# Stethoscope hacking.



## jameswf (Sep 22, 2012)

So from what I gather stethoscopes like to grow legs and walk off, get soiled beyond proper sanitation or otherwise expierience other events that makes investing a lot of money in one a silly idea. So how can you hack up a cheap one to make it work better. 

Some advice from my teacher:

- Replace the diaphram with xray film. (done)
- Replace the tubes with suction tubing. (cant due to single tube design)
- Get Gel ear pieces (cant find cheap but got some rubber ones)

Any hacks you do to yours? Ethnic engineering etc...


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## Achilles (Sep 22, 2012)

Buy a littman and keep it under your bed, no one will know you have it so it won't get stolen.


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## abckidsmom (Sep 22, 2012)

I just make do with the cheap ones.  I don't make a lot of clinical decisions prehospitally off of heart sounds, so if I can't hear them, it's not a big deal.

I can usually always hear lung and bowel sounds very easily, even with the hearing damage I have sustained over the years of siren exposure.


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## NomadicMedic (Sep 22, 2012)

I have a couple of "frankenscopes". I have Littmann tubing with a Kila Labs bell and my Vet length ADC with Littmann ear pieces.


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## Handsome Robb (Sep 23, 2012)

Disregard the jibberish


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## usalsfyre (Sep 23, 2012)

MaxiScope by UltraScope...


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## Veneficus (Sep 23, 2012)

jameswf said:


> So from what I gather stethoscopes like to grow legs and walk off, get soiled beyond proper sanitation or otherwise expierience other events that makes investing a lot of money in one a silly idea. So how can you hack up a cheap one to make it work better.
> 
> Some advice from my teacher:
> 
> ...



I offer my loyal assurance, If I ever saw a provider walking around with suction tubing with a cut piece of xray film hanging off of it as something other than an emergency repair, at best they would lose significant professional credibility in my veiw. 

If it were in my power, they certainly would not appear before a patient as such. 

In the matter of professional pride, you don't need the most expensive equipment or even high priced equipment, but it does have to be in good repair and demonstrate pride in what you do.

Otherwise, it is not your equipment that is a hack, it is you. 

EMS is a healthcare field. 

Professional miinded people take care of their equipment. They clean it. They replace it when it becomes too worn.

Boots get dirty and scuffed. Why not just wrap some plastic bags around your feet and save some money? 

Pants and shirts become stained, frayed, and faded, why not just wear a leather apron?

You do not need to spend a lot of money. But you do need to represent yourself, your voacation, and your agency with professionalism.


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## mrg86 (Sep 23, 2012)

Go to allheart.com and buy a Littmann, they're on sale now. I just bought a Classic II for 70 bucks, the Lightweight is $45 and they will engrave your name on it if you want to prevent it walking off.


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## bigbaldguy (Sep 23, 2012)

Vene has a very good point. Some of the old timers in EMS (and folks who want to pretend to be old timers) seem to think the more worn out and beaten up their equipment/uniform is the more credibility they'll have. While I'm not advocating that every medic needs to look like a well polished penny I do think that wearing boots well past their polishable days or repeatedly piecing together a stethoscope from odds and ends is not something that we should be doing. 

Using X-ray film to repair a scope is great if you're behind enemy lines in Iraq or deep in the outback and there are no alternatives but it looks kind of silly outside of that context. You might look like you're trying to hard.


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## TransportJockey (Sep 23, 2012)

As usual Vene hits it on the head.


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## Martyn (Sep 23, 2012)

[YOUTUBE]http://www.youtube.com/watch?v=l1wjpZDVa24[/YOUTUBE]


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## Martyn (Sep 23, 2012)




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## socalmedic (Sep 23, 2012)

I have had my littman lightweight II for over two years now, best $35 I have ever spent. if you dont put it down it wont walk away...

If I had a partner who had a stethoscope with suction tubing and x-ray film I would politely ask him to either put it in his locker or in his car, because it is coming nowhere near a real ambulance. take pride in what you do, look like a professional, and if you dont know ASK.


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## DrParasite (Sep 23, 2012)

jameswf said:


> Some advice from my teacher:
> 
> - Replace the diaphram with xray film. (done)
> - Replace the tubes with suction tubing. (cant due to single tube design)


uhh what?  why?  it's a piece of equipment, one that you own.  treat it well, and replace it if it gets broken.  the diaphram breaks?  go on ebay, and get a new one.  replace the tubes with suction tubing?  do you want to get laughed out of the ambulance?


jameswf said:


> - Get Gel ear pieces (cant find cheap but got some rubber ones), or at least get some littmann ear buds to put on your cheap scope for comfort purposes.
> 
> Any hacks you do to yours? Ethnic engineering etc...


ok, the gel ear pieces aren't a bad idea.

here is Dr. P's advice:

1) its your scope.  treat it well.  it's your scope.  always know where it is.

