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Posted: 9/8/2009 8:27:34 AM EST
Alright guys (and women folk), I'm having some difficulty in obtaining a manual BP while our rig is in motion (I can hear the sirens, road noises and voices). I have a cheap Prestige steth I got for about $24 when I had CNA class long ago. Right now I'm browsing through different brands and types of stethoscopes looking for something that is geared toward eliminating ambient noise. I've seen the Littmann 3200, looks nice but I can't justify the $385 price tag for it (not to mention I don't need to record & share anything). I don't deny I may have crappy technique. I locate the brachial pulse and place the diaphragm side on the approximate location. My index and middle fingers straddle the bell side to apply pressure. What do the ARFcom medics say?
Link Posted: 9/8/2009 8:45:17 AM EST
[Last Edit: 9/8/2009 8:49:19 AM EST by capt205]
Littmann Master Classic II in Black Edition
Link Posted: 9/8/2009 9:08:10 AM EST
Originally Posted By capt205:
Littmann Master Classic II in Black Edition


++1

Something else to try is a trick I learned from a seasoned medic. When youre taking your BP on the move put your feet on the head of the stretcher. It takes a lot of the vibrations of the truck out and you'd be surprised how that helps you hear despite the other noises. Your mileage may very. You could also turn the lights and sirens off.......
Link Posted: 9/8/2009 9:44:10 AM EST
All you medics need this fancy gear....


Can't you just hold your ear to his/her chest?
Link Posted: 9/8/2009 9:53:37 AM EST
[Last Edit: 9/8/2009 9:58:13 AM EST by Bed_Head]
Can't go wrong with a Littmann. I would suggest making sure you get a model with a long length though. I hate it when I borrow someone else's and it's a short one. I don't like getting my face that close to patients.

Mine's old. I think it's a Master Classic (II?). 13 years old and still going strong!


(P.S. Engrave your name on it as soon as you get it!)



eta: I see a few of the models are available in a 22" length. The 27" is better for EMS, IMO. Those extra 5" are a good thing!
Link Posted: 9/8/2009 10:02:12 AM EST
A Littman Cardio III has a thicker tubing and therefore better sound. Also to dispute the suggestion for a longer tube the shorter one will also be louder. However if you get the Cardio III you shouldn't have too hard of a prob. I got mine from allheart.com and they laser engraved the tubing for free.
Link Posted: 9/8/2009 10:09:00 AM EST
Link Posted: 9/8/2009 10:34:45 AM EST
Originally Posted By PatG:
Originally Posted By capt205:
Littmann Master Classic II in Black Edition


++1

Something else to try is a trick I learned from a seasoned medic. When youre taking your BP on the move put your feet on the head of the stretcher. It takes a lot of the vibrations of the truck out and you'd be surprised how that helps you hear despite the other noises. Your mileage may very. You could also turn the lights and sirens off.......


Meh, switch is all the way in the cab...
Link Posted: 9/8/2009 10:52:05 AM EST
Link Posted: 9/8/2009 11:14:26 AM EST
Most any Littmann will do you good, I'd reccomend staying away from electronic or higher end ones as they don't work out well in this field, over amplify the stuff you're already hearing like road noise and sirens. They have a great warranty too, I broke the metal ear piece, shipped the steth back to them and around a week later got back my essentially new stethoscope with an updated warranty. They cleaned the bell and put it on new tubing/ear pieces.

I have a Classic II S.E. but may wind up with a Master Classic II by the end of Paramedic school.
Link Posted: 9/8/2009 12:07:32 PM EST

Originally Posted By jcast141:
Most any Littmann will do you good, I'd reccomend staying away from electronic or higher end ones as they don't work out well in this field, over amplify the stuff you're already hearing like road noise and sirens. <snip>

I found that to be a problem too when using a partner's Cardiology. For EMS related assessments like ausculated BPs, lung sounds, etc., you really don't need all those bells and whistles. They're great for a quiet, clinical setting, but overkill for the field.
Link Posted: 9/8/2009 12:35:18 PM EST
Originally Posted By medicmandan:

Originally Posted By PatG:
Originally Posted By capt205:
Littmann Master Classic II in Black Edition


++1

Something else to try is a trick I learned from a seasoned medic. When youre taking your BP on the move put your feet on the head of the stretcher. It takes a lot of the vibrations of the truck out and you'd be surprised how that helps you hear despite the other noises. Your mileage may very. You could also turn the lights and sirens off.......

