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Buying Stethoscope & Sphygmomanometer

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    #2
    vidar
    Registered Users Posts: 18 ✭vidar


    If you can afford it recommend this one, i bought it for my EMT and it is very easy to use. Have used it in "action" a bit too and it makes doing a plap BP so easy

    http://www.euroems.net/upgrade/scripts/prodView.asp?idproduct=1430

    Steth, I only went for a €20 one as unless you go into the mad money there is very little difference


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    #3
    Kwekubo
    Registered Users Posts: 1,238 ✭✭✭Kwekubo


    It depends on what you want them for. For an EMT, all you will be using the stethoscope for is taking blood pressure by auscultation so pretty much anything will do, the cheapo ones are fine. You only need a "good" stethoscope like a Classic II or Cardiology if you need to discriminate between different types of heart/lung sounds; that would be more within the skillsets of advanced paramedics or doctors.


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    #4
    baronflyguy
    Registered Users Posts: 533 ✭✭✭baronflyguy


    Thanks guys for your replies and feedback.

    I've decided to buy the following:

    (1) Professional ANEROID SPHYGMOMANOMETER standard adult D Ring Cuff with
    artery indicator - approx €19 (inc conversion and p&p)
    http://www.amazon.co.uk/Professional-ANEROID-SPHYGMOMANOMETER-standard-indicator/dp/B003541RQO/ref=pd_sim_ce_1

    (2) Prestige Medical Basic Dualhead Stethoscope Latex Free - S108 - €14.95
    http://www.clarendonmedical.com/ItemsStore.asp?sku=6000003714


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    #5
    First Aid Ireland
    Closed Accounts Posts: 190 ✭✭First Aid Ireland


    Doesn't make much difference what you buy if you're just taking BPs in controlled environments.

    If you're auscultating chests/hearts/abdos don't bother with anything other than the littmann classic range.

    Splash out a bit more if you're doing BPs in noisy environments, though.

    When buying your sphyg make sure it has a range of cuff size options. nothing makes you look like more of a fool than having your cuff constantly burst open when trying to measure a BP in front of the patient and their family.

    A good automated sphyg is probably your best bet, but would be expensive I guess.


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    #6
    emmet the rover
    Registered Users Posts: 246 ✭✭emmet the rover


    baronflyguy wrote: »
    Thanks guys for your replies and feedback.

    I've decided to buy the following:

    (1) Professional ANEROID SPHYGMOMANOMETER standard adult D Ring Cuff with
    artery indicator - approx €19 (inc conversion and p&p)
    http://www.amazon.co.uk/Professional-ANEROID-SPHYGMOMANOMETER-standard-indicator/dp/B003541RQO/ref=pd_sim_ce_1

    (2) Prestige Medical Basic Dualhead Stethoscope Latex Free - S108 - €14.95
    http://www.clarendonmedical.com/ItemsStore.asp?sku=6000003714

    did you get these? are they any use? looking at them myself


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    #7
    medic112
    Registered Users Posts: 110 ✭✭medic112


    For all you'll be doing a quality reliable one is all that is required, these do the job well & are cheap.

    http://www.criticalhealthcare.com/onlineshop/scripts/prodView.asp?idproduct=67085

    personally i do not like the steth to awkward & bulky, so this does the job.

    http://www.criticalhealthcare.com/onlineshop/scripts/prodView.asp?idproduct=128

    As for automated, stay away! unreliable, never accurate due to environment/storage/cold/batteries etc & very unprofessional in my opinion. An adult cuff should do just fine, no need for multicuffs.

    + remember a BP done by palp is just as good for a first set of ob's.:cool:


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    #8
    baronflyguy
    Registered Users Posts: 533 ✭✭✭baronflyguy


    emmet the rover wrote: »
    did you get these? are they any use? looking at them myself
    I did yes and they seem fine.
    medic112 wrote:
    For all you'll be doing a quality reliable one is all that is required, these do the job well & are cheap.

    http://www.criticalhealthcare.com/on...dproduct=67085
    Price of this looks very good. Nylon bag is handy. Emmet I'd get this if I was you.


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    #9
    bill buchanan
    Closed Accounts Posts: 120 ✭✭bill buchanan


    medic112 wrote: »
    For all you'll be doing a quality reliable one is all that is required, these do the job well & are cheap.

    http://www.criticalhealthcare.com/onlineshop/scripts/prodView.asp?idproduct=67085

    personally i do not like the steth to awkward & bulky, so this does the job.

    http://www.criticalhealthcare.com/onlineshop/scripts/prodView.asp?idproduct=128

    As for automated, stay away! unreliable, never accurate due to environment/storage/cold/batteries etc & very unprofessional in my opinion. An adult cuff should do just fine, no need for multicuffs.

    + remember a BP done by palp is just as good for a first set of ob's.:cool:

    I'd just add to this that I've done pre-hospital BP many many times with automated sphygs and never had a problem. Don't think there's any good evidence int he literature that they're unreliable. In fact, many copanies publish the validation results from their own models. Nothing unprofesisonal about them, IMHO.

    As someone who spent a lot of time as a paediatrician, multicuffs are great if you're going to have adult and younger patients. Whether it's of benefit to do BP in most of the very small people you'll see, I geuss that's a whole other debate. But adult cuffs are inappropriate (and far less reliable than an automated BP) in many of your younger patients.

    I wouldn't splash out big for a stethoscope that's only going to be used for BP, either.


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    #10
    Mycroft H
    Registered Users Posts: 9,313 ✭✭✭Mycroft H


    bill buchanan wrote: »
    I'd just add to this that I've done pre-hospital BP many many times with automated sphygs and never had a problem. Don't think there's any good evidence int he literature that they're unreliable. In fact, many copanies publish the validation results from their own models. Nothing unprofesisonal about them, IMHO.

