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When's a good time to purchase a stethoscope?


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hehehehe and it is all about style :)

 

(and we really should have pocket US everywhere. It is the 21st century people)

 

As an aside... Some comments on bedside US.

 

I had a chance to play with a next gen portable ultrasound machine. This is the future guys. Here is a video of the machine I used in action, a glimpse of what will be routine in the decades to come.

 

 

Slowly getting closer to that star trek medical tricorder... :)

 

I do bedside US every day as being trained on it is part of my residency program. I pretty much use it as much as my stethoscope. Sadly on a day to day basis I use the big clunky bedside US. However, now that I know how to do a handful of scans I find bedside US is simple indispensable. I can evaluate so many cool and useful things with it from pneumonia to fluid status, to pericardial effusions etc. Many of the procedures I do are US guided as well. After being trained in a handful of key scans and getting my scans routinely critiqued and evaluated I can easily say that I feel US is several times more useful than my stethoscope at the bedside. I also feel more confident in a diagnosis made via US compared to the stethoscope. US has a definite role at the bedside as much as the stethoscope.

 

We should be teaching key US scans (cardiac, subcutaneous/soft tissue, fluid assessment, pulmonary, aorta, ruling in and out pregnancy, fetal HR assessment etc.) from early med school. It should be taught in the same manner as we teach auscultation today. The only reason it is not taught early on is that there is a limited number of MDs who have the skill. So currently the training is specialty dependent. This is changing quickly. One day, sooner than later, we will reach a critical mass of clinicians who feel comfortable with basic US techniques and interpretation. Then it will be taught in pre-clerkship during clinical skills. Just watch, it's gonna happen.

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As an aside... Some comments on bedside US.

 

I had a chance to play with a next gen portable ultrasound machine. This is the future guys. Here is a video of the machine I used in action, a glimpse of what will be routine in the decades to come.

 

 

Slowly getting closer to that star trek medical tricorder... :)

 

I do bedside US every day as being trained on it is part of my residency program. I pretty much use it as much as my stethoscope. Sadly on a day to day basis I use the big clunky bedside US. However, now that I know how to do a handful of scans I find bedside US is simple indispensable. I can evaluate so many cool and useful things with it from pneumonia to fluid status, to pericardial effusions etc. Many of the procedures I do are US guided as well. After being trained in a handful of key scans and getting my scans routinely critiqued and evaluated I can easily say that I feel US is several times more useful than my stethoscope at the bedside. I also feel more confident in a diagnosis made via US compared to the stethoscope. US has a definite role at the bedside as much as the stethoscope.

 

We should be teaching key US scans (cardiac, subcutaneous/soft tissue, fluid assessment, pulmonary, aorta, ruling in and out pregnancy, fetal HR assessment etc.) from early med school. It should be taught in the same manner as we teach auscultation today. The only reason it is not taught early on is that there is a limited number of MDs who have the skill. So currently the training is specialty dependent. This is changing quickly. One day, sooner than later, we will reach a critical mass of clinicians who feel comfortable with basic US techniques and interpretation. Then it will be taught in pre-clerkship during clinical skills. Just watch, it's gonna happen.

 

+1

 

I had the chance to use the GE Vscan a few times, great device and fits well in a labcoat pocket. It is still very basic in term of

 

It is getting more and more popular among ER staffs/residents at the MUHC.

It is still expensive ($8000), I guess one day the price will drop significantly enough and pre-clerks and clerks will buy it.

 

Ultrasound is even making its way to rheumatology where it is used to visualize joints to detect inflammation/arthritis.

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+1

 

I had the chance to use the GE Vscan a few times, great device and fits well in a labcoat pocket. It is still very basic in term of

 

It is getting more and more popular among ER staffs/residents at the MUHC.

It is still expensive ($8000), I guess one day the price will drop significantly enough and pre-clerks and clerks will buy it.

 

Ultrasound is even making its way to rheumatology where it is used to visualize joints to detect inflammation/arthritis.

 

Yeah it can really help with aspirating joints, esp if the the effusion is more subtle.

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+1

 

I had the chance to use the GE Vscan a few times, great device and fits well in a labcoat pocket. It is still very basic in term of

 

It is getting more and more popular among ER staffs/residents at the MUHC.

It is still expensive ($8000), I guess one day the price will drop significantly enough and pre-clerks and clerks will buy it.

 

Ultrasound is even making its way to rheumatology where it is used to visualize joints to detect inflammation/arthritis.

 

it is extremely powerful - it will be come a key tool very soon. In comparison we are wasting time learning some clinical exam skills that are outdated and have a low sensitivity anyway.

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As an aside... Some comments on bedside US.

 

I had a chance to play with a next gen portable ultrasound machine. This is the future guys. Here is a video of the machine I used in action, a glimpse of what will be routine in the decades to come.

 

 

Slowly getting closer to that star trek medical tricorder... :)

 

I do bedside US every day as being trained on it is part of my residency program. I pretty much use it as much as my stethoscope. Sadly on a day to day basis I use the big clunky bedside US. However, now that I know how to do a handful of scans I find bedside US is simple indispensable. I can evaluate so many cool and useful things with it from pneumonia to fluid status, to pericardial effusions etc. Many of the procedures I do are US guided as well. After being trained in a handful of key scans and getting my scans routinely critiqued and evaluated I can easily say that I feel US is several times more useful than my stethoscope at the bedside. I also feel more confident in a diagnosis made via US compared to the stethoscope. US has a definite role at the bedside as much as the stethoscope.

