Hi, all. Assuming that this question has been asked a million times, I did a search for “stethoscope,” but only got an error page saying that no matches were found. So please excuse me if this is a well-worn subject.
The folks from 3M and Welch Allyn came to my school today to sell stethoscopes and diagnostic kits. I’d appreciate some advice on the following questions:
1. Stethoscope: I’m leaning toward the Littman Cardiology III because it seemed to feel pretty good, and has a pediatric side (I’m interested in pediatrics). The other stethoscope line they showed was Tycos-Harvey (the DLX and Elite). Those seemed a bit heavy and harder to hear through, though I really only had a couple of minutes to compare. I’ve heard everything from, “get a $15 POS because you won’t know the difference anyway,” to “buy the best you can afford now and grow into it.” I’ve also read that the Cardiology III is sort of showy and may prompt attendings to see how well you can use it!
2. Diagnostic kit: The clinical instructors that spoke before the presentation said that, while expensive, these kits are good investments because having one tends to make you want to use it, thereby giving you lots of good practice. But, of course, I’ve read that many people never use them since almost every exam room has one anyway. In my case, I am looking sort of hard at the new panoptic opthalmoscope because my youngest son has retinoblastoma and I would like very much to have a tool that will let me see as much of his retina as possible. The panoptic is, naturally, quite a bit more expensive than the traditional scope, and I doubt that it’s in wide use in hospitals.
3. Misc.: I don’t think I will get a blood pressure cuff, but what about reflex hammers and tuning forks? Are they of any real use?
Anyway, if I want to order from the reps, I have to make my decision by Friday. If you have experience to share, I’d sure welcome it. Thanks!
I am assuming that you’re one of the fortunate ones to be starting med school this fall? That so…CONGRATULATIONS!!! Please take a moment to tell us where you will attend, about your journey getting there and something about yourself. If you have already done this & simply missed it…my apologies, please point to the thread.
Stethescope: Personally, I have toted a Littman scope around for many year and have the Cardio III myself - it is an excellent scope!! And, to bump to the next model, I do not feel the samll gain merits the expense. Now, let me be blunt…at your level of expertise, you will not be able to tell a whole hell of a lot of difference b/t an inexpensive scope and the Littman…inexpensive DOES NOT INCLUDE the $15 dollar model you mentioned. When I started resp therapy school, I cheaped out and got a $25 scope…it was essentially a heavy paperweight!
Auscultation is very much a learn art…let me repeat that for effect…Auscultation is a learned art!!! You will have to train your ears to dissect the multiple layers of sounds that you will here to isolate what tones you are looking for. It takes a looooooong time to do it and the only way you will ever get good at it is listening to hundreds and hundreds of chests. Few medical students, or even most residents, are even marginally competent at it, even at the conclusion of their training.
Want a piece of advice on how to get good, I mean REAL GOOD? Find you an ICU respiratory therapist who is respected by the staff. Ask he or she to elp you learn to appreciate heart & lung sounds. There is no one any better at listening to a chest than an RT – afterall, it is their bread & butter.
Once you’re good, you can actually take that $15 POS and do some effective assessments…but you need to start with some appreciable quality first.
Diagnostics Kit: Yep, everyone wants one cause it is a way cool Doc-toy. I know I did…and I have used it fewer than a 12 times in the three years I’ve had it. Every where I have worked, there are several available to use. However, going into my internship in a few months, I plan to tote my kit around for convenience.
I would not spend a load of $$ on it, although that is the temptation…and I succumbed to it too! I had that first loan check in my grubby paw and thought, “Wow, I just got a $11k check, I can afford to drop $800 on my kit!!”. I could has easily not bought it & passed med school just fine. And, the wisest option would probably have been to wait & buy one just before I started my internship.
Hi, Dave. And thanks for the advice. As for my story - I started visiting the board about a year and a half - 2years ago when I had made the decision to leave my career in public broadcasting and revisit an interest in medicine that I had shelved for 10 years. I spent a year taking all the required sciences (I'd been a hardcore English major), took Orgo and the MCAT during the summer of last year and started at Albany Medical College this past September. I'm 36, married with three sons (2, 4 and 7)
I appreciate your advice on the stethoscope - especially about how to learn to use it. I have no illusions about being able to tell much of a difference, but I do know that having a decent tool usually makes things easier, so I'll probably go for the Littmann. (Actually, my parents will - they've offered to give me the scope as a Christmas present…)
You're right about the diagnostic kit, too, I'm sure. But like you said it does seem cool! The only thing that bothers me is the advice that the clinical faculty gave about needing the practice. Then again, they bought theirs in the late 60s/early 70s when the kits probably cost a lot less than $600 - $800.