2) its your scope, clean your scope when it gets dirty.  decon the diaphram, as well as the tubing with alcohol prep wipes, and if you lend it to someone else, clean the ear buds.

3) it's your scope, don't leave the truck at the end of your shift without knowing where it is.  if you can't find it at the end of the shift, keep looking.  if after tearing the truck apart looking for it, admit that you lost it, it's your fault, and purchase a new one, accepting the cost as the cost of a learning experience.

I have owned two scopes, an all black edition littmann master classic (that developed legs because I didn't follow rule #3), and a blue littman master classic (that is kept in my EMS gear bag.  I loved them.  

I also have two generic littmann cardiology ebay knockoffs, one that was given as a gift to a friend of mine, and one that is my backup scope in case I ever need it.  I don't use them, but my friend likes hers.


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## sirengirl (Sep 23, 2012)

socalmedic said:


> I have had my littman lightweight II for over two years now, best $35 I have ever spent. if you dont put it down it wont walk away...



I've got posession of 2 Littmans myself- a S.E. and a limited all-back master classic. And amazingly even on the times that I have set it down (or, as more likely, dropped it), all my coworkers have let me know or grabbed it for me. Seems I may actually work in a place where people have integrity.

....That and they like to make fun of me for being the only one to carry their own stethoscope rather than use the P.O.S. one on the vanbulance


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## Tigger (Sep 23, 2012)

sirengirl said:


> I've got posession of 2 Littmans myself- a S.E. and a limited all-back master classic. And amazingly even on the times that I have set it down (or, as more likely, dropped it), all my coworkers have let me know or grabbed it for me. Seems I may actually work in a place where people have integrity.
> 
> ....That and they like to make fun of me for being the only one to carry their own stethoscope rather than use the P.O.S. one on the vanbulance



Yea, the people I work with are for the most part great people, I've misplaced my Littmann a time or two and had it returned to me the next day or hidden away in the truck for safe keeping. 

As for my Sports Medicine job, the attitude seems to be what's yours is mine and mine yours. I come into work and someone is using my steth, someone else has my nice shears, another person has my personal kit (it looked the nicest so I borrowed it! :angry. I think it's more ignorance than anything else though, most of our staff has no idea what's nice and what isn't.


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## NYMedic828 (Sep 23, 2012)

I get annoyed any time I see a medic with a $5 stethoscope that I know they have just for show. Worse is the rare occasion you see a doctor with one.

If I see someone with one of these on their neck, I usually assume they don't check lung/heart sounds.





A stethoscope is the sole assessment tool you need to do your job that comes out of your own pocket. Is $50-100 seriously that much for something you will use EVERY day you are at work?


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## leoemt (Sep 24, 2012)

I can't tell you how many times I have heard EMS people brag about the $250 Danner boots they just bought or the $75 pair of EMS pants with a gazillion pockets, yet you want to jerry rig a stethoscope? 

You won't be making clinical decisions in the field likely, but it is a VITAL piece of equipment. It is probably one of the only pieces of equipment that has a impact on patient care (at least for us basics). I mean look at medication. As a basic I can assist with Nitro, BP has to be above 100 to give it. If you have a crappy stethoscope and can't hear the Korokoff sounds how are you going to obtain an accurate BP. 

You don't need a fancy stethoscope but invest in a good one. Littman's can be had for around $50 which is what I have. Some ADC scopes are around 20 or 30 bucks.


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## fast65 (Sep 24, 2012)

leoemt said:


> You won't be making clinical decisions in the field likely



How do you expect to treat patients then?

Anyways, couldn't agree more with what Vene said. My Littmann is the best $120 I ever spent, it's probably one of the best tools I have. Granted, I can hear lung sounds well enough with the crappy stethoscopes provided by my company, but they kill my ears, and quite honestly, they gross me out. 

I could never take a provider seriously if I saw them with the kind of stethoscope described above. It's unprofessional, an it only serves to make you look like a hack to your patient, and to fellow healthcare staff. It's not horribly difficult to keep track of your stethoscopes, granted there are times when things get hectic and it may get misplaced temporarily, but that seems rather rare. Buy a decent scope, get your name engraved on it, and take care of your things so you can take care of others.


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## VFlutter (Sep 24, 2012)

fast65 said:


> How do you expect to treat patients then?



