Thursday, February 1, 2007

Auscultating Joy

Dr Dork is excited.

He bought himself a new toy today. A new stethoscope. The first one in a decade.

When Dr Dork was a medical student, he spent the equivalent of many weeks wages at his part-time job on a swish stethoscope that would purportedly stop him from misdiagnosing things like death and dextrocardia.

He used this until fairly recently.

However - Dr Dork also received a free "cheapo" stethoscope as a medical student. A Rappaport-Sprague* (double lumen) type.

Dr Dork also made much use of this "cheapo" stethoscope. And found it much easier to use than his swish mucho dinero version, more sensitive in particular.

Today, Dr Dork compared the "cheapo" double lumen versions with the "swish" stethoscopes, the latter costing several times the former.

He still prefers the double lumens to the fancy ones.

Dr Dork is interested in the preferences of others, if anyone would care to share.

*Maurice Rappaport and Howard Sprague invented this type of stethoscope in the 1940's. It is a style of stethoscope, not a specific manufacturer or brand.

Nice summary of the history of stethoscopes here.


Kim said...

I recently bought a Littman Cardiology II, mainly because I could not affort a Cardiology III! LOL!

Those electronic babies are over $500 dollars! The way stethoscopes run off, I'd be afraid of losing it!

ditzydoctor said...

i use a littman electronic one (forgot the model), apparently it's pretty high on the WOW factor with medical personnel!

but rest assured it's not by choice, i really wanted the one you showed in the photo but couldn't use it (i have a hearing problem and need amplification).

but it's ok because it means that i won't be doing cardiology anytime in the future! =D

The MSILF said...

Oh, it will be a sad, sad day when I have to replace my simple little green first one! Don't you get attached to inanimate objects?

Mama Mia said...

Mama Mia personally prefers her Littmann Cardiology III that she purchased on eBay for a cool $106. Mama Mia's mild hearing deficit is balanced nicely by this beautiful piece of jewelery. However, Mama Mia would really like one of the new electronic stethoscopes, as aging takes its toll on her ears.

Merys said...

I have my brightly coloured Littmann SE II which I love to pieces, even though it matches none of my outfits.

Thanks for the link by the way!

DrWes said...

I'm a double lumen guy from the beinning - the ol' Sprague Rappoport rocks! It cost a pretty penny, but HP stands behind 'em if something breaks...

Bo... said...

I've lost so many Littmann's that these days I usually use whatever freebie scope I can get from the various reps who haunt road nurse companies---which are usually cheap-imitation Littmanns (but they work pretty well.)

The Girl said...

I have a shiny new Littmann SE II. I am looking forward to the day when it is not shiny and new any more, and I know how to use it properly.
Besides, as a student I didn't want to get a hideously expensive steth and then leave it on the ward somewhere. Replacing expensive equipment is not something I want to factor into the budget!

#1 Dinosaur said...

I too recently splurged on a new Littman Cards II; identical in every respect to my previous instrument except for the absense of the word "Celebrex" in pale gray letters on the tubing; barely noticeable really.

Regarding various models: pretty much from the beginning, I have maintained that what's between the ear pieces is more important that what's between the chest piece and the ear pieces.

Charity Doc said...

Most of the time, the cacophony of chaos my ED is too freggin' loud for me to auscultate any thing, much less those fine rubs and gallops. All I'm interested in is, are breath sounds equal. That's pretty much it. Wheezes and crackles are adventitious bonuses. So why spend a whole lot of $$$ on fancy stethescopes at all except for social status? I'm a practical guy. I just use the cheapo ones lying around the ED that no one wants to claim. Or I just grab the ones of the nurses' or techs' neck whenever I enter the room, risking getting their ear cooties, of course.

Dr Dork said...

Hi peoples,

Thanks for all the feedback. A lot seem to favour the Littman, which I have as my swish one...and presumed it must be better as it costs much more.

I have had an engraved scope stolen before. Some people.

I wonder what those electrickery ones are like, never used one. Very good for teaching students, I would expect.

Yes I do. Replacement is due to necessity not choice.

As above, would love to know more about the electrical ones. Especially if they can be calibrated to specifically augment the frequencies we lose with presbyacusis.

You're welcome, of course. It will be fascinating for us older docs to watch you guys starting to blog in medschool evolve, if you keep it up, as the years roll by.

Dr Wes,
I am very chuffed! A cardiological opinion in favour of double lumens...perhaps I'm not as delusional as I thought...

I didn't mention this in the post, but the freebie double lumen I got as a medical student was from a pharma rep at a hospital round.

The girl,
I agree, they are easy to lose. And stains from bodily fluids etc. do give character.

Dr Dino,
Can't disagree with that.

In the hospital system there is certainly a bit of w**kerism about swish scopes as a fashion accessory. I think there is a genuine issue with transporting skin bugs via scopes, not sure about ears.

Kind regards

Midwife with a Knife said...

I need a new stethescope too. The plastic tubing on my old one (a Littman card. II) has become hard.

I'm not a double lumen person. I find that the tubes have a tendancy to rub on each other when I use them, making it difficult for me to hear well.

I might go with burgundy this time.

AzRN said...

Midwife with a knife: Send your Littman in to have the tube changed. It's cheaper than replacing it. I've done that with my Littmans and it worked well for me. I have an old Littman Cardiology II (before they made the III). Beside my daughter, it was the best thing I got out of the

View from the Trekant said...

The length of the tubing has more impact on quality than the brand.

Before the insertion to the head became so fancy, cardiologists used to cut the tubes shorter and reinsert the head for better sound.

Of course this may place you in a patient's bosom if you cut too short.

Echo Doc

PsychoToddler said...