Thanks again for your advice.
The peddlers visited us recently, too 
I got my diagnostic kit (we were required to have one). Anyway, here is a thought-- I have NO IDEA if this will occur or not, but… with the new Clinical Skills exam being added to USMLE, might they not require use of “standardized” equipment? I’m not sure I’d want to have practiced with the Panascope (but it was sure cool), and then have to use another piece of equipment on the exam, that I was less familiar with. But I’m speaking from ignorance here! Buying the stuff was sort of fun— can’t wait to actually learn to use some of it! (Oh, I had a Littman that was given to me as a “congratulations for getting into med school gift”; it’s a Classic SCE. We were fortunate that the “peddlers” gave us all sorts of free stuff with our purchase of a diagnostic kit- reflex hammer, penlights, practice “eye” for the opthalmascope, etcetera.
| QUOTE (Epidoc @ Nov 20 2002, 10:23 PM) |
| Anyway, here is a thought-- I have NO IDEA if this will occur or not, but.. with the new Clinical Skills exam being added to USMLE, might they not require use of "standardized" equipment? I'm not sure I'd want to have practiced with the Panascope (but it was sure cool), and then have to use another piece of equipment on the exam, that I was less familiar with. |
Yeah, that concern crossed my mind. I asked the peddler about skills transfer between the panoptic unit and the more traditional one. Received the answer I expected from a salesman.
Sounds like your peddlers were a lot more generous than ours. The best ours offered was a CD of heart sounds. Big deal. I got one of those with my Bates book. Oh, well...
I also went with the Cardiology III. Don't know a lick about what I'm listening for yet but oh well. I'll bring it with my on my Family Practice preceptorships and listen to a few heartbeats/lung sounds just to get used to finding the right places and the normal sounds. I did not buy a diagnostic kit although some of the 3rd years did so I assume they can be somewhat useful on clekships even though there are otoscope, ophthalmascopes in every examining room.
Hi all,
I've used the Littman Cardiology II/III for all the time I've been a paramedic. Working in the back of a moving vehicle, I can still hear lungs sounds - but that's about all. But I'm happy with that.
One piece of advice - get it personlized, i.e., engraved or tagged, as soon as possible. They have a tendency to 'walk' in hospitals. I'd go the engraved route myself - those tags rip right off. Just go to the mall - Things Remembered, etc., and have your name or initials put on.
And one more thing - get the longer model. 3M states that the difference in the length of tubing equates to a loss of sound that is undetectable to the human hear. But the extra length - you'll be grateful come the next 'fragrant' patient. Plus, it drapes better over the neck.
- Tae
| QUOTE |
| And one more thing - get the longer model. 3M states that the difference in the length of tubing equates to a loss of sound that is undetectable to the human hear. But the extra length - you'll be grateful come the next 'fragrant' patient. Plus, it drapes better over the neck. |
ROFLMAO!!!!!
I sooooo thoroughly enjoyed that comment!! I cannot tell you how many times I have given that same piece of advice to folks looking to purschase a set of ears. In fact, I shocked at myself for neglecting to include it!
For those of you who do not know...this is one of the massive advantages of pediatrics...when adults get sick, they think that that means I do not have to bathe, wash my hair or brush my teeth. When one of them elects to talk to you whilst you're auscultating them, and ALL of them WILL DO IT, you will thank your soul that you got those looooooooong tubes. I have had my eyes water, hair curled and damned near lost my contacts when some highly intoxicated, filthy dude w/ green, brown & black teeth staggers into the ER complaining of Lord knows what.
Get the Littmann with loooooong tubes!
http://steeles.com/catalog/length.html
"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."
Hey Folks,
I have a Littmann Classic II, one of the cheapest, that has been my constant companion. It isn’t the scope but the trained ear that will makes the difference. My advice on stethoscopes is to get the cheapest scope that has both a bell and an diaphragm. For those folks who are going into peds, get your peds scope when you are an intern. Every NICU, Nursery and PICU had plenty of peds scopes around; so did the general wards.