The only thing I expect a Basic to actually listen for is lung sounds. How many paramedics, let alone basics, can actually distinguish various heart tones? Furthermore what impact will it have on your actual treatment? Maybe realizing muffled tones in relation to a tamponade but I can't really think of much else. 

I wish I still had the article but they did a study with medical students, residents, and various MD specialties on recognition of heart sounds and it was overwhelmingly poor. It is one of those skills that takes a lot of practice and experience.


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## Veneficus (Sep 24, 2012)

ChaseZ33 said:


> they did a study with medical students, residents, and various MD specialties on recognition of heart sounds and it was overwhelmingly poor.* It is one of those skills that takes a lot of practice and experience*.



That is the key.

Of course if you ask people who hardly ever or never do something to do it the results will be poor.


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## VFlutter (Sep 24, 2012)

Veneficus said:


> That is the key.
> 
> Of course if you ask people who hardly ever or never do something to do it the results will be poor.



I had a patient with dementia who had an artificial valve that no one knew about until I brought it up. If you did not hear that then you are just blatantly lying about listening.


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## Aidey (Sep 24, 2012)

I don't care if basics can differentiate between heart tones, but I think they should know how to asses whether they exist or not. If you are a BLS crew and "aren't sure" if there is a pulse, please for the love of the flying spaghetti monster listen for heart sounds before starting CPR.


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## leoemt (Sep 24, 2012)

fast65 said:


> How do you expect to treat patients then?
> 
> Anyways, couldn't agree more with what Vene said. My Littmann is the best $120 I ever spent, it's probably one of the best tools I have. Granted, I can hear lung sounds well enough with the crappy stethoscopes provided by my company, but they kill my ears, and quite honestly, they gross me out.
> 
> I could never take a provider seriously if I saw them with the kind of stethoscope described above. It's unprofessional, an it only serves to make you look like a hack to your patient, and to fellow healthcare staff. It's not horribly difficult to keep track of your stethoscopes, granted there are times when things get hectic and it may get misplaced temporarily, but that seems rather rare. Buy a decent scope, get your name engraved on it, and take care of your things so you can take care of others.



I don't use my stethoscope to "treat" patients. I am a Basic and as a basic my "treatments" are bandaging, splinting and rapid transport to put it simply.

My stethoscope is used for BP's and lung sounds. While both can be very important and have and impact on patient outcome, there is nothing I can do at the Basic level for them. 

Probably the most important thing I do with my stethoscope that can have a negative effect is obtaining a BP when I am going to assist a patient with their Nitro. 

My decisions are sick or not sick, ALS or straight to the ER. I don't diagnose (though I do try to narrow it down as much as I can). Therefore I am not making "clinical" decisions. I am not ordering treatments or procedures to be done.


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## leoemt (Sep 24, 2012)

Aidey said:


> I don't care if basics can differentiate between heart tones, but I think they should know how to asses whether they exist or not. If you are a BLS crew and "aren't sure" if there is a pulse, please for the love of the flying spaghetti monster listen for heart sounds before starting CPR.



Is there a website or a source where we can listen to the heart sounds? I would like to learn these but don't know where to start. I've been going to a website that lets me listen to lung sounds so I am getting pretty good at those.


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## VFlutter (Sep 24, 2012)

leoemt said:


> Is there a website or a source where we can listen to the heart sounds? I would like to learn these but don't know where to start. I've been going to a website that lets me listen to lung sounds so I am getting pretty good at those.



http://solutions.3m.com/wps/portal/3M/en_US/3M-Littmann/stethoscope/littmann-learning-institute/heart-lung-sounds/

They also sell a CD that comes with some stethoscopes. It's worth picking up if you can find it cheap.


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## Veneficus (Sep 24, 2012)

leoemt said:


> Is there a website or a source where we can listen to the heart sounds? I would like to learn these but don't know where to start. I've been going to a website that lets me listen to lung sounds so I am getting pretty good at those.



It is not as simple as listening to them ad identifying the sound. 

You must first understand the physiology and pathophysiology of it.

There is a really good explanation in Guyton's medical physiology.

Many of the Study guides for medicine also have this information.

Once you know what is going on and what you are listening for, then you can start practicing.

As for not diagnosing or ordering treatments, if you have a suspected fracture (a differential diagnosis) do you not splint ( a treatment) it?

If you have no pulse or respiration do you not diagnose cardiopulmonary arrest and begin treatment with CPR?

Do you not diagnose uncontrolled external hemorrhage and treat by controling bleeding according to the clinical presentation and escalate treatment modalities as needed?