    As someone who spent a lot of time as a paediatrician, multicuffs are great if you're going to have adult patients. Whether it's of benefit to do BP in most of the very small people you'll see, I geuss that's a whole other debate. But adult cuffs are inappropriate (and far less reliable than an automated BP) in many of your younger patients.

    I wouldn't splash out big for a stethoscope that's only going to be used for BP, either.



    It's fun trying to watch a lifepak trying to guess a BP with someone with an AV block (or anything irregular for that matter).


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    #11
    bill buchanan
    Closed Accounts Posts: 120 ✭✭bill buchanan


    BX 19 wrote: »
    It's fun trying to watch a lifepak trying to guess a BP with someone with an AV block (or anything irregular for that matter).

    The chances of someone on an EMT course buying a lifepack is pretty slim. They would also have very few therapeutic options for a hypotensive bradycardic patient in AV block or any arrhythmia. What I'm trying to say is that a BP in these patients, while useful, is almost never going to be the only good indicator of poor perusion, even if he was reliant on a lifepak.

    Having said that I used a manual BP kit in lots of occasions outside of hospital. I'm just a fan of the good automated kits, now that they've become very reliable.

    What I would say to the EMT students, too, is is that we all tend to gravitate towards our gear for answers, especially when it's use is a new skill. I know I used to love shiny pre-hospital kit. BP is exceptionally useful, to be fair. But remember that it's just part of an overall picture including colour, resp rate, heart rate, alertness, cap refill, tone. In kids, they compensate very well. So BP often doesn't fall at all until they've dropped their circulating volume by 25%+. Some patients will compensate better than others for longer, too.

    I wouldn't stress too much about equipment. But I wouldn't buy too much "Gucci kit". If, like you say, you're not flush with money, then a good automated BP kit is probably out of your price range. In that case, a very basic steth and most of the sphyg kits will be just fine. The most important part of using the kit is HOW you use it and WHEN, as opposed to what brand of kit you buy. While you're doing any observation, think to yourself "why am i doing this? And what am I going to do about the result?". Obs for the sake of obs are fine. But if it delays definitive care, then there should be a good reason for doing it.


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    #12
    Mycroft H
    Registered Users Posts: 9,313 ✭✭✭Mycroft H


    bill buchanan wrote: »
    The chances of someone on an EMT course buying a lifepack is pretty slim. They would also have very few therapeutic options for a hypotensive bradycardic patient in AV block or any arrhythmia. What I'm trying to say is that a BP in these patients, while useful, is almost never going to be the only good indicator of poor perusion, even if he was reliant on a lifepak.

    I don't think anyone is going to be buying a lifepack personally, even a second hand Lifepack 12 is pushing 4,000 euro. And the quality of automatic machines can very wildly. Lifepack 12 has a range of +-8mmgh while a cheaper OMRON I met an EMT using has a range of 20mmgh either side (and that's in ideal conditions. Irregular HR? Forget it). Would you use one of the cheaper automatic BPs for clearing the contraindication for GTN? I wouldn't.

    But my point is, there not 100% reliable compared to a decent sphyg.

    bill buchanan wrote: »
    Having said that I used a manual BP kit in lots of occasions outside of hospital. I'm just a fan of the good automated kits, now that they've become very reliable.

    Me too, though I'll always take a baseline off a decent sphyg rather then a machine.


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    #13
    bill buchanan
    Closed Accounts Posts: 120 ✭✭bill buchanan


    BX 19 wrote: »
    I don't think anyone is going to be buying a lifepack personally, even a second hand Lifepack 12 is pushing 4,000 euro. And the quality of automatic machines can very wildly. Lifepack 12 has a range of +-8mmgh while a cheaper OMRON I met an EMT using has a range of 20mmgh either side (and that's in ideal conditions. Irregular HR? Forget it). Would you use one of the cheaper automatic BPs for clearing the contraindication for GTN? I wouldn't.

    But my point is, there not 100% reliable compared to a decent sphyg.




    Me too, though I'll always take a baseline off a decent sphyg rather then a machine.


    I already made the point that the lifepak is an unlikely purchase. I was just responding to a point.
    I think the reality is that we have no definitive study on this issue, but the evidence suggests that both types of measurement are fine for clinical practice. The one advantage that the automated machines seem to have in the literature is that they produce very good intra-operator reproducibility (ie when 100 people use them on the same person, they mostly get the same result. When 100 people use a manual sphyg on the same person, the fluctuation in results is much larger). One ramdomised controlled trial when I was in australia showed very good reliability for automated machines, but slight concern about them maybe being less accurate in taking diastolic readings than the manual sphygs, but this study was looking at very experienced nurses.But a much bigger study in Canada showed that the automated machines were just as reliable for systolic and diastolic. In fact, that study showed slightly better results in estimating BP by the automated method. The only one group who seem to have consistent problems are those with very high blood pressure. Though there are apprently a few studies in the wings which when published will show that this isn't such an issue with newer models.

    I think the key is to use a good brand. The hospitals use good machines, which give no very few problems with arrhythmias or even in severe trauma. Some people who are not very experienced with manual sphygs don't use them well. Especially when under pressure. There's no way you can say that a manual sphyg is "100% reliable" in the hands of, say, an EMT student.

    if i was dealing with very sick people outside of hospital with only one other person to help me, or if i was alone, I'd be using a good, validated, automated machine.

    I don't understand your last point about taking your baseline from a different modality if you're looking for a trend and you don't trust one of the types of measurement.


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