Designed to enable the medical professional to
obtain superior and accurate auscultation.
The Harvey DLX Double Head and Triple Head Stethoscopes were
designed after extensive research and testing. The critical design of the
tubing, proper weight and sizing of the chestpiece and rotatable binaurals,
combine to make the Harvey Stethoscopes exceptional instruments for
auscultation. The final testing, of course, was on the patient.
The Harvey Stethoscopes will give you the ability to identify the lowest
frequencies that the human ear can detect, such as a faint diastolic
gallop or rumble, as well as the higher frequencies of the faint early
blowing aortic diastolic murmur.
Furthermore, with over five decades of experience
using stethoscopes, Dr. W. Proctor Harvey has
designed his stethoscopes to meet the comfort and
portability needs which physicians demand.
Chestpieces
Both the double head and triple head
offer a flat diaphragm and bell. The triple head also
utilizes a corrugated diaphragm for additional
auscultatory capabilities. Selection is accomplished by
Triple Head
holding the chestpiece stem in one hand and rotating
the chestpiece until a click is heard or felt.
Flat Diaphragm
“The workhorse.” Excellent for all sounds and murmurs. Best
for higher frequencies (such as faint diastolic murmur of aortic
regurgitation). Also ideal to identify splitting of sounds, systolic
clicks and ejection sounds. 4.76 cm diameter.
2
Double Head
Corrugated Diaphragm
Amplifying quality. Excellent for an overview of heart sounds.
Especially good for low-frequency gallop sounds and murmurs.
4.76 cm diameter.
Bell
Provides excellent detection and clarity for low and mediumfrequency heart sounds and murmurs (such as a faint gallop
or diastolic rumble). 2.79 cm diameter.
Headset Adjustment
Your new Harvey Stethoscopes are designed to give you the
maximum ability to adjust for your personal comfort and acoustic fit.
A. Select the correct size and texture eartip. For
maximum acoustic seal, two sizes of “soft” and
“hard” eartips are provided. Choose the size
which best seals off your outer ear canal and
feels the most comfortable. As a rule the larger
size is best for the majority.
B. To adjust the
angle of the
binaurals, hold
the spring in one
hand and rotate
each binaural to
the correct angle.
C. Make sure that the
binaural tubes are
pointed slightly
forward going into
the ear canal.
3
Page 3
D.To reduce spring
tension, grasp
each eartube at
its bend and
gently pull
outwards.
E. To increase spring
tension, squeeze
the eartubes
together.
Simply press the diaphragm disc out of the metal ring
C.
and replace with new disc. Thread the ring back on to
chestpiece.
Care and Maintenance
•
It is important to clean and disinfect your stethoscope to prevent
possible cross-contamination.
•
Eartubes and tubing can be wiped down with alcohol or mild
soapy water.
•
Eartips may be removed for thorough cleaning with alcohol or mild
soapy water.
•
Diaphragm replacement: Under normal use you should rarely need
to remove the rim and diaphragm for cleaning purposes. The exterior of
the diaphragm can be cleaned with alcohol or mild soapy water.
However, if you do need to remove diaphragm:
A.
Hold the bell and turret section in one hand, and
exert pressure on the back of the diaphragm. Grip
the threaded ring of the diaphragm with your other
hand and turn the ring counterclockwise to loosen.
B.
Separate the threaded ring from the turret section.
4
Warranty
Your Harvey DLX Stethoscope comes with a 10-year warranty against
parts and manufacturing defects. Should a material or workmanship
defect be discovered, Welch Allyn will repair or replace the product at
no charge.
This warranty does not cover damage in shipment or failure caused by
tampering, obvious carelessness or abuse.
Return the unit for service, to any of the Welch Allyn Service Centers
below:
• In Japan, send to IMI Co., 3-3-12 Ryutsu-danchi, Koshigaya-shi Saitama, 343 Japan.
5
Page 4
Ordering Information
All Welch Allyn brand stethoscopes and accessory parts can be purchased
from an authorized distributor in your area. Call Welch Allyn directly for
the name of the dealer near you.