Do you observe a cool, clammy, and diaphoretic patient with hypotension and not diagnose "shock?" Do you not treat for shock when you find it?

I am not sure who told you that you do not dagnose or treat, but they are either a fool or a liar.


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## fast65 (Sep 24, 2012)

leoemt said:


> I don't use my stethoscope to "treat" patients. I am a Basic and as a basic my "treatments" are bandaging, splinting and rapid transport to put it simply.
> 
> My stethoscope is used for BP's and lung sounds. While both can be very important and have and impact on patient outcome, there is nothing I can do at the Basic level for them.
> 
> ...



My point is not "treating" patients with a stethoscope, my point is that it can be a key point in making clinical decisions in the patients course of treatment. Your assessment is just as important as anyone else's, at least in my opinion.


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## NYMedic828 (Sep 24, 2012)

leoemt said:


> My stethoscope is used for BP's and lung sounds. While both can be very important and have and impact on patient outcome, there is nothing I can do at the Basic level for them.



You don't carry albuterol?


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## NomadicMedic (Sep 24, 2012)

NYMedic828 said:


> You don't carry albuterol?



Basics in WA don't carry albuterol.


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## NYMedic828 (Sep 24, 2012)

n7lxi said:


> Basics in WA don't carry albuterol.



:huh:

Wow.


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## DesertMedic66 (Sep 24, 2012)

n7lxi said:


> Basics in WA don't carry albuterol.



Same in my county.


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## TransportJockey (Sep 24, 2012)

n7lxi said:


> Basics in WA don't carry albuterol.



Coming from NM I have a hard time wrapping my head around that. Our EMT-Bs can give Atrovent, Albuterol, Narcan, Epi 1:1000 SQ w/ MCEP, charcoal, glutose paste, and ASA, along with assisting with pt NTG and MDIs (which never happens since we carry at least Albuterol they give on the truck)... So weird.


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## NYMedic828 (Sep 24, 2012)

TransportJockey said:


> Coming from NM I have a hard time wrapping my head around that. Our EMT-Bs can give Atrovent, Albuterol, Narcan, Epi 1:1000 SQ w/ MCEP, charcoal, glutose paste, and ASA, along with assisting with pt NTG and MDIs (which never happens since we carry at least Albuterol they give on the truck)... So weird.



It's because EMS is not nationally standardized and probably never will be.

If I'm an RN in NY, I can do the same thing as an RN in California.

EMT/Paramedic could be vastly different. It's moronic.


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## exodus (Sep 24, 2012)

leoemt said:


> I don't use my stethoscope to "treat" patients. I am a Basic and as a basic my "treatments" are bandaging, splinting and rapid transport to put it simply.
> 
> My stethoscope is used for BP's and lung sounds. While both can be very important and have and impact on patient outcome, there is nothing I can do at the Basic level for them.
> 
> ...



Out here, if you're working with a medic that trusts you, you will be telling him what the lung sounds are and he will base treatment off of them. I would say that is clinical decision.


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## TransportJockey (Sep 24, 2012)

NYMedic828 said:


> It's because EMS is not nationally standardized and probably never will be.
> 
> If I'm an RN in NY, I can do the same thing as an RN in California.
> 
> EMT/Paramedic could be vastly different. It's moronic.



Very true, but as long as we have glorified ambulance drivers (EMT-B) as the entry level with next to no education required to get there, it's never going ot change. Plus with various factions who do EMS stating they need certain things, but don't want to get the training or education that's really needed.


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## TransportJockey (Sep 24, 2012)

exodus said:


> Out here, if you're working with a medic that trusts you, you will be telling him what the lung sounds are and he will base treatment off of them. I would say that is clinical decision.



I'm sorry, but that's not how it should be. I have a few partners at my 911 job I trust with my life, but I still will listen to lung sounds myself if it's my patient before I base a treatment off of that.


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## DesertMedic66 (Sep 24, 2012)

TransportJockey said:


> I'm sorry, but that's not how it should be. I have a few partners at my 911 job I trust with my life, but I still will listen to lung sounds myself if it's my patient before I base a treatment off of that.



So if your going to give nitro and your partner records a set of vitals (even if you've been working with the same partner for a while) you will still get your own set before the nitro?


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## STXmedic (Sep 24, 2012)

TransportJockey said:


> I'm sorry, but that's not how it should be. I have a few partners at my 911 job I trust with my life, but I still will listen to lung sounds myself if it's my patient before I base a treatment off of that.