I just recently also bought my first new stethescope in about 10 years. Mainly because I ran out of ear pieces for my last one (also my medical school one) and it was getting painful jamming those raw metal screw ends into my canals. I bought it over the internet on one of those medical student sites. I think it was also a litmann II.

Mmmm....cushy ear pieces...

NeoNurseChic said...

Here are my 2 stethoscopes. (and up close here)The adult one is a Littmann Cardiology II, and I got it at the start of nursing school - made a choice for a higher end stethoscope at the time - at least out of the choices they were suggesting to us. The neonatal one is also a Littmann, though I don't know what specific model. I always liked both stethoscopes, although the adult one spends the majority of its time on my closet floor along with the rest of the adult supplies I bought.

Now the neonatal one - I don't know if there are high tech neonatal models - never really checked into it. If someone has a neonatal stethoscope, however, it is the one that I have. I've never seen any other types. Our cheapo stethoscopes to use in isolation are adult sized and remind me of those fisher price stethoscopes that came in the play doctor kit when I was a kid...with the foam in the diaphragm. I'll never forget having it in my ears and my brother grabbing the end of it and yelling. Yeow... That's what little brothers are for, right? haha

A lot of docs (especially consulting from adult based services as we are not a peds hospital) ask to borrow my stethoscope because it's a lot easier to differentiate neonatal sounds with a neonatal sized stethoscope. If you have a 700 gram baby and an adult or even a peds sized stethoscope (like my Littmann adult has on the bell side), then you're still gonna get heart, breath and bowel sounds all in one. And while the trained ear should be able to differentiate, why make it that hard on yourself? In a neonate, the most difficult thing is that their heart rate is very fast (and when agitated, a tiny preemie's heart rate can be near 200 bpm) and they also can have rapid respirations. If they are vented or are allowed to have a binky (most parents of our long-term NICU kids allow them to have a pacifier), then it's much easier to listen to them because you can get them to stop crying in order to hear anything. But the hardest part is that if you're trying to hear a faint murmur (which could indicate a large PDA versus a loud murmur which might indicate a small or closing ductus), the breath sounds can mask the whoosh with the heart beat...especially if very coarse. I do think I'm actually pretty good at distinguishing murmurs, however. I try to have students or interns listen to the loud murmurs and if they want to know what I'm listening for when I hear a softer murmur, then I am more than happy to try to talk them through it. The most common one I hear, though, is the whoosh whoosh whoosh with each heart beat (heart rate too fast in neonates to distinguish systole from diastole in most cases - at least in my experience, but someone who has been at this a lot longer than me may disagree)...and often can be a PPS in a newborn or something like that. I cannot differentiate which murmurs mean what - but I don't know if too many people can do least without an echo! And again I'm sure I'm still not as good at it as nurses who've been doing it for years, but I really do enjoy listening to heart sounds. :)

Hope you enjoy your new stethoscope!

Take care,
Carrie :)

Anonymous said...

MWWAK, I've heard that said before, don't seem to notice it myself though.

Psychotoddler - didn't that hurt? Ouch!

Carrie - that neonatal one must come in handy. I've always been impressed with neonatal docs (and nurses!) who can differentiate murmurs with a tiny little heart gallavanting at thrice adult speed.

Hi Echo Doc,
Thanks for that explanation. I seem to recall one of the reasons the stethoscope was invented was due to it being considered indecorous to rest one's ear upon the chest directly. A pleasure to just now discover your blog, as well, very interesting, and Dr Wes is the only other blogging cardiologist I know of.

Kind regards

Calavera said...

I've got a Littman II Classic one in black (because I felt the need to conform, and besides, black goes with all my outfits anyway!) but recently I was eyeing up another one - the Littman 3000 with ANR (Ambient Noise Reduction, like, duh, didn't you know what that stood for, how can you be a doctor without an ANR stethoscope?!)

A really nice cardiology consultant let me use his and it's so SWISH! (for lack of better words.)

TO be honest, though, I'm just a third year, and the Littman II is more than good enough for me!

#1 Dinosaur said...

I once detected a *friend's* heart murmur during -- er -- an intimate moment. The pinna remains an excellent chest piece. (Acoustically speaking, of course.)

PsychoToddler said...

Psychotoddler - didn't that hurt? Ouch!

What did you say?

Dr. Deb said...

I like using a paper towel roll over the heart...but then again, I'm not a real doctor.

Dr Dork said...

That sounds very swish!

Deb - *chortling* Atleast it's not a toilet roll.

Psychotoddler - . ,

Thank you for the mental image.

Kind regards

dragonflyfilly said...

i have really acute hearing, so i don't really need one, but then again i'm not a "real" doctor either -- we Witch Doctors usually just relie on our finely honed instincts, .... that may explain why people run a mile when they see me approach with my rattles, snakes, and collection of skulls...*sigh* ...oh well!

...but as a patient i prefer the ones that don't make you jump when your bare chest comes in contact with cold metal....???

p.s. i did have to use one when i was working with Psyche Patients to record statistics, a really old one, don't know the name of it. Also an electronic one which i did not like ...

i DO, however, share your joy over a nice new shiney "tool of the trade" that make your job easier!

Sid Schwab said...

Sorry; I'm a surgeon. What the hell is everyone talking about?

Benedict 16th said...

Bugger all that stuff, if you want to do a heart exam, do what most GPs do - send them off for an echocardiogram....
It takes less time to print off a form than to actually listen to someones chest.


Dr Dork said...

Perhaps take off the witch-doc mask ? I think few are 'cold' nowadays..

'lol', as the kids say, Sid.

Hi Benedict,
My experience of general practice, scant as it was, was many moons ago - but I would hope an echo isn't done without good reason, and certainly not without prior examination at some stage.

One of the first things clinical medical students are taught is "if you don't look, you don't find!"

Kind regards

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