Harvey DLX Triple Head, Black Tubing
Harvey DLX Double Head, Black Tubing
Accessory Kit
Hard Eartips, Extra Large
Hard Eartips, Large
Soft Eartips, Large
Soft Eartips, Medium
Binaural/Spring Assembly
Tubing, Black
Pediatric Chestpiece Assembly
Adult Flat Chestpiece Assembly
Bell Chestpiece
Corrugated Chestpiece Assembly
Flat Diaphragm Disc Only
Adult Corrugated Diaphragm Disc Only
Adult Corrugated Chestpiece Assembly
Français.....7
Auscultation.....37
Stéthoscopes
double et
triple tête DLX
de Harvey
6
Page 5
Pour une auscultation supérieure et précise.
Les stéthoscopes double et triple tête de Harvey DLX sont le fruit de recherches
et d’essais approfondis. La conception soignée du tube, le poids et la taille
précis du pavillon et les branches rotatives de la lyre s’associent pour faire des
stéthoscopes de Harvey des instruments d’auscultation exceptionnels. Le test
déterminant a été, bien sûr, effectué sur le patient.
Les stéthoscopes de Harvey vous permettent d’identifier les fréquences les
plus basses que détecte l’oreille humaine, telles qu’un bruit de galop ou un
roulement diastolique faibles, ainsi que les plus hautes fréquences du souffle
diastolique aortique précoce faiblement perceptible.
Qui plus est, fort de cinquante ans d’expérience dans l’utilisation de
stéthoscopes, le Dr W. Proctor Harvey a conçu ses
stéthoscopes pour qu’ils répondent aux demandes de
confort et de portabilité des médecins.
Pavillons
Les modèles double et triple tête offrent
une membrane plate et une cloche. La
triple tête comprend également une membrane ondulée qui
ajoute aux possibilités d’auscultation. On sélectionne la tête
en tenant le pavillon d’une main par sa tige et en le tournant
Triple tête
jusqu’à ce qu’un déclic se fasse entendre ou qu’on perçoive
l’enclenchement.
Membrane plate
« La bête de somme ». Excellente pour tous les bruits et souffles. Idéale pour
les hautes fréquences (telles qu’un faible souffle diastolique de régurgitation
aortique). Tout aussi parfaite pour faire la distinction entre les bruits,
identifier des clics systoliques et des bruits d’éjection. Diamètre : 4,76 cm.
8
Double tête
Membrane ondulée
Sert d’amplificateur. Excellente pour un examen général des bruits cardiaques.
Particulièrement adaptée aux bruits de galop et aux souffles de basses
fréquences. Diamètre : 4,76 cm.
Cloche
Permet de détecter avec une grande clarté les bruits et les souffles
cardiaques de basse et moyenne fréquences (tels qu’un faible bruit de
galop ou un roulement diastolique). Diamètre : 2,79 cm.
Réglage de la lyre
Vos nouveaux stéthoscopes de Harvey sont conçus pour vous permettre de les
adapter à vos critères de confort et d’ajustement acoustique.
A. Sélectionnez les embouts auriculaires de la taille et de la texture appropriées.
Pour une acoustique optimale, deux tailles d’embouts
auriculaires « mous » et « durs » vous sont proposées.
Choisissez la taille qui obture le mieux votre conduit
auditif externe et qui est la plus confortable. En règle
générale, le plus gros embout convient le mieux à la
majorité des utilisateurs.
B. Pour régler l’angle
des branches de
la lyre, tenez le
ressort d’une main
et tournez chaque
branche jusqu’à
l’obtention de
l’angle désiré.
C. Assurez-vous que les
branches binaurales
sont légèrement
dirigées vers l’avant
à l’entrée du conduit
auditif.
9
Page 6
D. Pour réduire la
tension du ressort,
saisissez chaque
branche à sa base et
tirez délicatement
vers l’extérieur.
E. Pour augmenter la
tension du ressort,
rapprochez les
branches de la lyre.
C.
Tenez la cloche et la monture d’une main et appuyez sur le dos
de la membrane. De l’autre main, saisissez la bague filetée de la
membrane et dévissez la bague en la tournant dans le sens
contraire des aiguilles d’une montre.
Nettoyage et entretien
•
Il est important de nettoyer et de désinfecter le stéthoscope pour empêcher une
contamination croisée.
•
Les branches de la lyre et le tube peuvent être nettoyés à l’alcool ou à l’eau
et au savon doux.
•
On peut retirer les embouts auriculaires pour les nettoyer en profondeur à
l’alcool ou à l’eau et au savon doux.
