stethoscopes ........which is best?

Discussion in 'Medical Students - MD' started by CaliMed, May 10, 2002.

  1. CaliMed

    CaliMed Member

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    Should I buy a stethoscope from a medical supply online or at medical school. What brand and model is the best?
     
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  3. t_kim

    t_kim Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by CaliMed:
    <strong>Should I buy a stethoscope from a medical supply online or at medical school. What brand and model is the best?</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">You'll get a lot of different answers on this one ...

    But, I've used a lot of them as a paramedic, and for nine out of eleven years, I used a Littman Cardiology III.

    Really the two things you should look for is the shape of the bell - whether it twists to give you a adult/pedi sized bell, or is one size, and the number of tubes leading from the bell to the earpieces.

    There are steths with two visible tubes leading up to the earpieces - avoid those like the plague, as those two tubes will rub against each other and cause extraneous noise.

    Most modern steths have two tubes encased in a single tube - that is, there are two channels within the tube. This prevents that rubbing noise I mentioned.

    Then there is the length of the tubes from bell to earpiece.

    Used to be that the shorter length was better, because you tend to lose some sound the further up it had to travel. No more.

    For Littman, there are 19 and ~22 in lengths, IIRC.

    Take my advice - get the longer length. The shorter one doesn't 'hang' right when draped around one's neck, and with the modern construction of the channels within the tube, there is minimal loss of sound with the longer distance - not enough for one to really notice.

    Also, it allows you to have a little more distance from the more 'fragrant' of one's patients.

    But really the most important part are the earpieces. Littman gives you a choice of hard or soft rubber earpieces - and two sizes of the hard ones at that.

    Now, the Cardiology III lies in the middle of the series - the top is the Master Cardiology - with it's gold anodized non-rotating head, below the II is the Classic - with a single, non-rotating head.

    WIth the single head models, you're supposed to increase/decrease pressure applied to the bell when pressed on skin to listen for low or high pitched sounds. Sounds complicated to me.

    Get what you can afford. I've used the Cardiology III and have had no complaints, though people tend to have the rotating head wear out after many years of use. I also prefer the Cardiology III because I have the pedi bell adaptor, which is a rubber insert for one side of the bell, permanently in place so I can auscultate adult or pedis without too much trouble.

    Get the Classic if you want to carry a lighter scope and don't want to shed tears when it 'takes a walk' - 2 of mine did.

    There are off-brands/clones of the Littmans - ADC comes to mind.

    Littmans are quality scopes, and the price difference between them and a knockoff brand isn't enough IMHO to justify pinching pennies on one of the most useful diagnostic tools you'll carry everywhere for years.

    - Tae
     
  4. mcwmark

    mcwmark Senior Member

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    Wow, what a reply. I think someone should save that answer and repost it whenever someone asks again.

    I'll second the Littman Cardiology III, though I myself have the Master Cardiology. Some people will say it doesn't make a difference (it's whats between the ears that counts) but after using the cheaper Littman Classic series for two years, I appreciate how much better the acoustics are in the Cardiology series.
     
  5. Smurfette

    Smurfette Antagonized by Azrael
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    I have to agree, it seems most docs I've seen (and med students) have Littmans.

    As far as buying on online or at school, I can tell you that at my school, the med equipment salesperson came in to allow us to 'try out' the equipment to get a sense for length, color, etc. Some people prefer slightly different stethoscopes, with or without a pediatric bell, different sound transmissions, etc. Getting to "play" with the different kinds made me feel like I picked well (tho very subjective to a first year who knew nothing at the time). So, maybe find out how your school works the whole equipment purchasing before going out and ordering one.
     
  6. jdaasbo

    jdaasbo Senior Member

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    This topic comes up once in a while. The stethoscope is becoming the vestigal instrument of the physician. Honestly, the vast majority don't know how to use it and don't really want to learn. it takes a long time to really tune your ears as instruments. As a result, when you ask different people what you should get/look for in a scope, you sometimes get strange answers. Here is my two cents.

