know if the tears in my eyes are from the feelings of loss or the thick haze permeating the air. I cycle through the first 4 stages of grief in a flash... Denial, anger, bargaining, depression. Acceptance would come much later.

I'm staring at my colleague in disbelief. He hands me the scope and says, "Take a listen."

So I do.

Bowel sounds.

Turns out the guy has an large incarcerated loop of bowel in his scrotum.

We call our attending, admit the guy, and book the OR. Needless to say, my colleague spent the next 15 minutes scrubbing down my stethoscope.

Quick tip if you find yourself borrowing someone's stethoscope in a similar situation: slide a latex glove over the chest piece and you will avoid the ire of your colleagues.

Maybe I still haven't hit acceptance yet.

All that is to say: I'd go with a basic one.

hahaha, that's good stuff professor.