•
Remplacement de la membrane : dans des conditions normales d’utilisation,
il est rarement nécessaire de retirer la bague et la membrane pour les nettoyer.
L’extérieur de la membrane peut se nettoyer à l’alcool ou à l’eau et au savon
doux. Toutefois, si vous avez besoin de retirer la membrane :
Tenez la cloche et la monture d’une main et appuyez sur le
A.
dos de la membrane. De l’autre main, saisissez la bague filetée
de la membrane et dévissez la bague en la tournant dans le
sens contraire des aiguilles d’une montre.
Détachez la bague de la monture.
B.
10
Garantie
Votre stéthoscope DLX de Harvey est assorti d’une garantie de dix ans contre tout
défaut de pièce ou de fabrication. Si un défaut de fabrication ou de matériau est
découvert, Welch Allyn réparera ou remplacera gratuitement le produit.
Cette garantie ne couvre pas les dommages pouvant survenir en cours
d’expédition, ni les dommages causés par les altérations, la négligence ou l’usage
impropre.
Renvoyer l’appareil à réparer à l’un des centres de réparation Welch Allyn
suivants :
• In Japan, send to IMI Co., 3-3-12 Ryutsu-danchi, Koshigaya-shi Saitama, 343 Japan.
11
Page 7
Commandes
Vous pouvez acheter tous les stéthoscopes et les accessoires Welch Allyn
auprès d’un distributeur agréé de votre région. Appelez directement
Welch Allyn pour obtenir le nom du revendeur le plus proche.
Stéthoscope triple tête de Harvey DLX, tube noir
Stéthoscope double tête de Harvey DLX, tube noir
Ensemble d’accessoires
Embouts auriculaires durs, extra-grands
Embouts auriculaires durs, grands
Embouts auriculaires mous, grands
Embouts auriculaires mous, moyens
Ensemble lyre et ressort
Tube, noir
Pavillon pour enfants
Pavillon plat
Pavillon à cloche
Pavillon ondulé
Disque de membrane plate uniquement
Disque de membrane ondulée uniquement
Pavillon ondulé
Deutsch.....13
Auscultation.....37
Harvey DLX
Doppel- und
Dreifach-
12
Stethoskope
Page 8
Ein Konzept, das dem medizinischen Personal
bessere und genauere Auskultation verspricht.
Die Harvey DLX Doppel- und Dreifach-Stethoskope sind das Resultat
umfangreicher Forschungen und Tests. Die Präzision beim Design der Schläuche,
das richtige Gewicht, die Größe des Bruststücks sowie die verstellbaren Ohrbügel
machen das Harvey-Stethoskop zu einem hervorragenden Auskultationsgerät,
das natürlich auch die Tests an Patienten bestens bestanden hat.
Mit den Harvey-Stethoskopen können Sie die niedrigsten vom menschlichen
Ohr erkennbaren Frequenzen feststellen, wie z.B. ein schwaches diastolisches
Galoppieren oder Rumpeln, sowie die höheren Frequenzen eines schwachen
frühzeitigen aortisch-diastolischen Murmelns.
Hinzukommt, daß Dr. W. Proctor Harvey auf über fünf
Jahrzehnte Erfahrung im Gebrauch von Stethoskopen
zurückgreifen konnte, um ein Design zu entwickeln, das
den heutigen Bedürfnissen der Ärzte in bezug auf Komfort
und Beweglichkeit entgegenkommt.
14
Bruststücke
Beide Ausführungen, d.h. die mit zwei und die mit drei Köpfen,
haben eine Flachmembran und eine Glocke. Das Modell mit drei
Köpfen bietet zusätzlich eine gewellte Membran für zusätzliche
Auskultationsmöglichkeiten. Die Wahl erfolgt durch Festhalten
Dreikopf
des Schlauchansatzes mit einer Hand und durch Drehen des
Bruststücks, bis ein Klicken gehört oder gefühlt wird.
Flachmembran
Hervorragend für Geräusche jeder Art. Am besten für höhere Frequenzen
geeignet (z. B. schwaches diastolisches Murmeln bei aortischer Insuffizienz).
Auch ideal zur Identifizierung der unterschiedlichsten Geräusche,
systolischem Klick und Ejektionsgeräuschen. Durchmesser: 4,76 cm.