    Your stethoscope should have a diaphragm and a bell. Some companies (ie. littmann) don't sell stethoscopes with real bells anymore. Their master cardiology is supposed to give you low and high frequency sounds by alternating the pressure on the the single head. It works in theory, but a real bell will give you ONLY low pitched sounds, while the littmann gizmo gives either low and high pitched simultaneously or only high pitch sounds. This is a fine point, but certain heart sounds (ie. S4 vs split-S1) are distinguised from eachother by this very mechanism-thus you need a real bell and a real diaphragm.

    Tube length is important. It should not be super long. The longer it is the poorer the sound quality and amplitude. Who cares how it looks sitting around your neck. Too short is impractical (and as someone pointed out is not always hygenic). Look for 22-25 inches.

    One vs Two tubes. Two tubes is a must. Some companies have two lumens inside of one tube. This is fine. The "rubbing" that occurs when you have two separate tubes is a nice notion, but you should be sitting/standing still when listening, so that really shouldn't matter at all.

    I like the following (and this is just my opinion):

    Welch Allyn Harvey DLX
    Welch Allyn Harvey Elite
    Hewlitt Packard

    these three all have good bells and diaphragms, two tubes, and the right lenght of tubing.

    The Littmann Master Cardiology is ok in my book, but suffers from only having the one sided head. Get the one with the shorter tubing. Littmann makes their's in either 22 or 27 inch tubing. Who cares if it is gold coated or whatever-more likely to get stolen the fancier it looks.

    The cardiology III i am not a big fan of. Out of the box it has two diaphragms, one adult and one peds. I have never seen a pediatrician use the peds side. There is NO bell. You can convert the peds diaphragm to a bell, but I have found with mine, that you really get poor low pitch sound response. I just don't like this model.

    DRG makes some interesting scopes. I don't know much about them, but I would look for the above items in their products and make up your own mind.

    Listening to a scope/test driving it is a good idea. This is hard to do in a store. Ideally you would be able to use one on the floor for a week or so and listen to actual patients at the bedside. The ear pieces should fit comfortably, neither so tight as to pinch your head nor too loose to make a good seal.

    All of that said, for most docs, it really doesn't matter. There was an interesting study a few years ago in the Annals of Int. Med I think wich looked at the ability of internal med,family residents, and third year med students to identify basic heart sounds (ie mid systolic murmers). They found that all three groups did equally poorly, identifying less than 40% of what they heard at all, and far less correctly. For the purposes of listening to breath sounds and to see if the heart is beating regularly, don't waste your money, use a 20 dollar cheapo scope. If you are interested in learning how to listen to the heart properly, invest some money, and more importantly, invest the time and effort. Find someone at your school who is interested in teaching you this stuff properly and who hopefully can hear these things themselves (look for a cardiologist). It is frustrating at times-some of these things are really quite difficult to hear! But they can change your patient management in certain circumstances.
     
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  7. t_kim

    t_kim Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by jdaasbo:
    <strong>
    Tube length is important. It should not be super long. The longer it is the poorer the sound quality and amplitude. Who cares how it looks sitting around your neck. Too short is impractical (and as someone pointed out is not always hygenic). Look for 22-25 inches.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Littman did a study - don't know how scientific it was, but here's the URL and info:

    <a href="http://steeles.com/catalog/length.html" target="_blank">http://steeles.com/catalog/length.html</a>

    "Quite often health care workers raise questions regarding tubing length based on early publications claiming shorter tubing length provides better acoustic response. Some instructors have recommended their students buy the shortest tubing possible. In an attempt to clarify many of the myths surrounding tubing length, 3M Littmann has tested their stethoscope product line to offer the following information about tubing length.

    To explain our test results, it will be helpful to compare the tubing of the stethoscope to a garden hose. For example, an increase in the length of a garden hose will decrease the pressure at the end of the hose as a result of frictional and other internal forces. The same effect occurs when the tubing length of a stethoscope is increased. However, in the case of stethoscope tubing, change in length is relatively small; this decrease in acoustic pressure is not detectable by the human ear.

    Additionally, as tubing length increases, resonant frequency decreases. Considering this fact, an increase in tubing length provides a better response to the lower frequency sound (an advantage in auscultation). Many heart sounds fall below 150 Hz and are considered low frequency. Because it has been shown that the human ear is least sensitive to low frequency sounds, improved low frequency response is an advantage.