As for the diagnostic kit, I used mine quite heavily. I made myself look into everyone’s eyes until fundoscopic exams were second-nature to me. You need to purchase the cheapest kit (about $400). Since I have been at UVa, my kit has been in my bag that is buried deep in my closet. Unlike Howard, UVa has working oto and opthalmoscopes in every exam room. You only need turn around to get one.
We also get plenty of free penlights too. The one thing that I have found need for lately is my Sanford Pocket Manual. The one that I am using is a 2000 version. I am in need of an update since Linezolid is one of my favorite antibiotics these days.
Things in my pocket these days: Surgilube, Developer for Guaiac cards, Guaiac cards, Surgical Intern Pocket Survival Manual, my paging directory, my Pocket Pharmacopaea, my surgical cap (custom made) and my Littmann Classic II scope. 
Natalie
P.S. If you want to keep your Littmann looking soft and new, wipe it down with Armor-All after you clean it with disinfectant and alcohol.
| QUOTE |
| P.S. If you want to keep your Littmann looking soft and new, wipe it down with Armor-All after you clean it with disinfectant and alcohol. |
LOL...guess what? Armor-All now comes in pop-up, wipie-type containers. Pull one out, tear it off. Cool.
I only have a couple of Sprague/Prestige Medical scopes right now, but want to get a Littmann eventually. (And Santa, if you're listening, I've been really good this year...).
A note on handling otoscopes: I got a battery powered otoscope, nothing fancy, after my first son was born...and had his first ear infection. We still have it; it was mail ordered. After that first infection, I examined his ears when he was well, when he had a cold coming on, or a fever...but ONLY while he was asleep so he was still! His little ears taught me a lot about "normal". From these few "well exams" (and looking at the otoscope manual), I knew, (KNEW!), when I saw his second and third (thankfully last) ear infection. Same goes for our second son, only he has only had one bout of these middle ear nasties. I've also examined my husband's ears. Our vet let me take a peak at our dog's too. Learning a lot about "normal" is a good starting place whether we're talking otoscopes or stethoscopes!
At mini-med school, we had a lab on heart sounds. Very well done! The doctor who lectured had a heart synthesizer that was remotely slaved to our stethophones. Stethophones look like a stethoscope, only without the long tube and bell & diaphragm. Instead, they have the usual ear thingie arrangement down to a single tube that has a little box on the end of it (i.e. a remote receiver). With all of us sitting in the "heart lecture", the doctor gave his presentation on heart sounds, gave us several "normals", then "abnormals" and what each murmur and click meant in terms of pathology, what valves were involved...while he simultaneously showed us EKG's and heart monitors' 'blips' on a big screen...all as we were hearing the heart (& lung) sounds through the stethophones! It was a lot to keep track of, but wonderful...next time I shadowed, I knew more of what I was hearing from auscultating different patients. Loved it!
| QUOTE (Mary Bois Byrne @ Dec 1 2002, 02:50 AM) |
| A note on handling otoscopes: I got a battery powered otoscope, nothing fancy, after my first son was born...and had his first ear infection. We still have it; it was mail ordered. After that first infection, I examined his ears when he was well, when he had a cold coming on, or a fever...but ONLY while he was asleep so he was still! His little ears taught me a lot about "normal". From these few "well exams" (and looking at the otoscope manual), I knew, (KNEW!), when I saw his second and third (thankfully last) ear infection. |
Yes, this is similar to my reason for wanting to buy an opthalmoscope though most people say don't bother. My son has bilateral retinoblastoma. It is, fortunately, controlled (read "gone") in his remaining eye, but I still can't get over the fear that some nasty surprise will rear its head between visits to Philadelphia, which are now spaced about six months apart.
I'm looking at a few, traditional, coaxial opthalmoscope kits right now - ebay is practically rotten with them - but the panoptic sounds so much more effective...
Anyway, thank you all for the excellent advice. I've already bought my stethoscope. Now I need to go get some Armor All!
Is it too late to add my two cents?
I also have a Littman Classic II stethescope. All of my classmates carry around the Cardiology II-III (I can’t tell them apart, but it’s one of the Cardiology series). Mine was a gift on my first day of medical school from my spouse and I wouldn’t trade it for the world! It works fine, and I haven’t ever NOT been able to hear something that my classmates can hear. And mine looks different, which is sometimes helpful!