Zweikopf
Gewellte Membran
Verstärkerqualität. Hervorragend geeignet für einen Überblick über die
Herzgeräusche. Besonders gut für galoppierende Geräusche niedriger
Frequenz und Murmeln. Durchmesser: 4,76 cm.
Glocke
Erstklassige Erkennung und Klarheit der Herzgeräusche von niedriger
und mittlerer Frequenz und der Murmelgeräusche (z.B. schwaches
Galoppieren oder diastolisches Rumpeln). Durchmesser: 2,79 cm.
Einstellen der Ohrbügel
Ihr neues Harvey-Stethoskop bietet optimale Anpassungsmöglichkeiten für
Ihren persönlichen Komfort und beste Akustik.
A. Wählen Sie die richtige Größe und Beschaffenheit der
Ohroliven. Für maximale akustische Abdichtung
stehen zwei Größen von “weichen” und “harten”
Ohroliven zur Verfügung. Wählen Sie die Größe, die
Ihren äußeren Ohrkanal am besten verschließt und
bequem sitzt. Allgemein gilt, daß die größere Größe
meistens am besten sitzt.
B. Halten Sie zur
Winkeleinstellung
der Ohrbügel die
Feder mit einer
Handfest, und
drehen Sie jeden
Bügel in die
gewünschte
Position.
C. Stellen Sie sicher,
daß die Ohrbügel
leicht nach vorne
gerichtet im
Ohrkanal sitzen.
15
Page 9
D. Zur Reduzierung
des Federdruckes,
halten Sie jeden
Ohrbügel an seiner
Biegung, und
ziehen Sie sie
vorsichtig nach
außen.
E. Zum Erhöhen der
Federspannung
drücken Sie
die Ohrbügel
zusammen.
Pflege und Instandhaltung
•
Es ist wichtig, das Stethoskop zu reinigen und zu desinfizieren, um etwaige
Übertragungskontamination zu verhindern.
•
Ohrbügel und Schläuche können mit Alkohol oder milder Seifenlauge
abgewischt werden.
•
Die Ohroliven können zur gründlichen Reinigung mit Alkohol oder milder
Seifenlauge abgeschraubt werden.
•
Auswechseln der Membran: Bei normalem Gebrauch sollten der Ring und
die Membran nur selten zur Reinigung abgenommen werden müssen. Die
Membranaußenseite kann mit Alkohol oder milder Seifenlauge abgewischt
werden. Sollte ein Auswechseln der Membran erforderlich sein:
Halten Sie die Glocke und den Drehkopf mit einer Hand
A.
fest, und drücken Sie von hinten mit der anderen Hand
auf die Membran. Ergreifen Sie den Schraubring der
Membran mit der anderen Hand und lockern Sie ihn
durch Drehen nach links.
Nehmen Sie den Schraubring vom Drehkopf.
B.
C.
Drücken Sie die Membranscheibe einfach aus dem Metallring und
setzen Sie eine neue Scheibe ein. Schrauben Sie den Ring wieder
auf das Bruststück.
Garantie
Das Harvey DLX Stethoskop ist durch eine 10-Jahres-Garantie gegen Defekte und
Verarbeitungsfehler geschützt. Sollte dennoch ein Material- oder
Verarbeitungsfehler auftreten, repariert oder ersetzt Welch Allyn das
Produkt kostenlos.
Diese Garantie gilt nicht bei Versandschäden, falscher Anwendung, Verwahrlosung
und normaler Abnutzung.
Senden Sie das Gerät an eines der nachstehend aufgeführten Welch Allyn Service
Centers zur Wartung:
• In Japan, send to IMI Co., 3-3-12 Ryutsu-danchi, Koshigaya-shi Saitama, 343 Japan.
16
17
Page 10
Bestellinformationen
Alle Welch Allyn Stethoskope und Zubehörteile sind von einem
autorisierten Vertreter in Ihrer Gegend erhältlich. Wenden Sie sich direkt
an Welch Allyn, um den Namen des nächsten Händlers zu erfragen.
Diseñado para permitir al profesional médico
obtener una auscultación superior y precisa.
Los estetoscopios Harvey DLX de doble y triple cabeza fueron diseñados después
de un largo proceso de investigación y prueba. El diseño especial de los tubos, el
peso y tamaño adecuados de la pieza para el pecho y los auriculares giratorios se
combinan para hacer de los estetoscopios Harvey unos instrumentos excepcionales
para la auscultación. La prueba final, por supuesto, fue en el paciente.
