New EMT Stethoscope issue/question

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evilmedic

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Hello,
I am just finishing up EMT school, and have started going doing ride alongs with the department I want to get on with. I have always had a hard time with BPs hearing the pulse, even with the training dual stethoscope. However there was one, on one of the ambulances that I did a ride along with that I could actually hear the pulse loud and clear. However any identifying brand marks were worn off. Without having to buy a $300 amplified stethoscope any suggestions or brands to look for? Thanks
 
The go to brand for stethoscopes is Littmann. There are a number of people who also like UltraScopes.
 
DesertMedic66 said:
The go to brand for stethoscopes is Littmann. There are a number of people who also like UltraScopes.
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What he said. To be more specific, a midrange Littmann such as the Classic series will fit your needs well.

In addition, don't fall into the trap of thinking that better equipment will make up for faults in technique.
 
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DesertMedic66 said:
The go to brand for stethoscopes is Littmann. There are a number of people who also like UltraScopes.
Click to expand...

Flying said:
What he said. To be more specific, a midrange Littmann such as the Classic series will fit your needs well.

In addition, don't fall into the trap of thinking that better equipment will make up for faults in technique.
Click to expand...
Both of the above posters are correct. I will probably go one step farther and simply state that you need to look for a stethoscope that is between $30 and $70 (approximately) and anything within that range, regardless of brand, should serve you well. My own primary stethoscope is a Littmann Cardiology III. My backup stethoscope is not made any longer, it is a Littmann Lite S.E. And they stopped making this one up about 15 years ago. What you need to do first and foremost is to concentrate on getting good stethoscope technique. Once you have good to excellent technique, you will find that with time and experience, you will be able to effectively use almost any stethoscope on the market. I would say probably the biggest difference between the low end and the high-end stethoscopes is outside noise isolation. My Littmann Cardiology III stethoscope is very good at both isolating outside noise and transmitting noise from the diaphragm/stethoscope head to my ears. With some experience, I have been able to hear some very difficult BP sounds under some fairly challenging conditions such as siren use, high-speed driving on a freeway, bumpy roads, or a combination of all of those.

Would I like to have a high-end electronic stethoscope? Yes, I suppose I would, if only for the ability to record sounds or transmit them via Bluetooth. That being said, if I need to, I can use anything from a $4 drugstore supercheap stethoscope to the >$500 electronic stethoscope just as easily. All it takes is time, experience, and a willingness to learn!
 
I have been using an Ultrascope for the past four years. I seem to have a much easier time hearing using it than I do using my Littmann Cardio 3 that is my backup scope. Plus the price isn't too bad for Ultrascopes, and they have a great warranty.
 
Littman Classic. Less than $70 on Amazon. Worth every penny. I can't hear ANYTHING on the cheap who-knows-what-brand standard-issue ones that are on our ambulances. I know I'm half deaf from being stupid about not wearing hearing protection in my previous professional life (aviation), but the Littman lets me hear what I need to hear and didn't cost a fortune.
 
evilmedic said:
Hello,
I am just finishing up EMT school, and have started going doing ride alongs with the department I want to get on with. I have always had a hard time with BPs hearing the pulse, even with the training dual stethoscope. However there was one, on one of the ambulances that I did a ride along with that I could actually hear the pulse loud and clear. However any identifying brand marks were worn off. Without having to buy a $300 amplified stethoscope any suggestions or brands to look for? Thanks
Click to expand...

Yeah just like someone mentioned. Always check your technique. With all these auto machines and lifepak's we hardly use Manual BP anymore.
 
The earpieces on stethoscopes tend to get squashed so the stethoscope lays flat. When they aren't flat, the angle is still typically too shallow. This means the wanted sound is going into the wall of the ear canal instead of down the ear canal to the ear drum. It also causes a poor seal letting outside noise in. Also, the ear canal doesn't go in the direction it appears to if you stick your pinkie in. Adjust the tilt of thyour head so the earpeaces go in deep.earwax and clogged eustation tubes cause problems.
 
I have a Littmann Cardiology III. You can find them online for $150. Pretty pricey, but (unless you lose it...) I don't think you'd regret buying one. It's a massive improvement over the Littmann Lightweight I used to use (which costs $50 or so).
 
Akulahawk said:
My Littmann Cardiology III stethoscope is very good at both isolating outside noise and transmitting noise from the diaphragm/stethoscope head to my ears. With some experience, I have been able to hear some very difficult BP sounds under some fairly challenging conditions such as siren use, high-speed driving on a freeway, bumpy roads, or a combination of all of those.
Click to expand...

Gurby said:
I have a Littmann Cardiology III. You can find them online for $150. Pretty pricey, but (unless you lose it...) I don't think you'd regret buying one. It's a massive improvement over the Littmann Lightweight I used to use (which costs $50 or so).
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I second the Cardiology III. When you take a BP with it, it sounds like drum beats at a rock concert.
 
I would really try to learn to use a cheap stethoscope for a year or two and then buy a nice one. Basically, on scene, someone will throw you whatever they open out of a bag, and that will be whatever is available whether is is a $60 stethoscope or a $5 one. You might use a different agency's gear or hospital gear, etc. you should be familiar with it all.

