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At least 73 records · Page 4Linked to original sources
PubMed2002

Evaluation of dedicated stethoscopes as a potential source of nosocomial pathogens.

OBJECTIVE: To determine whether the ear tips of dedicated stethoscopes (DS) that are used on patients prescribed contact precautions for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium, or multiple antibiotic-resistant Acinetobacter baumannii become contaminated with these micro-organisms. DESIGN: Culture of DS ear tips. SETTING: A 524-bed tertiary care university hospital. METHODS: DS ear tips were inoculated directly onto bacteriologic media and incubated for 48 to 72 hours. Growth of more than 10 colonies from the 2 ear tips collectively was indicative of contamination. RESULTS: Ear tips of 78 DS from 69 patients were cultured. Ear tips from 17% (13/78) of the DS were contaminated with potentially pathogenic bacteria: 2 with S aureus (1 MRSA), 1 with E faecalis, 7 with Acinetobacter species, 2 with Pseudomonas species, 1 with Escherichia coli, and 1 with Moraxella. None of the stethoscope ear tips was contaminated with the same pathogen for which the patient was prescribed contact precautions (95% CI, 0-3.8%). CONCLUSION: Although the ear tips of DS from patients who were prescribed contact precautions for MRSA, vancomycin-resistant E faecium, or multiple antibiotic-resistant A baumannii were not contaminated with the indicated nosocomial pathogen, 94% of the evaluable ear tips were contaminated, including with MRSA (1.3%) and Acinetobacter (11%). Regular disinfection of ear tips of DS between users should be considered.

Acinetobacter baumannii↗
PubMed2001

Bacterial contamination of fabric stethoscope covers: the velveteen rabbit of health care?

To determine if fabric stethoscope covers pose an infection control problem, we studied how they are cared for by our healthcare workers and performed microbiological investigations on 22 covers collected over a 3-week period. Our study suggests that fabric stethoscope covers represent a potential infection control problem because they are used for prolonged periods, are infrequently laundered, and are contaminated with bacteria.

Bacteria↗
PubMed1998

An adaptive noise reduction stethoscope for auscultation in high noise environments.

Auscultation of lung sounds in patient transport vehicles such as an ambulance or aircraft is unachievable because of high ambient noise levels. Aircraft noise levels of 90-100 dB SPL are common, while lung sounds have been measured in the 22-30 dB SPL range in free space and 65-70 dB SPL within a stethoscope coupler. Also, the bandwidth of lung sounds and vehicle noise typically has significant overlap, limiting the utility of traditional band-pass filtering. In this study, a passively shielded stethoscope coupler that contains one microphone to measure the (noise-corrupted) lung sound and another to measure the ambient noise was constructed. Lung sound measurements were made on a healthy subject in a simulated USAF C-130 aircraft environment within an acoustic chamber at noise levels ranging from 80 to 100 dB SPL. Adaptive filtering schemes using a least-mean-squares (LMS) and a normalized least-mean-squares (NLMS) approach were employed to extract the lung sounds from the noise-corrupted signal. Approximately 15 dB of noise reduction over the 100-600 Hz frequency range was achieved with the LMS algorithm, with the more complex NLMS algorithm providing faster convergence and up to 5 dB of additional noise reduction. These findings indicate that a combination of active and passive noise reduction can be used to measure lung sounds in high noise environments.

Auscultation↗
PubMed2005

Identification of endotracheal tube malpositions using computerized analysis of breath sounds via electronic stethoscopes.