Seconded, and I work with other medics. If I am the medic in charge of patient care, and I am giving the treatment, it'll be based off my assessment.


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## NYMedic828 (Sep 24, 2012)

TransportJockey said:


> I'm sorry, but that's not how it should be. I have a few partners at my 911 job I trust with my life, but I still will listen to lung sounds myself if it's my patient before I base a treatment off of that.



I don't think it's inappropriate if you know and trust in the competency of the person? I know many EMTs I trust more than medics I work with...


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## TransportJockey (Sep 24, 2012)

firefite said:


> So if your going to give nitro and your partner records a set of vitals (even if you've been working with the same partner for a while) you will still get your own set before the nitro?



No, but lung sounds can be a little different. Combine that with history, and I could have a patient with cardiac wheezing as opposed to asthma induced wheezing and will treat accordingly. Vital signs half the time I wind up getting myself anyways.


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## exodus (Sep 25, 2012)

firefite said:


> So if your going to give nitro and your partner records a set of vitals (even if you've been working with the same partner for a while) you will still get your own set before the nitro?



Seen it before multiple times, if your partner is competent and you know and trust them, why is it inappropriate?  If a procedure is within the SoP of the EMT and they should be competent and the company states that they are competent in it, then it shouldn't be a problem either if they are making the numbers up and they get caught.


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## Tigger (Sep 25, 2012)

TransportJockey said:


> No, but lung sounds can be a little different. Combine that with history, and I could have a patient with cardiac wheezing as opposed to asthma induced wheezing and will treat accordingly. Vital signs half the time I wind up getting myself anyways.



Exactly, not to mention that interpretation of lung sounds is far more subjective than taking a blood pressure.

If a medic asked me to listen for breath sounds, and I reported them to him and then he administered a medication, I would not be happy. That is just poor patient care on the medics part.


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## exodus (Sep 26, 2012)

Tigger said:


> Exactly, not to mention that interpretation of lung sounds is far more subjective than taking a blood pressure.
> 
> If a medic asked me to listen for breath sounds, and I reported them to him and then he administered a medication, I would not be happy. That is just poor patient care on the medics part.



So are you not comfortable in obtaining lung sounds then?


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## Handsome Robb (Sep 28, 2012)

Depends on my partner but if I trust them I have no problem with them listening for me.

With that said I've made it a habit to listen to lung sounds on every one of my patients just for my own personal benefit.


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## Veneficus (Sep 28, 2012)

NVRob said:


> Depends on my partner but if I trust them I have no problem with them listening for me.
> 
> With that said I've made it a habit to listen to lung sounds on every one of my patients just for my own personal benefit.



Listen to heart tones while you are at it.


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## Handsome Robb (Sep 28, 2012)

Veneficus said:


> Listen to heart tones while you are at it.



Been trying too. I'll admit I definitely don't know what I'm listening to when I do for the most part. I can identify irregularities but unfortunately can't tell you much more than "not normal". I'm getting better though, slowly.

I'm realizing more and more every day how much I really don't know.


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## Veneficus (Sep 28, 2012)

NVRob said:


> Been trying too. I'll admit I definitely don't know what I'm listening to when I do for the most part. I can identify irregularities but unfortunately can't tell you much more than "not normal".



Read the chapter in Guyton's medical physiology.

There is only a little to know, but it takes lots of practice.


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## NYMedic828 (Sep 28, 2012)

Veneficus said:


> Read the chapter in Guyton's medical physiology.
> 
> There is only a little to know, but it takes lots of practice.



But why should I learn these things? I'm just an ambulance driver, I mean paramedic.


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## mycrofft (Sep 28, 2012)

I wonder if some people are less-equipped to auscultate. Same as there being people who learn better by listening than watching, or vice-versa, etc.  I had coworkers I could NOT teach to use an otoscope, but they did fine auscultating lungs fields and abdomens.


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## Chief Complaint (Sep 28, 2012)

What kind of animals do you work with that you have to worry about coworkers stealing your scope?!?


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## mycrofft (Sep 28, 2012)

Did someone say "steal"? I'm sure it was just borrowed....then stuck in their ears....and left in their car for a couple years.


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## NYMedic828 (Sep 28, 2012)

Chief Complaint said:


> What kind of animals do you work with that you have to worry about coworkers stealing your scope?!?



Come to NYC. I can show you a few zoos that aren't located in central park or the Bronx.


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## Joe (Sep 28, 2012)

Chief Complaint said:


> What kind of animals do you work with that you have to worry about coworkers stealing your scope?!?



Or how someone got my littman that had my full name engraved on the metal... jack a...


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