All cheap stethoscopes are hard to hear. They either require practice of exact placement and listening for specific sound, or sincerely, you might have difficulty hearing. I don't say that as something mean. We're all different. Find out whether it is a hearing difficulty or an experience issue.

AFTER you learn to use a cheap one (if you can), then buy a really nice one.
 
I found for me the ear pieces are what make a difference and how they fit in my ears. Cheap or expensive alike if they don't fit my ear well I can barely hear the diaphragm being tapped.
 
joshrunkle35 said:
I would really try to learn to use a cheap stethoscope for a year or two and then buy a nice one. Basically, on scene, someone will throw you whatever they open out of a bag, and that will be whatever is available whether is is a $60 stethoscope or a $5 one. You might use a different agency's gear or hospital gear, etc. you should be familiar with it all.

All cheap stethoscopes are hard to hear. They either require practice of exact placement and listening for specific sound, or sincerely, you might have difficulty hearing. I don't say that as something mean. We're all different. Find out whether it is a hearing difficulty or an experience issue.

AFTER you learn to use a cheap one (if you can), then buy a really nice one.
Click to expand...

I put my nice stethoscope into the first-in bag at the start of every shift (and I have a little check-list in my car that I run through after a shift to make sure I don't forget anything when I leave). That way, it's always there if I need it.

I think most people say to learn on a cheap one and you'll be able to use anything... But I don't know if I agree. I kind of feel like just save yourself the headache and buy a nice stethoscope from the start. As a new EMT (or even as an experienced one), I think it's more productive to focus on assessment skills, how to interact with patients and other healthcare providers, etc, rather than banging your head against the wall trying to auscultate with a crappy stethoscope. A nice stethoscope will also be handy for listening to lung sounds, especially if you're in a state where BLS can give albuterol or nitro.
 
I've had my cheap Littmann for 3 years, served its purpose. I just bought an ADC Cardiology 600, total impulse buy but it was half the price of the Littmann and I've heard good things about it. Haven't received it yet but if you're just starting out you don't need anything fancy.
 
I never owned a cheapy or used one in class (borrowed a friend's spare Littmann). When I forget my master cardiology (a gift, could not afford one), I can still function just fine but the difference is certainly noticeable. And they're just uncomfortable.
 
I would suggest trying to improve your technique, first and foremost. Try palpating for a brachial pulse, on the inner medial portion. Place the diaphragm at that location. Extend the patients arm and place it on your knee. I feel that the most difficult aspect is attempting to isolate the pulses from movement, bumps, and other noises in the cabin. Try your best to differentiate sounds you are hearing with the stethoscope in your ears for a few seconds before bleeding the air out of the cuff. Don't rely on the needle jumps, as in many case, you can hear the pulse before or after the needle begins to jump. However, it could give you a ballpark of where to pay attention for a pulse. You could try to bleed the air until the needle begins to jump, quickly reinflate the cuff, then pay careful attention around that range. Obviously, depending on the situation, you may need to get a BP quickly, and you will not have much time to do all this prep. I feel that you can really learn to get good BP's from IFTs because you will not be rushed, and you can try to improve your technique to the point where you will not need much time or preparation. With that being said, it is not a bad idea to invest in a solid stethoscope, as many others have stated, there are stethoscopes that are better than others. I have a Littman on hand, but I honestly use whatever is in the rig or whatever a medic hands to me. Lastly, never guess or make up a BP. If you can't get it, say so. Do you really want to gamble when a PT with chest pain will be or already has been administered nitro? If someone gives you a hard time for not getting a BP, that tells you more about that person than you. You will get better with time and practice, just keep at it.

Jordan wasn't the player he was because of his shoes. Practice, practice, practice.
 
Corey said:
Don't rely on the needle jumps,
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Corey said:
Lastly, never guess or make up a BP. If you can't get it, say so.
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These are pet peeves of mine haha. Also I forgot to state in my previous post, there is a vast noticeable difference between my Littman (Cadrio III) and the cheap ones on the ambulance (not sure of the brand). I can still get a BP with the cheap ones on the ambulance, but it is considerably easier with my Littman. Also like Corey states: practice, practice, practice. You don't become awesome at BP's overnight, you have to work at it.
 
Another random blood pressure pro tip: When taking a manual blood pressure, make sure you say even numbers (128/74, for instance) because most manometers only have markings for even numbers. Some people will freak out if you tell them an odd number. Never mind that most BP cuffs have a variance of +/- 3mmHg at best anyways, or that a measured pressure of 125 vs 126 makes no difference whatsoever in how you're going to treat a patient, or that patient position/movement can affect readings, etc etc etc...

I hate people who get worked up about this. But it's best to pick your battles, and this is not something worth fighting about. As the new guy, just give them an even number and avoid the situation entirely.
 
I wonder how people even started having an issue with odd numbers. Without even delving into the issues of precision, why can one not read the spaces between the marks as an odd number?
 
I have two ADC stethoscopes. The classic Littman clone, and the cardiology clone. I've found them both more than adequate for EMS. No need to shell out big bucks for a Littman that will get snatched any chance someone has.
 
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