freelow

Hi Lynnzee, what made you change steths 3 times? The first 2 you mention perform reasonably well with the sprague slightly out performing the littman. What exactly are you looking for? Apical pulses and breath sounds can be heard with just about any steth. The hardest sounds to hear are normally the diastolic and holosystolic murmurs. I can tell you a trained ear can hear all pathologic heart sounds on all the steths you mention. If you are switching steths because of the surrounding noise problem. I would recommend only replacing the earpieces. If you are happy with the cards 3, fine. Clinically speaking the only significant difference between the 3 you mention is the price with the sprague being ~10 times cheaper.

hi everyone, i am a l2 cards resident. many of you have many more years experience than me, but i find it interesting to read some of your posts. i have used just about every brand of stethoscope there is. here is what i can tell you: expensive is not always better. i use a traditional sprague. these are probably the best steths out there and the most inexpensive. every pathologic heart sound can be heard with a sprague. if you can't hear a heart sound on a sprague, it is not important. i was tricked into buying a littman steth for 100+ dollars in medical school because of the schools affiliation with them. it wasn't until i entered my fellowship (5 years later) and heard 100's of heart sounds that i realized i had been going about this all-wrong. tunable diaphragms are probably the worst steths. they require much more work than a traditional steth. try listening to a child with pericarditis on with a tunable diaphragm. it is a mess. it requires the patient to be very still and able to resist pressure on the chest. better yet, try listening to a carotid bruit with a tunable diagram. it’s just as bad because the neck isn’t a flat surface and pressing too hard can stimulate the baroreceptors. it's amazing how people tend to run to tunable diaphragms, and the sound quality is only 60% at best that of a sprague. the sound is muffled, it picks up just about every movement, and you have to play around to get the sound you would normally get on a sprague with a gentle press. lastly, i would only recommend electronic steths to people who are going deaf or for very obese patients. again, if you have to amplify a sound then probably you don't know what you are doing or the sound you want to work up is not important. if you have a steth and you can hear s1/2/3/4 and murmurs/clicks/rubs and pathologic breath sounds you are ok. there is no need to change to a more expensive steth if the one you have is performing. it always amazes me how medical students show up with electronic/ tunable/ 300+ dollar steths thinking they will dx some new heart sound. it's their job to detect when something is wrong. it's my job to detect and work-up what's been detected.