 

We should be teaching key US scans (cardiac, subcutaneous/soft tissue, fluid assessment, pulmonary, aorta, ruling in and out pregnancy, fetal HR assessment etc.) from early med school. It should be taught in the same manner as we teach auscultation today. The only reason it is not taught early on is that there is a limited number of MDs who have the skill. So currently the training is specialty dependent. This is changing quickly. One day, sooner than later, we will reach a critical mass of clinicians who feel comfortable with basic US techniques and interpretation. Then it will be taught in pre-clerkship during clinical skills. Just watch, it's gonna happen.

 

One of the big reasons I chose Calgary was that ultrasound training is a feature of the curriculum, and I keep hearing again and again how it's the future.

 

Nice to hear that reaffirmed!

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related to all this tech - I have an electronic stethoscope. So when the cardiologists are all saying "listen for that faint murmur" blah, blah my response was to turn up the volume on my noise cancelling device. You mean the loud and clear sounding murmur? Yeah that one. Sounds pretty loud and clear to me.

 

It is also funny when they ask what it sounded like and I just play back the heart beat. It kind of sounded exactly like this :)

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related to all this tech - I have an electronic stethoscope. So when the cardiologists are all saying "listen for that faint murmur" blah, blah my response was to turn up the volume on my noise cancelling device. You mean the loud and clear sounding murmur? Yeah that one. Sounds pretty loud and clear to me.

 

It is also funny when they ask what it sounded like and I just play back the heart beat. It kind of sounded exactly like this :)

 

What brand/model was that? While I have a bit of a sentimental attachment to my stethoscope (long story as to why I have one) that sounds really useful.

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What brand/model was that? While I have a bit of a sentimental attachment to my stethoscope (long story as to why I have one) that sounds really useful.

 

http://www.littmann.com/wps/portal/3M/en_US/3M-Littmann/stethoscope/stethoscope-catalog/catalog/~/3M-Littmann-Electronic-Stethoscope-Model-3200-Black-Tube-27-inch-3200BK27?N=4294958300+3294857497+5928483&rt=d

 

oh yeah....

 

be careful with your sentimental one - they can get lost in the hospital at times.

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One of the big reasons I chose Calgary was that ultrasound training is a feature of the curriculum, and I keep hearing again and again how it's the future.

 

Nice to hear that reaffirmed!

 

Although I wasn't aware that we would be learning bedside ultrasound (or as we call it POCUS: point of care ultrasound), NOSM also has this incorporated into the curriculum in pre-clerkship. So far we have done aorta (AAA), heart (pericardial effusions, tamponade etc..), abdominal and intrauterine pregnancy in first year. And will have a similar amount of training in second year in other modalities.

 

I'm sure residents or docs on here have taken the EDE (emergency department ultrasound) courses (the ER doc who helped develop them is in Sudbury and works at NOSM). I believe we get the equivalent of EDE 1 spread out over the first two years (although don't quote me on that)

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Pre-clerkship US courses are making their way to McGill as well. The first year students are now getting trained. Much more useful than 95% of the lectures we get in 1st-2nd year anyway.

 

I did not get a chance to get this early training. I had the chance to play with a few US machines in workshops organized by student groups (ER medicine interest group mainly) and I did a 2-days week-end course taught by ER physicians and radiologists on my free time. It is designed for family physicians

I had the opportunity to do about 30 scans (cardiac, lungs, abdomen, aorta, dvt, FAST echo) on 15 different models.

 

It is pretty decent to acquire a skill that is really useful. During an ER shift in a rural location, a patient comes in with RUQ abdominal pain - I do the US and it clearly shows an acute chole. The staff was impressed and it takes a few minutes to do.

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what's the big deal? wipe that **** down. it's as good as new.

 

If it's like mine it's been left overnight in all manner of locations and otherwise spend an inordinate amount of time on my sleep-deprived neck.

 

And, honestly, med students find much more extravagant things to spend their LOC money on. Getting a new stethoscope isn't that much of an expense. :rolleyes:

 

As for the ultrasound thing, I think POCUS-type training is going to be something of a standard going forward. But it doesn't really replace basic clinical exam (including the odd auscultation) or the flexibility of a stethoscope. A handheld ultrasound is not, for example, something you're going to use to check for bilateral breath sounds post-intubation. For someone like me, it's just one more thing to lose, and it's still just an expensive bauble that's fun and cool and helps, sometimes, but we need better evidence that it's cost-effective. (Hard to get, I know)

 

In the meantime I'll continue to wheel in the big machines for my own interest. Can't remember it really changing management much so far, but some middle-of-the-night images have confirmed a diagnosis (e.g. pericardial effusion without tamponade, RV failure).

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what's the big deal? wipe that **** down. it's as good as new.

 

Don't the Litmann ones have interchangeable earbuds so you can swap them out to avoid that whole yuck factor? Mine came with a bunch - the squishy silicone ones are particularly nice.

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When you purchase stethoscopes during O-week, is there a laser engraving option? That's the only upside I see to buying it online before O-week - I like the idea of knowing which one's mine if I end up accidentally leaving it around somewhere.

 

there was at Western so I would think there would be in general :)

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