Endotracheal tube (ETT) malpositioning into a mainstem bronchus or the esophagus may result in significant hypoxemia. Current methods to determine correct ETT position include auscultation, radiography, and bronchoscopy, although the current acceptable standard procedure for proper endotracheal (versus esophageal) intubation is detection of end-tidal carbon dioxide (ETco(2)) by capnography, capnometry, or colorimetric ETco(2) devices. Unfortunately, capnography may be unavailable or unreliable in nonhospital/emergency settings or in low cardiac output states, and it does not detect endobronchial intubation. The purpose of this study was to quantify and assess breath sound characteristics using electronic stethoscopes placed over each hemithorax and epigastrium to determine their ability to detect ETT malposition. We recorded breath sounds in 19 healthy, non-obese adults before general surgical procedures. After intubation of the trachea, the ETT was bronchoscopically positioned 3 cm above the carina, after which 3 breaths of 500 mL were given and breath sounds were recorded. A second ETT was placed in the esophagus and the same series of breaths and recordings were performed. Finally, the tracheal ETT was advanced into the right mainstem bronchus and breath sounds were recorded. Using computerized analysis, breath sounds were digitized and filtered to remove selected frequencies, and acoustic signals and energy ratios were obtained for all 3 positions. Total energy ratios using band-pass filtering of the acoustic signals accurately identified all esophageal and endobronchial intubation (P < 0.001). These preliminary results suggest that this technique, when incorporated into a 3-component, electronic stethoscope-type device, may be an accurate, portable mechanism to reliably detect ETT malposition in adults when ETco(2) may be unavailable or unreliable.

Blood Gas Analysis↗
PubMed1999

[To use the stethoscope correctly is not easy. The intricate art of auscultation should receive more attention in medical education].

Although the stethoscope is used daily by almost every physician, the full potential of the art of stethoscopy is seldom tapped. It has been replaced by newer and more costly techniques. In the article it is argued that more time in medical education should be allocated to stethoscopy, so that it can be used in selecting patients who will benefit most from examination with modern diagnostic tools. The medical technological background of stethoscopy is also reviewed, as are the reasons why it is difficult to give sound advice on the choice of stethoscope.

Acoustics↗
PubMed2000

The efficacy of stethoscope placement when not in use: traditional versus "cool".

OBJECTIVE: To determine whether the "cool" or circumcervical placement of the stethoscope when not in use is as efficacious as the traditional placement in terms of transfer time to the functional position. METHODS: Measurement of time taken by 100 health care professionals in each group to transfer stethoscope to functional position. RESULTS AND INTERPRETATION: The cool group was much slower than the traditional group, despite their younger years. This wasted time could translate into a substantial financial burden on Canada's health care system.

Humans↗
PubMed2003

The stethoscope: some preliminary investigations.

Textbooks, clinicians, and medical teachers differ as to whether the stethoscope bell or diaphragm should be used for auscultating respiratory sounds at the chest wall. Logic and our results suggest that stethoscope diaphragms are more appropriate.

Auscultation↗
PubMed1998

[Laënnec, re-inventor of the stethoscope?].

According to our common medical culture, some facts are simply unquestionable, for instance Laënnec invented the stethoscope. But was he the first one? On a recent trip to Egypt we visited the temple of Kom Ombo, built prior to the roman period and renowned as a medical care center. Today, the tourist is fascinated by the magnificent hieroglyphics on the well-preserved walls testifying to significant advances in various fields of medicine including ophthalmology and gynecology. We were particularly interested by the basreliefs presenting vivid drawings of some of the first medical instruments. We easily identified curettes, scissors, a balance, forceps for dental extraction, and a surgical saw, but were captivated by two other instruments. The first one looked a lot like what Laënnec invented around 1820. The second one was amazingly similar to the instrument we use everyday, with a distal opening and flexible tubes (woven papyrus?) leading to proximal ear pieces. Our Egyptian guide was formal: the stethoscope was invented in Egypt. The scientific impact of our observations leaves something to be desired, but did make us think about the huge gap between the advancement of medical knowledge in ancient Egypt and Laënnec's (re)-invention. Exposed to a similar gap in history, what would our documents stored on CD and video tapes have to say to future touring doctors?

Egypt↗
PubMed1994

Stethoscope acoustics and cervical auscultation of swallowing.

Frequency response characteristics of six popular stethoscopes are reported for the higher frequency range (to 3000 Hz) to supplement equivalent measurements for the lower frequencies (35-1000 Hz) published previously. Spectra of the sounds of swallowing from the throat, transduced with an accelerometer, demonstrate important frequency composition in this higher range. Two stethoscope models were found to have superior transmission characteristics for use in cervical auscultation of swallowing sounds.

