The stethoscope is probably the most important tool of daily medical practice. Although all stethoscopes are intended to serve the same purpose of providing sounds of the sounds, modern stethoscopes differ significantly from each other according to their application. From the simple One-Side-Membran-Stethoscopes for blood pressure measurement to electronically amplified sound recorders. But which stethoscope is right one for me? And how do I use my stethoscope correctly? A purchase guide and practical tips for professional users.
With the invention of the stethoscope in 1816 by René Théophile Hyacinthe Laënnec, the era of the urine beaker ended, which was considered as the symbol for medical arts until that time. Considering the urine was replaced as the core competence of the physician by a far more appetizing examination form out of modern medical practice: The auscultation, i.e. listening to body sounds like heart beat, respiration or digestion.
The stethoscope is one of the first medical devices, which every paramedic or nursing student and every medical student should possess in person – beside a hygienic point of view of not to insert the earwax of the pre-user into the own auditory canal. In addition, your own stethoscope is simply a statement and a personal incentive, that you are a member of the health care system and that you are now giving your best for the patients. Wearing it feels like being awarded with a medal.
But if you want to buy your first stethoscope, you need to be clear about what you want to use and what budget is available. These ten points are designed to help you choose the right stethoscope and to facilitate the correct application during cupping.
1. Does a stethoscope have to be expensive?
It does not have to, though it is possible. Ask yourself on what purpose you need your stethoscope and in which environment you will use it. The danger of damage or even losing it is always given in the preclinical use, working for emergency rescue. And if it is only used for simple tasks such as the blood pressure measurement, a disposable or cheap stethoscope in the construction design of the flathead stethoscope with only one membrane side is probably sufficient.
If the heart and lungs are to be examined, the cheap devices quickly reach their acoustic performance limits. If you do not have perfect hearing, you will end up with a wrong diagnosis because of the stethoscope will not get the right frequencies. A double headed stethoscopes with a membrane side, which is suitable for the higher frequency when breathing, and a bowel side for loerw frequencies which are monitored during the auscultation of the heart, should be your choice then. In the lower price segment, double headed stethoscopes are available with a twin hose, thus with separate sound lines to each ear. But pay attention: These devices are susceptible to interference when the two tubes rub against one another during movement and produce artifacts (up to 30 Euro).
Single-hose stethoscopes with double heads are available from 60 Euro. Usually, they have an external clip that keeps the stethoscope in shape. If you get disturbed by dirt or hair attached to the clip, choose a more expensive advanced / student edition with single-stube technology and a double head without external clip. These are available up from 80 Euro.
Stethoscopes for cardiology use are very expensive, but they also afford more. The models with electronic sound amplifier should be reserved for the specialist physician, as the purchase of a cardiology stethoscope only makes sense if the user can assess what he hears – and that needs a lot of experience.
2. Get to know your stethoscope
A good stethoscope comes with a care instruction and a selection of ear plugs. In addition to the hard plastic caps, which are predominantly used for the cheaper products, there are rubberized soft eartips in olive form. Just find the most comfortable earplug for you.
In addition, the stethoscope should be accompanied by a brief user guide explaining all functions and, for example, how to change between the membrane and the bowl side of the double-headed chest (as the distal section of the stethoscope is called, which is the part to touch the patient). A CD or a linke to an interactive site with examples of body sounds for theoretical practice should complete the set.
3. Stay clean!
Well, you are the owner of your stethoscope. But in hospital at the bedside it happens quite often that you exchanged the stethoscopes true to the motto: “Listen to that sound, I stay on it and you have a quick hearing with my stetho…”. Cleanliness is a must in medicine and the ears must not be missing. Always remember: After each patient, the stethoscope has to be cleaned and disinfected after each share. The stethoscope otherwise acts as a potential vector and could also contribute to transferring dangerous germs, such as MRSA!
4. If you hear nothing …
… but the patient is look vital and joyful in your eyes, first check if there is a mistake in the transport of the sound by the stethoscope before you initiate a resuscitation. Most times the angle of the earplugs is adjusted and the opening on the receiver of the stethoscope does not fit into the auditory canal.
Check the setting of the double-headed chest piece and, if necessary, re-align it to the desired head side.
With screwed stethoscopes, a sound-conducting connection could have loosened, which you can simply tighten again.
In the worst case, the tube itself is damaged, since disinfectants brittle the rubber and improper transport in the pocket of your scrubs have kinked and broken the hose. If this is no longer to be saved with a lot of tape, you have the best reason to buy yoursef a new stethoscope.
5. Skills create trust
Auscultating your patient is a trust creating moment and the patient interprets it: Are my doctor’s hands cold and sweaty? Is he trembling? Am I in good hands? So show your skills by taking the several steps in a coordinated and confident way:
Adjust the earplugs: Bend the two bows of the stethoscope slightly forward so that an imaginary line between your ears and the tip of your nose is created. At this angle, the openings of the earplugs end right in front of the auditory canal and the sound can reach your eardrums straight.
Turn the head of the stethoscope to the correct side: If you use a double headed breast piece, you can turn it 180 degrees before it is locked in. Make sure the side of your stethoscope you want to use is the activated one. Usually an optical marker is attached to the active side or an opening in the center of the bowl gets visible.
When checking the blood pressure: Ensure that the stethoscope is placed directly above the brachial artery. It can be palpated before you inflate the cuff. Then place the membrane side right on the spot. As beste case scenario, the stethoscope head does not need to be held, as noise is caused by the movement of the fingers while you press the bowl to the inner elbow.
6. Get skin contact
The sound you want to listen, whether heart or lungs, loses quality and intensity when it is damped by the patient’s clothing. This also applies to the most expensive and sensitive stethoscopes: the clothing must always be removed and the stethoscope must be placed on the skin.
7. Reduce surrounding noise
It can be quite noisy in an emergency room or in any place of use, especially during the transport of patients. Even if the earplugs are well sealed, noise always makes any acoustic examination more difficult. Therefore: close doors, curtains inside the ER or ask the people around you for a brief moment of rest for the examination.
In the ambulance vehicle, you can not stop for every blood pressure monitoring. Two tricks for less noise: when you stand, stand on your toes. When sitting next to the patient, you can put your feet on the edge of the stretcher. This reduces the vibrations of the vehicle which are effecting on you and so you reduce the amount of noise that can disturb you.
8. Pressure on the ear? Do not crack!
A problem in altpine or any other high altitude rescue operation and even more on board of a helicopter: you want to auscultate, but there is that pressure on your ears. Most of us can deliberately crack their eardrums to force a pressure equalization. This does not work with the stethoscope attached! As the pressure can not evade to the outside as your ears are sealed by the stethoscope you force the air further into the auditory canal. This can be painful and reduce the hearing ability for a short periode.
9. Be honest!
No matter what you do, you can not hear anything. This usually has a reason that might not depend on you or your abilities. Under any circumstances you should never claim a suspicion or your expectation of a blood pressure or a lung noise life it is a determined diagnosis. Let a colleague review the measurement. If he gets to the same conclusion of hearing nothing, you are closer to a diagnosis than by guessing an even correct result.
10. If you can hear nothing at all …
All the other EMTs can hear the basal rattling sound with your stethoscope, but you do not? So check in for an audiometric examination and have your hearing diagnosed. Perhaps listening to real loud music via headphones might have caused the damage that your parents have always prophesied to you?
Conclusion: Reminding those top 10 clues will bring you lots of fun with your status symbol. Yes, that’s what stethoscopes even are … So color and brand might be your last buying criterions.
Good luck and success when auscultating! Leave us your feedback and add practical tips on the subject in the comments. THANK YOU!