    Taking these two factors into account, there is no detectable difference in acoustical performance between stethoscope with shorter tubing vs. that with longer tubing. In fact, there may be some enhancements to low frequency sounds.

    When purchasing a stethoscope, the customer needs to consider their own needs and practices. Longer tubing might be more appropriate for people wearing the stethoscope around their neck as it drapes better. The customer's height and arm length should also be a factor to determine optimal tubing length. Many practitioners would like a little more distance from sicker patients while auscultating. Longer tubing also reduces the amount needed to bend over the supine patient which can stress the health care provider's lower back."

    <strong> </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">One vs Two tubes. Two tubes is a must. Some companies have two lumens inside of one tube. This is fine. The "rubbing" that occurs when you have two separate tubes is a nice notion, but you should be sitting/standing still when listening, so that really shouldn't matter at all.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Perhaps, but as a paramedic, I work in environments that typically have lots of ambient noise, and in situations, i.e., a moving vehicle, that does not afford me the ability to sit or stand still. In these situations, I find the single tube-double lumen configuration indispensible.

    I have seen people who purchase the double tube Sprague-Rappaport-type steths tape the tubes together in frustration with the ambient noise they get from the tubes rubbing.

    <strong> </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">
    The cardiology III i am not a big fan of. Out of the box it has two diaphragms, one adult and one peds. I have never seen a pediatrician use the peds side. There is NO bell. You can convert the peds diaphragm to a bell, but I have found with mine, that you really get poor low pitch sound response. I just don't like this model.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Ah, this must be a newer model than I have, which has a bell on one side and a diaphragm on the other. I will say that having diaphragms on both sides would prevent a lot of dust and build-up from falling into the hole on the bell side - where the ball-bearing action is located.

    Here's another URL listing the features of the different Littmans:

    <a href="http://steeles.com/catalog/chart.html" target="_blank">http://steeles.com/catalog/chart.html</a>

    - Tae
     
  8. Sweaty Paul

    Sweaty Paul Senior Member

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    Just a note on the Littmann Cardiology III, the pediatric side w/diaphragm actually has a removable diaphragm that will allow you to convert that side into a bell. Now I cannot say if this is a 'true' bell as one of the above posters mentioned, however, the sales people assured me that it was a bell when it was configured in such a manner ('course I could be gullible).

    End result, I have a Cardiology III as do the majority of students in my class and everyone seems pleased.

    Sweaty Paul
     
  9. motogirl

    motogirl Junior Member

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    Hi everyone. I will be entering med school come this August, but I have been volunteering in a local clinic in town. The doctor gave me a stainless bell DRG cardiology as a gift last year. It has great acoustics and features (You can check out spec's at an online med equipment page.). It is a little heavier than the Cardio III, so if you were to purchase the DRG, I would suggest getting the titanium bell if weight were an issue. I have met many students who use the classic II S.E. and the Cardio III. They like both models. Another student I talked to uses a Welch Allyn. Just thought I would throw in my 2 cents.
     
  10. Firebird

    Firebird 1K Member

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    Don't get a stethoscope. Take a piece of paper, roll it into a cone, and stick it in your ear. That's what we do in KY/WV.

    (just to clarify, put the small part of the cone in your ear)
     
  11. Bradleyp

    Bradleyp Senior Member

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    I read an article about stethoscopes that now digitally record breath and heart sounds so they can be placed in the patients chart (digital records) for future reference and teaching. They are supposed to have great accoustics, but they run about 500 or so (some even much more).
     
  12. PainMan

    PainMan Senior Member

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    Bradley, your .gif is great! I had a poster in college similar, but John was wearing his green "COLLEGE" sweatshirt from animal house....ah the good ol days.
     