Los estetoscopios Harvey le permitirán identificar las frecuencias más bajas que
puede detectar el oído humano como, por ejemplo, un tenue galope o ruido
sordo diastólico, así como las frecuencias más altas del débil soplo diastólico
aórtico temprano
Además, con más de cinco décadas de experiencia usando
estetoscopios, el Dr. W. Proctor Harvey ha diseñado sus
estetoscopios de acuerdo con las necesidades de
comodidad y portabilidad que exigen los médicos.
Cabeza doble
20
Piezas para el pecho
Tanto la cabeza doble como la triple presentan un diafragma
plano y una campana. La cabeza triple también utiliza un
diafragma corrugado para ampliar las capacidades auscultatorias.
La selección se logra sosteniendo la pieza para el pecho por el
Cabeza triple
eje en una mano y girándola hasta que se oiga o sienta un
chasquido.
Diafragma plano
Verdaderamente resistente . Excelente para todo tipo de sonidos y soplos.
Óptimo para las frecuencias altas (tales como el débil soplo diastólico de
la regurgitación aórtica). También es ideal para identificar divisiones de
sonidos, chasquidos sistólicos y sonidos de expulsión. 4,76 cm de diámetro.
Diafragma corrugado
Calidad amplificadora. Excelente para un examen general de los sonidos
cardíacos. Especialmente bueno para ruidos de galope y soplos de baja
frecuencia. 4,76 cm de diámetro.
Campana
Proporciona una detección y claridad excelentes para sonidos y soplos
cardíacos de baja y media frecuencia (tales como un galope tenue o un
ruido sordo diastólico). 2,79 cm de diámetro.
Ajuste del conjunto para la cabeza
Sus nuevos estetoscopios Harvey están diseñados para proporcionarle la mayor
comodidad personal y adaptación acústica posible mediante un mecanismo
flexible de ajuste.
A. Seleccione la punta para los oídos del tamaño y textura
correctos. Para obtener el máximo sello acústico, se
incluyen dos tamaños de puntas “blandas” y “duras”.
Elija el tamaño que selle mejor su canal auditivo externo
y con el que más cómodo se sienta. Por regla general, el
tamaño más grande es el mejor para la mayoría.
B. Para ajustar el
ángulo de los
auriculares,
sostenga el resorte
en una mano y gire
cada auricular hasta
lograr el ángulo
correcto.
C. Asegúrese de que l
os tubos de los
auriculares estén
dirigidos ligeramente
hacia delante al
penetrar en el canal
auditivo.
21
Page 12
D. Para reducir la
tensión del resorte
[la fuerza elástica
del resorte], tome
cada tubo para el
oído por su doblez
y tire suavemente
hacia fuera.
E. Para aumentar la
tensión del resorte
[la fuerza elástica
del resorte], apriete
juntos los tubos
para el oído.
Cuidado y mantenimiento
•
Es importante limpiar y desinfectar su estetoscopio para evitar posible
contaminación cruzada.
•
Los tubos para el oído y los tubos mismos pueden limpiarse con alcohol o agua
ligeramente jabonosa.
•
Las puntas para los oídos pueden quitarse para limpiarse a fondo con alcohol o
agua ligeramente jabonosa.
•
Reemplazo del diafragma: Bajo condiciones normales de uso, rara vez se
necesitará quitar el borde y el diafragma para limpiarlos. El exterior del
diafragma puede limpiarse con alcohol o agua ligeramente jabonosa. No
obstante, si necesita quitar el diafragma:
Sostenga la sección de la campana y la torreta en una mano y
A.
ejerza presión en la parte de atrás del diafragma. Tome el aro
roscado del diafragma con la otra mano y gire el aro hacia la
izquierda para soltarlo.
Separe el aro roscado de la sección de la torreta.
B.
Presione el disco del diafragma para sacarlo del aro metálico y
C.
reemplácelo con un disco nuevo. Coloque el aro nuevamente en la
pieza para el pecho.
Garantía
Su estetoscopio Harvey DLX viene con una garantía de 10 años contra defectos en
componentes y fabricación. En caso de que se descubra un defecto de material o
fabricación, Welch Allyn reparará o reemplazará el producto sin cargo alguno.
Esta garantía no ampara los daños causados en el transporte o las fallas descuido
o maltrato de la unidad.