Definitely skip the diagnostic kit. My otolaryngology prof calls it ‘a very expensive flashlight’ which seems to be the prevailing opinion around the hospital as well. Almost every clinical environment you’ll be in will have them mounted on the wall. I used mine a bit in first year to practice the eye exam, but that’s about it. I’m certainly not going to carry it around if I don’t have to. I’m actually hoping to sell it to an unsuspecting first year in the class of 2007.
Same with the BP cuff. It will be on the wall. And Murphy’s Law states that whatever size BP cuff you happen to have on you will be the wrong size for the patient you’re seeing. It’ll either wrap around their arm twice or won’t even make it halfway 
. Again, these are on the wall. If not, you can borrow one from the nurses station. Unless you’re going to invest in the package with the different sizes of cuffs and then cart them around the hospitals with you, skip this one as well.
I definitely recommend getting a tuning fork and reflex hammer. I like the Queens Square hammer myself. And the only tuning fork I ever use is my 128Hz. My 512Hz usually gathers dust at home. These are cheap tools that can be used for more than one test, and fit easily in your pocket. And good luck finding them on the ward if you didn’t bring your own!
Caveat emptor.
Natalie
I second everything that Tae said… I have a Master Cardiology (engraved!!) due to a little miscommunication w/ Santa. For about a year and a half prior to making the decision to go full time pre-med, I worked on an ambulance.
When I came thru the door at the beginning of shift w/ my nice new steth, my partner was impressed. So, while we’re blazing back “hot” to the hospital that night, he sees that i have my “ears” on and am listening for a BP. My partner shouts back, (mind you, we’re going code three… lights/siren/air horn/yelling out the window at dumb drivers) "Can you hear better with that new scope??"
I shout back, “pressure is 80/60 and we have a piece of gravel in the left rear tire!!”
okay okay… not QUITE that good, but ALMOST that good. However… since I didn’t buy it, I can be extremely extremely honest… the Classic II that my partner uses is JUST as good for what we were doing.
I can’t tell you what would be better in a relatively quiet clinical setting… I’ve never done a pressure or auscultated ANYTHING under those cond’s 
Knowing the problems we had in the back of the rig, I have no idea how the flight medics hear a single thing.
Just as a matter of fashion… it seems the RN’s go for the colored steths, and dr’s go for black. There seems to be a little leeway for the female dr’s, and DEFINITELY if they’re in ped’s. Just an observation!!
Christine
| QUOTE (Couz27 @ Dec 10 2002, 09:07 AM) |
|
I definitely recommend getting a tuning fork and reflex hammer. I like the Queens Square hammer myself. And the only tuning fork I ever use is my 128Hz. My 512Hz usually gathers dust at home. These are cheap tools that can be used for more than one test, and fit easily in your pocket. And good luck finding them on the ward if you didn't bring your own! Caveat emptor. Natalie |
Hi there folks,
If you are investing in a tuning fork, be sure to have both the 128Hz and the 512 Hz. The 128 Hz is good for vibration testing for the neuro exam. You do not want to perform a Weber or Rinne test with a 128 Hz because the patient can feel the vibrations rather than hear them. You want to use your 512 Hz for these tests.
For a good neuro exam, I use lab tubes filled with hot and cold water, a Q-Tip broken for sharp and dull along with my reflex hammer. If you don't have a hammer, you can use the end of your Littman Classic as a reflex hammer. This cuts down on the amount of stuff that you have in your pockets. Again, if you invest the $400 or so in an opthalmoscope/otoscope, you need to take the time to learn how to use this equipment. I recently had a patient who had papilledema that I was able to pick up. Not bad for a surgeon who does take the time to do a fundoscopic exam.
Natalie
| QUOTE (njbmd @ Dec 14 2002, 04:25 AM) |
| If you don't have a hammer, you can use the end of your Littman Classic as a reflex hammer. |
But - if you get the heavier Cardiology II/III/Master, you can also use it a bolo to snare the ocassional 'eloping' patient.
- Tae
| QUOTE (taehyongkim @ Dec 14 2002, 01:45 PM) | ||
But - if you get the heavier Cardiology II/III/Master, you can also use it a bolo to snare the ocassional 'eloping' patient. - Tae |
And you lose 20 pounds each month carrying the extra weight of this scope around in your jacket or lab coat pocket. You can skip the gym all together!
Natalie
Assuming, of course, that someone does not decide to lighten your pocket-load by light-fingering your Master Cardio!!