Acceleration↗
PubMed1980

Assessment of the left ventricular function with the nuclear stethoscope.

The evaluation of the left ventricular function with the "Nuclear Stethoscope" was performed on 27 patients with heart diseases. The reproducibility of the measurements was good. Repetitions of EF, ER and EDV estimations yielded errors of 2.63%, 1.45% and 0.31%, respectively. The comparison with the results of camera ventriculography showed a good agreement of EF, contraction velocity parameters and relaxation velocity parameters, with a cor. coeff. of greater or equal to 0.750. An especially high correlaton was found between the NS EF and NS ER (r = 0.968). It was concluded that the "Nuclear Stethoscope" provides a reliable evaluation of left ventricular function.

Adult↗
PubMed1987

Now that we have pulse oximeters and capnographs, we don't need precordial and esophageal stethoscopes.

One clinician argues that precordial and esophageal stethoscopes are obsolete. Current technology, including pulse oximetry, electrocardiography, and capnography, is both easier to use and more accurate. Another clinician argues that these stethoscopes have an important place in safe patient management. They are an inexpensive but effective extension of the anesthesiologist's own senses.

Carbon Dioxide↗
PubMed1991

The two-headed stethoscope: its use for ruling out airway foreign bodies.

Foreign body aspiration is a common concern for physicians and surgeons who care for children. Evaluating infants and toddlers to rule out this possible diagnosis is often fraught with difficulties. Specifically, the standard stethoscope is of limited use unless unilateral asymmetry of breath sounds can be appreciated. Inspiratory and expiratory chest X-rays in children often appear to show a very similar diaphragmatic excursion and, unless the object is radiodense, the determination of foreign body aspiration is frequently not possible. Other procedures, such as flexible or rigid endoscopy, are more invasive and are reserved for children with positive findings or a less acute but more perplexing scenario. We present the use of the two-headed stethoscope as an option for evaluation of children to rule out foreign body aspiration. Our experience with this instrument over the past 10 years has consistently allowed us to non-invasively differentiate the presence or absence of objects in the airway.

Airway Obstruction↗
PubMed1994

ESTRACE--1: a stethoscope for functional checking of electrostimulators and low cost body surface mapping system.

In a project on the mapping of body surface potentials evoked by implanted spinal cord stimulators and transcutaneous electrostimulators, a simple device was developed for use in polyclinical practice for easy checking of the function of these stimulators. The device is an electrical stethoscope and consists of an instrumentation amplifier, bandpass filter, a distortion circuit and a headphone. In vivo measurements demonstrate the generation of an amplitude-dependent tone by the distortion circuit. The apparatus is in many aspects similar to a stethoscope: simple to understand and a practical tool for a fast Go/No-Go test. The device can be optionally connected with a PC and enables body surface mapping documentation within a few minutes.

Adult↗
PubMed1981

The use of the Doppler stethoscope in anatrophic nephrotomy.

Anatrophic nephrotomy has facilitated greatly the surgical removal of staghorn calculi. However, the methylene blue technique used to define the anatrophic plane proves time-consuming and may jeopardize renal parenchymal vascular supply by provoking vasospasm. Any technique to minimize these complications would be advantageous. The use of the Doppler stethoscope effectively reduces extensive renal segmental vessel dissection as well as operative and warm ischemia time. The advantage of the Doppler stethoscope in other forms of renal stone surgery is alluded to also.

Auscultation↗
PubMed1990

Effect of back support and stethoscope head on seated blood pressure determinations.

Seated BP measurements were taken in 48 men with a history of essential hypertension: in a chair with back support v on an examining table with no back support, and with bell v diaphragm stethoscope head in each condition. There were no significant differences between bell and diaphragm in SBP or DBP determinations. SBP was not significantly different between table and chair, but table DBP was 6.5 mm Hg higher (P less than .0001) than chair DBP. We conclude that back support, but not bell v diaphragm stethoscope head, affects seated BP determinations.

Back↗
PubMed1991

Atrial pacing thresholds measured in anesthetized patients with the use of an esophageal stethoscope modified for pacing.