Does this help the machine get a better reading?

I usually get my initial BP manually and let the machine get the rest. I have a minimum 90 minute transport, 45 minutes to a helicopter.



Thats actually one of the reasons I'm looking for a new steth or better technique. On one of the last pt I had, the machine took about 10 min each time and it was looking quite uncomfortable. To me, its just crappy pt care to put them in that much discomfort to get a BP (which probably wasn't too accurate).
Link Posted: 9/8/2009 6:31:03 PM EST
Link Posted: 9/8/2009 6:33:17 PM EST
Link Posted: 9/8/2009 6:39:54 PM EST
have a Littman Cardiology III and I love it. Of course I don't have to contend with to much ambient noise in the hospital.
Link Posted: 9/8/2009 8:19:24 PM EST
Originally Posted By Bed_Head:
Those extra 5" are a good thing!


Nice Title
Link Posted: 9/9/2009 4:15:50 AM EST
I also use the Master Classic II. I had a Master Cardiology and learned real quick that was too sensitive for the back of a truck screaming down the road at 75mph. I talked with one of the ER Doc's that started life as a medic and he pointed me in the direction of the master classic II. I sold the master cardiology and picked up the master classic II and it's absolutely perfect for anything pre-hospital.
Link Posted: 9/9/2009 9:22:31 AM EST
I would get the single bell housing and not the double sided. You can vary how you hold it to change the "pitch" coming into the bell .My dad bought me the Littmann for my EMTB graduation and Ive used it for 5 years now. I use the harder ear peices as it comes with 2 sets.
Link Posted: 9/10/2009 5:51:00 PM EST
Before you go for the BP, put the stethascope in your ears, and listen. Listen to the road noise, the sirens and whatever else and then just zone them out as you go for the BP. I don't know if it makes sense but it's how I've done it for 12 years and it works for me.

BTW, I use a department issued Littman.
Link Posted: 9/10/2009 6:27:46 PM EST
[Last Edit: 9/10/2009 6:28:40 PM EST by qualityhardware]
Littmann FTW.
Link Posted: 9/10/2009 8:37:54 PM EST
I'll go against the grain here. I use a dual tube cheapo but, I replaced the ear pieces with some soft ones from Littman and it made all the difference in the world. They seal well and keep out the majority of road noise unlike the hard ones they come with. I just cannot see spending $100+ for something I am bound to leave on scene.
Link Posted: 9/13/2009 9:10:25 PM EST
I've been using a Littmann Lightweight for the past few month and love it. Cost less than $50 on eBay.

Before that I used a Sprague with few problems after a medic told me to adjust the earpieces so they point at an angle so they seat better in your head.
Link Posted: 9/14/2009 7:49:34 AM EST
[Last Edit: 9/14/2009 7:50:05 AM EST by mdulitz]
A cheap Littmann is the way to go. The lightweight II SE or the Master Classic should work well for what you will be using it for. The sprague type are too heavy I think.

Also, if you get a littmann, put your name on it, they develop legs VERY easily.
Link Posted: 9/14/2009 11:38:17 AM EST
I take one before we roll, anything else I just palp.

Our rigs are really bad with the noise. Its like being in a wind tunnel.

Again we keep the cheapo ones on the rigs, and you can hear anything.

I have been yelled at for palping the BPs, and I explained that we have cheap scopes and it is inaudible in our rigs.

My boss told me to buy one of those really good expensive scopes. My response: I make less than $10 an hour, there is no way in HELL I am going to spend MY money on something work related.

If they would reimburse me for it Id be happy to get one, but till then they are SOL and Im gonna keep having to Palp.
Link Posted: 9/14/2009 5:58:43 PM EST
Originally Posted By Pav56C:
I take one before we roll, anything else I just palp.