  13. Future_Doc

    Future_Doc Senior Member

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    The real question is this . . . which stethescope looks best hanging from the rear-view mirror? :D
     
  14. motogirl

    motogirl Junior Member

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    Future_Doc wondered which looks best dangling from the rear view. I would definitely say those nurse mates ones with that bent piece of metal holding it together cuz it has a glimmer in the sunlight. <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> And, they come in so many pastel colors to choose from. <img border="0" title="" alt="[Wink]" src="wink.gif" />
     
  15. Future_Doc

    Future_Doc Senior Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by motogirl:
    <strong>Future_Doc wondered which looks best dangling from the rear view. I would definitely say those nurse mates ones with that bent piece of metal holding it together cuz it has a glimmer in the sunlight. <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> And, they come in so many pastel colors to choose from. <img border="0" title="" alt="[Wink]" src="wink.gif" /> </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif"><img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />
     
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  17. operadoc

    operadoc Member

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  18. Rads

    Rads Member

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    EMT's and fire buffs hang stethoscopes from rear-view mirrors, physicians do NOT. Don't look like an idiot.
     
  19. t_kim

    t_kim Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Rads:
    <strong>EMT's and fire buffs hang stethoscopes from rear-view mirrors, physicians do NOT. Don't look like an idiot.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Only idiots make sweeping generalizations such as these.

    - Tae
     
  20. dr_lecter

    dr_lecter Senior Member

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    There's this interesting story with stethoscopes. Hope you ppl like it.

    During our first class in general medicine, our professor asked us this-" Which is the most important part of a stethoscope?". He further went on to add that, he'd give his stethoscope as a prize to the one who got it right (the stethoscope is still with him).

    Everyone in our class went about giving answers like, 'the ear piece', 'the bell'. Some even went on to give credit to the tube. After everyone were done giving answers. He came out with the answer......

    And the answer he gave was, " It is what is in between the two ear pieces that is important". If you still didn't get it. It is all in the BRAIN.
     
  21. acshore

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    riger-bowles.JPG riger-bowles2.JPG View attachment 195736 View attachment 195737
    I am inclined to agree with you, jdaasbo, in regards to the two-tube vs. one-tube theory. I am in the process of beginning my certification for becoming a Paramedic. A gentleman I encounter while at work - who is not only a Medic himself, but teaches the curriculum - told me it not just a matter of preference, but also the quality of the diaphragm/bell. Weight is above all the main determining factor. I have read numerous reports online as well as asked around; the bottom line is the heavier the mechanism, the more of a seal you will get and better acoustics during auscultation. Dr. David Littmann is responsible truthfully for designing a more lightweight and simple model of a stethoscope. This has long been a favorite of medics especially because of its less-bulky and more portable-friendly scheme. That being said, Littmann scopes are good enough to get the job done however it does not mean they are better acoustically, but more in the area of convenience. Two-tubes scopes allow you better stereo separation and are especially good for allowing a better sound profile; tubes rubbing together often times because they are no longer the norm and medical personnel are not familiar with how to accurately position and/or hold them. The gentleman of whom I talked also informed me many medical devices were not only at one time more affordable but higher quality than now. I invested in a 1930's Rieger-Bowles stethoscope; all original hardware and tubing. The bell, unlike later models - which became bakelite and easy to chip - is aluminum, and the heft is quite something. Original designs consisted of a smaller bell and was not as large nor detachable; the later development of an improved bell size and wider round hole in its center provided better acoustics. Also, rubber tubing is a a fraction of the cost to replace if cracked or gashed versus Littmann plastic design by 3M which is roughly $78.00; over half the cost of a new Littmann scope. Medics Instruments based out of Brooklyn, New York, as well as Riester in Germany, made their own take-off of the Rieger-Bowles scope; as did Polka, whos were cheap knock-offs made of brass coated with nickel-plating.

    When Bowles partnered with Sprague to create the two-sided head like Sanborn (later Hewlett-Packard) scopes, the position of the tube mounts were much less practical and is what caused a lot of the friction with having two tubes. With the exception of their being easier to handle, I am not a fan of Littmanns as a rule. I have included the first design of the Rieger-Bowles, patent in 1927, and a newer and improved lever/bell design some few years later; the later being the one I purchased from ebay. View attachment 195736
     
  22. frosted_flake

    frosted_flake waaahmbulance attendant
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    IT'S ALIVE!!! :eek:
     
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  23. samac

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    I'm glad this was necro bumped so I could read this comment.
    I'm dying lol
     
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