Transesophageal atrial pacing (TAP) with the use of standard, thermistor-equipped, esophageal stethoscopes, modified for pacing by incorporation of a 4-French, bipolar TAP probe (pacing esophageal stethoscope [PES]), was evaluated in 100 adult patients under general anesthesia. A commercially available TAP pulse generator supplied 10-ms pulses with current variable between 0 and 40 mA. Pacing distances (in centimeters) were measured from the infraalveolar ridge to midway between PES electrodes (1.5-cm interelectrode distance). Pacing thresholds (milliamperes) were measured at the point of a maximum-amplitude P-wave (PMAX) in the bipolar esophageal electrogram and points 1 cm proximal or 1, 2, or 3 cm distal to PMAX. TAP (70-100 beats per min) was used for sinus bradycardia less than or equal to 60 beats per min (36 patients) or atrioventricular (AV) junctional rhythm (2 patients) and blood pressure changes with TAP documented. In male patients (n = 49), PMAX was 32.7 +/- 0.3 cm (mean +/- SE) and minimum pacing threshold 5.1 +/- 0.4 mA (range, 1-13 mA) at 33.6 +/- 0.3 cm (range, 30-37 cm). In female patients (n = 51), PMAX was 30.4 +/- 0.4 cm and minimum pacing threshold 4.4 +/- 0.4 mA (range, 2-14 mA) at 31.1 +/- 0.4 cm (range, 26-40 cm). TAP produced an average 13-16 mmHg increase in systolic, diastolic, or mean arterial pressure in patients with sinus bradycardia or AV junctional rhythm. There were no subjective patient complaints (epigastric discomfort, dysphagia) that could be attributed to TAP; objective evaluation (esophagoscopy) was not performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Evaluation of transesophageal atrial pacing stethoscope in adult surgical patients under general anesthesia.

Sinus bradycardia (SB) and atrioventricular junctional rhythm (AVJR) commonly cause circulatory insufficiency in anesthetized surgical patients. Treatment is usually with drugs, which can be ineffective or have adverse effects. Cardiac pacing might be preferred, but the transvenous or epicardial routes are too invasive for routine use, and transcutaneous pacing fails to preserve atrial transport function. Transesophageal atrial pacing (TAP) lacks these disadvantages, yet unavailability of inexpensive products has prevented more widespread use. Therefore, a pacing esophageal stethoscope (PES) fabricated by addition of bipolar electrodes to disposable esophageal stethoscopes routinely used for intraoperative monitoring, was evaluated in 100 anesthetized adults. TAP thresholds (10-msec pulses) and hemodynamic effects of TAP as treatment for incidental SB (< or = 60 beats/min) or AVJR were determined. Minimum TAP thresholds (mean +/- standard error) in 48 males were 7.3 +/- 0.3 mA and in 51 females were 8.5 +/- 0.4 mA. Corresponding inferior alveolar ridge-to-electrode distances were 32.5 +/- 0.2 and 30.4 +/- 0.2 cm. For 48 patients with SB < or = 60 beats/min (54 +/- 1 beats/min), TAP (81 +/- 1 ppm) produced average 15, 11, and 14 mmHg increases in systolic, diastolic, and mean arterial pressure, respectively (P < 0.001). For 11 patients with AVJR (71 +/- 5 beats/min), TAP (92 +/- 3 ppm) produced average 23 and 15 mmHg increases in systolic and mean arterial pressure, respectively (P < 0.05). There were no apparent complications of TAP. TAP with a PES appears practical, safe, and effective for prophylaxis and treatment of SB or AVJR in anesthetized surgical patients.

Adult↗
PubMed1981

Reception of the stethoscope and Laënnec's book.

A study of contemporary book reviews and other notices enables us to trace the reception of the stethoscope and Laënnec's book between 1816 and 1826. It is quite clear from these that the stethoscope was welcomed with enthusiasm by most people who saw it as the first major diagnostic tool medicine had ever had. Laënnec's book was recognised as being the most important, interesting, accurate, and complete work on diseases of the chest that had ever been published.

Academic Dissertations as Topic↗