Our rigs are really bad with the noise. Its like being in a wind tunnel.

Again we keep the cheapo ones on the rigs, and you can hear anything.

I have been yelled at for palping the BPs, and I explained that we have cheap scopes and it is inaudible in our rigs.

My boss told me to buy one of those really good expensive scopes. My response: I make less than $10 an hour, there is no way in HELL I am going to spend MY money on something work related.

If they would reimburse me for it Id be happy to get one, but till then they are SOL and Im gonna keep having to Palp.


Do you not have monitors in the backs of your rigs?
Link Posted: 9/14/2009 6:11:16 PM EST
Lit. Cardiology III for me.
Link Posted: 9/14/2009 6:43:55 PM EST
[Last Edit: 9/14/2009 7:28:12 PM EST by Bed_Head]

Originally Posted By Pav56C:
I take one before we roll, anything else I just palp.

Our rigs are really bad with the noise. Its like being in a wind tunnel.

Again we keep the cheapo ones on the rigs, and you can hear anything.

I have been yelled at for palping the BPs, and I explained that we have cheap scopes and it is inaudible in our rigs.

My boss told me to buy one of those really good expensive scopes. My response: I make less than $10 an hour, there is no way in HELL I am going to spend MY money on something work related.

If they would reimburse me for it Id be happy to get one, but till then they are SOL and Im gonna keep having to Palp.

People in all kinds of careers invest money so they can do their jobs. Some of us are willing to put the investment in for two reasons: One, we don't like sharing earwax. Two, we like to do our jobs well. I don't feel like I've done the best job possible if I'm only palping a BP. That is an absolute LAST resort, and I'd smack any of my students upside the head if they did it on a regular basis. You can miss all sorts of shit by palping BPs. (I bought mine when I was making less than $10/hour too, btw)

To the OP, it's less than $100 for a decent Littmann. If you don't want to put that much into it, it's only $30 or so for a Sprague. They last for years and years. It's worth the investment.

Link Posted: 9/14/2009 6:48:25 PM EST
Of course, if you are deaf like me, it wont really matter in the long run.....
Link Posted: 9/14/2009 6:50:42 PM EST

Originally Posted By E22CAPT:
Of course, if you are deaf like me, it wont really matter in the long run.....
Pshaw. You just 'delegate' all the work out anyway, Mr. Captain/Paragod.

Link Posted: 9/14/2009 8:29:32 PM EST
You tryin to get in my pants?
Link Posted: 9/15/2009 5:25:10 AM EST
Well..... duh.
Link Posted: 9/15/2009 6:12:09 PM EST
Originally Posted By Bed_Head:

Originally Posted By Pav56C:
I take one before we roll, anything else I just palp.

Our rigs are really bad with the noise. Its like being in a wind tunnel.

Again we keep the cheapo ones on the rigs, and you can hear anything.

I have been yelled at for palping the BPs, and I explained that we have cheap scopes and it is inaudible in our rigs.

My boss told me to buy one of those really good expensive scopes. My response: I make less than $10 an hour, there is no way in HELL I am going to spend MY money on something work related.

If they would reimburse me for it Id be happy to get one, but till then they are SOL and Im gonna keep having to Palp.

People in all kinds of careers invest money so they can do their jobs. Some of us are willing to put the investment in for two reasons: One, we don't like sharing earwax. Two, we like to do our jobs well. I don't feel like I've done the best job possible if I'm only palping a BP. That is an absolute LAST resort, and I'd smack any of my students upside the head if they did it on a regular basis. You can miss all sorts of shit by palping BPs. (I bought mine when I was making less than $10/hour too, btw)

To the OP, it's less than $100 for a decent Littmann. If you don't want to put that much into it, it's only $30 or so for a Sprague. They last for years and years. It's worth the investment.



I'm typing this w/ my new Littmann Master Classic II around my neck. So far I'm quite impressed & satisfied w/ the $110-ish I shelled out for it. And yes, I did get my name engraved/etched on it. If someone gets eyes for this little puppy there will be problems. But yeah, its definitely an investment for me.
Link Posted: 9/17/2009 4:09:29 AM EST
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