Devuelva la unidad para fines de servicio a cualquiera de los Centros de Servicio
de Welch Allyn a continuación:
• In Japan, send to IMI Co., 3-3-12 Ryutsu-danchi, Koshigaya-shi Saitama, 343 Japan.
22
23
Page 13
Información para pedidos
Todos los estetoscopios Welch Allyn y sus componentes accesorios [piezas
auxiliares] pueden adquirirse a través de un distribuidor autorizado en su
área. Llame directamente a Welch Allyn para informarse sobre el nombre del
distribuidor más cercano.
Cabeza triple Harvey DLX, Tubo negro
Cabeza doble Harvey DLX, Tubo negro
Juego de accesorios
Puntas duras para los oídos, extragrandes
Puntas duras para los oídos, grandes
Puntas blandas para los oídos, grandes
Puntas blandas para los oídos, medianas
Conjunto de auriculares/resorte
Tubos, negro
Conjunto de pieza para el pecho pediátrico
Conjunto de pieza para el pecho plano
Pieza para el pecho de campana
Conjunto de pieza para el pecho corrugado
Disco de diafragma plano únicamente
Disco de diafragma corrugado únicamente
Conjunto de pieza para el pecho corrugado
Auscultation.....37
Stetoscopi a
doppia e
tripla testa
DLX Harvey
Page 14
Ideati per consentire al medico un’auscultazione
accurata e di alta qualità.
Gli stetoscopi a doppia e tripla testa Harvey DLX sono il risultato di
approfondite ricerche e test accurati. La particolare concezione dei tubi, il peso
adeguato e la giusta dimensione della testa e gli auricolari ad angolazione
regolabile rendono gli stetoscopi Harvey strumenti ideali per l’auscultazione.
La prova finale è stata ovviamente la verifica sul paziente.
Gli stetoscopi Harvey consentono di identificare le frequenze più basse rilevabili
dall’orecchio umano, quali il debole ritmo di galoppo o soffio diastolico così
come le più alte frequenze del debole soffio aortico diastolico precoce.
Inoltre, sulla base di oltre cinque decenni di esperienza nell’uso di stetoscopi, il
Dr. W. Proctor Harvey ha progettato gli stetoscopi in
modo da soddisfare le esigenze del medico in termini di
comfort e facilità di trasporto.
Teste
Testa doppia
26
Sia la doppia che la tripla testa sono
dotate di diaframma piano e di
campana. La testa tripla utilizza anche un diaframma
corrugato per maggiori capacità auscultatorie. Per la relativa
selezione è sufficiente tenere in una mano la base della testa e
Testa tripla
ruotare con l’altra la testa finché si sente o percepisce un click.
Diaframma piano
“Il cavallo di battaglia”. Eccellente per tutti i suoni e soffi. Ideale per le alte
frequenze (quali il debole soffio diastolico o rigurgito aortico). Ottimale
anche per identificare la divisione di suoni, click sistolici, click di eiezione.
Diametro di 4,76 cm.
Diaframma corrugato
Per livelli di qualità ancora più elevati. Eccellente per una percezione globale
dei toni cardiaci. Particolarmente adatto per ritmi di galoppo e soffi a bassa
frequenza. Diametro di 4,76 cm.
Campana
Consente una rilevazione ottimale e massima chiarezza dei toni cardiaci
e soffi alle basse e medie frequenze (quali il debole ritmo di galoppo o
soffio diastolico). Diametro di 2,79 cm.
Regolazione degli auricolari
I nuovi stetoscopi Harvey sono stati concepiti per consentire la massima flessibilità
di regolazione per il proprio comfort e adattamento acustico.
A. Selezionare il tappo auricolare della misura e consistenza corretta. Ai fini di
una tenuta acustica ideale, vengono fornite due
misure del tipo “morbido” e del tipo “duro”.
Scegliere la misura che si adatta meglio al Vostro
condotto uditivo esterno consentendo un maggiore
comfort. Di norma la misura più grande è la più
idonea nella maggior parte dei casi.
B. Regolare l’ango-
lazione degli
auricolari tenendo
la molla in una
mano e ruotando
ciascun auricolare
fino a raggiungere
l’angolazione
corretta.
C. Assicurarsi che i tubi
degli auricolari siano
orientati leggermente
in avanti all’ingresso
del condotto uditivo.
