I want a new stethoscope.

3 Dec

master_low  I am offically obsessed. Last week I somehow lost my stethoscope and had to “borrow” one from the drawer of left behind stethoscopes at work. There is usually the garden variety in that drawer, the disposables, the one without ear pieces, the big heavy one with 3 bells that looks funny. Well last week I grabbed the steth on top and had no idea the amazement that was to follow during my morning assessments! It was black, had no bell, and the tubing was engraved with the name of some nurse that did not work on our floor. The acoustics were so awesome that I could actually hear turbulent blood flow in the heart chambers! I swear I could hear that! Can you imagine? I found out that it was a Littman Master Cardiology Stethoscope.  What is neat is that there is no bell needed! Just by pressing lighter or with more pressure, low and high frequency sounds can be auscultated. It is so neat! I just want one!

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11 Responses to “I want a new stethoscope.”

  1. PQRST December 17, 2008 at 00:56 #

    Hey, great blog! I often stop by to read, and it’s very interesting to see how nurses work in the US. I’m just wondering why and when regular floor nurses in the US do auscultation of heart sounds, etc. I live in Scandinavia, and here nurses are not even taught how to auscultate anything, unless they specialize in anesthesia ,intensive care, etc..

    Just curious! :-)

    • seejanenurse December 17, 2008 at 01:07 #

      Really? We are definately taught to listen to heart, lung and bowel sounds during our assessments.

  2. PQRST December 17, 2008 at 14:23 #

    Really. It’s strange really, but auscultation is considered to be the doctor’s job. Some of us of course are good at it after many years of practice, but if I assess a patient and auscultate his lungs, the doctor will auscultate anyway and my findings will not be considered.

    I guess there are differences between all countries..? For instance, here nurses insert IV cannulas, urinary catheters, take blood gas samples. All these things are done by the doc in many other countries..

    What about in the US?

    • seejanenurse December 17, 2008 at 15:22 #

      Really? Of course the physician has to auscultate during their assessment and it does matter what the nurse auscultates because the physician only comes to the bedside usually only once a day. Nurses are assessing our patients all day. For example: Your patient is admitted with mild CHF, you assess in the morning for lung sounds and you hear rales in the lung bases, the MD assesses rales in the lung bases, six hours later your patient has increased shortness of breath, you have to auscultate: you hear rales throughout all lung fields and a new S3 heart sound. What will you tell the MD when you call? “My patient is more short of breath.” or will you give a better picture of symptoms, objective +subjective informtation such as: “The BP is 200/98, respiratory rate 44, pulse ox 90%, heart rate 99 weak and rapid, rales throughtout all lung fields and a new S3 heart sound, the patient complains of shortness of breath and assuming the tripod position.”
      Now since the total picture was communicated the nurse can get better interventions for the patient. Anticipating to be done for the patient: Chest X Ray, possible ABGs, oxygen therapy, Morphine in small doses to reduce anxiety and dyspnea, Lasix IV for a fast diuretic, hydralazine IV to get the pressure down etc…and probably transfer to critical care. Also in the scenerio above I would initiate a “rapid response” which bring to the bedside immediately: a critical care nurse, the charge nurse, the House MD, the Respiratory therapist, and the pharmacists, and usually the priest. The rapid response “team” will ensure that all the interventions are done immediately and the patient will be stabilized either to stay on the telemetry (progressive care unit) or need to be transfered to ICU. All of these interventions of course are initiated by the MD~but if we can anticipate and know what works I think the patients have better outcomes.
      We do insert IV cannula and urinary catheters, some nurses collect ABG but they have to be certified, usually here our respiratory therapists collect the blood gases for us, we also insert NG tubes etc. Some nurses have trained to insert central lines (periphally inserted central lines).
      So the short answer is yes it is the doctors job to auscultate, but nurses must auscultate too.

  3. PQRST December 18, 2008 at 17:12 #

    I’m impressed. You seem very skilled. And it makes me feel a bit stupid on behalf of my brothers and sisters in the nursing profession here in Scandinavia. You see, while many of us would think and act the way you describe on a daily basis, most nurses here wouldn’t even dream of wearing a stethoscope around their neck. This is because nurses are not trained to auscultate. And yes, most nurses here would just call the doctor and say “my patient has become more ill”. I’m a bit ashamed to admit this on behalf of my nursing colleagues, but it is the truth. Of course, some of us would act like you, do the proper assessment and give a more precise description of the problem. But auscultating heart sounds? The doctor would start laughing. Nursing in the US is a dream for many over here, as it seems to us that the nursing profession is much more respected than it is here, and the nurses act on a much more professional basis than many do here. By the things you mention, it seems that we do many of the same procedures (iv lines, ng tubes, abg’s, etc), but I wish auscultation became a natural part of our job too. We do auscultate lungs sometimes, and also sometimes the abdomen. But for some strange reason, the heart is kind of prohibited area..

    • seejanenurse December 18, 2008 at 20:26 #

      Do not feel stupid! I am not sure if every nurse on the floor is listening to S1 –S2m heart murmers etc, but we are taught to! Actually we are supposed to count the apical rate before given certain medications as well. I am sure your nurses are GREAT! Besides I am sure you and your nurses are skilled with your EKG reading talents!
      I got my new stethoscope in the mail yesterday! I have been listening to my own heart with it! (I am a nerd)

  4. PQRST December 18, 2008 at 21:53 #

    Haha. I´ve been listening to my own heart for a long time. I palpate my radial pulse every day, almost hoping to feel a premature beat as I would find it more interesting than awkward. I practice and read ekg interpretation for many hours a day. Welcome to the nerd club:-)

    Thanks for your kind words. I really don’t feel stupid, as I’m confident of my own skills and the skills of my fellow nurses here. But still overall, I think that nurses in the US have a better authority and autonomy in their jobs..

    Seeing how things have developed over the past, nurses will probably overtake more and more of the doctors’ practical tasks.. Auscultation will probably come to nursing schools here too, and I hope so, because alongside palpation, percussion and other basic techniques, auscultation such an important part of the general assessment..

  5. PQRST December 18, 2008 at 21:54 #

    Congrats on the new stethoscope, by the way! :-)

  6. Strong One December 23, 2008 at 23:41 #

    Contrary to some popular opinion, your stethescope DOES matter. When I first graduated nursing school I was given a Littman Master II.
    I’ve never looked back.
    I’ve used the Cardiology series from Littman, and it IS awesome. But, for my purposes, and the environment I’m in I’ll stick with the Master II.
    Either way.. you’ll be dropping a pretty penny.
    Best of luck

  7. Scrubs May 27, 2009 at 21:28 #

    Informative and entertaining. I’ve added your blog to my “reading material.” Keep me updated!

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