Tourtier Jean-Pierre, Libert Nicolas, Clapson Patrick, Dubourdieu Stéphane, Jost Daniel, Tazarourte Karim, Astaud Cécil-Emmanuel, Debien Bruno, Auroy Yves
From the Emergency Medical Service (J.P.T., D.J., C.E.A.), Fire Brigade of Paris, 1 Place Jules Renard; Department of Intensive Care (N.L., P.C., S.D., B.D., Y.A.), Military Hospital Val-de-Grâce, Paris; Department of Intensive Care, Military Hospital Val-de-Grâce, Paris; Emergency Medical Service, Fire Brigade of Paris, 1 Place Jules Renard; Emergency Medical Service (K.T.), Melun, 11 Rue Freteau De Peny, Melun, France.
Simul Healthc. 2014 Apr;9(2):81-4. doi: 10.1097/SIH.0b013e3182a833e0.
The use of a stethoscope is essential to the delivery of continuous, supportive en route care during aeromedical evacuations. We compared the capability of 2 stethoscopes (electronic, Litmann 3000; conventional, Litmann Cardiology III) at detecting pathologic heart and lung sounds, aboard a C135, a medical transport aircraft.
Sounds were mimicked using a mannequin-based simulator SimMan. Five practitioners examined the mannequin during a fly, with a variety of abnormalities as follows: crackles, wheezing, right and left lung silence, as well as systolic, diastolic, and Austin-Flint murmur. The comparison for diagnosis assessed (correct or wrong) between using the electronic and conventional stethoscopes were performed as a McNemar test.
A total of 70 evaluations were performed. For cardiac sounds, diagnosis was right in 0/15 and 4/15 auscultations, respectively, with conventional and electronic stethoscopes (McNemar test, P = 0.13). For lung sounds, right diagnosis was found with conventional stethoscope in 10/20 auscultations versus 18/20 with electronic stethoscope (P = 0.013).
Flight practitioners involved in aeromedical evacuation on C135 plane are more able to practice lung auscultation on a mannequin with this amplified stethoscope than with the traditional one. No benefit was found for heart sounds.
在航空医疗后送过程中，使用听诊器对于提供持续的支持性途中护理至关重要。我们比较了两种听诊器（电子听诊器，Litmann 3000；传统听诊器，Litmann Cardiology III）在一架C135型医疗运输机上检测病理性心肺声音的能力。
使用基于人体模型的模拟器SimMan模拟声音。五名从业者在飞行过程中检查人体模型，存在以下多种异常情况：湿啰音、哮鸣音、左右肺无声，以及收缩期、舒张期和奥斯汀 - 弗林特杂音。使用电子听诊器和传统听诊器之间的诊断比较评估（正确或错误）采用麦克尼马尔检验。
总共进行了70次评估。对于心音，使用传统听诊器和电子听诊器听诊时，诊断正确的分别为0/15次和4/15次（麦克尼马尔检验，P = 0.13）。对于肺音，使用传统听诊器在20次听诊中有10次诊断正确，而使用电子听诊器在20次听诊中有18次诊断正确（P = 0.013）。
参与C135飞机航空医疗后送的飞行从业者使用这种放大听诊器比使用传统听诊器更能在人体模型上进行肺部听诊。在心音方面未发现优势。