27
Page 15
D. Per ridurre la
tensione della
molla, tirare
delicatamente
verso l’esterno i
tubi degli auricolari
afferrandoli nel
punto di curvatura.
E. Per aumentare la
tensione della
molla avvicinare i
tubi degli auricolari
con una leggera
pressione.
Cura e manutenzione
•
Al fine di evitare la possibile contaminazione incrociata, è particolarmente
importante pulire e disinfettare lo stetoscopio.
•
Gli auricolari e i tubi possono essere puliti con alcol od acqua con sapone
delicato.
•
I tappi auricolari possono essere rimossi per una pulizia accurata con alcol o
acqua con sapone delicato.
•
Sostituzione del diaframma: in normali condizioni d’uso, raramente è necessario
rimuovere la ghiera e il diaframma per la relativa pulizia. La parte esterna del
diaframma può essere pulita con alcol o acqua con sapone delicato. Tuttavia,
se si deve rimuovere il diaframma:
Tenendo in una mano la campana e la torretta esercitare
A.
pressione sul retro del diaframma. Afferrare la ghiera del
diaframma con l’altra mano e ruotarla in senso antiorario
per allentarla.
B.
Rimuovere la ghiera dalla torretta.
Tenendo in una mano la campana e la torretta esercitare pressione
C.
sul retro del diaframma. Afferrare la ghiera del diaframma con
l’altra mano e ruotarla in senso antiorario per allentarla.
Garanzia
Lo stetoscopio Harvey DLX è coperto da una garanzia di dieci anni contro difetti
di fabbricazione e pezzi difettosi. Qualora si dovesse rilevare un difetto di
materiale o di lavorazione, Welch Allyn provvederà a riparare o a sostituire il
prodotto gratuitamente.
La presente garanzia non copre i danni verificatisi durante il trasporto o i difetti
dovuti a manomissione, evidente negligenza o abuso.
Inviare l’unità per il servizio a uno dei seguenti centri di servizio della
Welch Allyn:
• In Japan, send to IMI Co., 3-3-12 Ryutsu-danchi, Koshigaya-shi Saitama, 343 Japan.
28
29
Page 16
Informazioni relative alle ordinazioni
Tutti gli stetoscopi Welch Allyn e relativi accessori possono essere
acquistati da un concessionario locale. Contattare direttamente la
Welch Allyn per individuare il concessionario a Voi più vicino.
Testa tripla Harvey DLX, tubo nero
Testa doppia Harvey DLX, tubo nero
Kit accessori
Tappi auricolari duri, misura extra large
Tappi auricolari duri, misura grande
Tappi auricolari morbidi, misura grande
Tappi auricolari morbidi, misura media
Auricolari /molla
Tubi, nero
Testa pediatrica
Testa piana
Testa a campana
Testa corrugata
Solo il disco del diaframma piano
Solo il disco del diaframma corrugato
Testa corrugata
Português.....31
Auscultation.....37
Estetoscópios
de cabeçote
30
duplo e triplo
Harvey DLX
Page 17
Criado para auxiliar o médico a obter uma
ausculta precisa e superior.
Os estetoscópios de cabeçote duplo e triplo Harvey DLX foram criados após muitas
pesquisa e testes. O projeto minucioso do tubo, o peso e as dimensões adequadas da
porção torácica e o binaural rotatório, juntos fazem dos estetoscópios Harvey excelentes
instrumentos de ausculta. O teste final, naturalmente, foi realizado nos pacientes.
Os estetoscópios Harvey conferem a capacidade de identificar as freqüências mais
baixas que o ouvido humano é capaz de detectar, tal como um galope diastólico
extremamente fraco ou roncos, assim como as freqüências mais altas de um fraco
sopro diastólico da aorta.
Além disso, tendo mais de cinqüenta anos de experiência com o uso de
estetoscópios, o doutor W. Proctor Harvey criou seus
estetoscópios para atender às necessidades de conforto
e de fácil transporte exigidas pelos médicos.
32
Porção torácica
Tanto o estetoscópio de cabeçote duplo
quanto o de cabeçote triplo possuem diafragma plano e campana.
O estetoscópio de cabeçote triplo também possui um diafragma
corrugado para obter uma capacidade auscultativa maior. A
Cabeza triple
seleção é feita prendendo a haste da porção torácica com uma
mão e girando a porção torácica até ouvir ou sentir um clique.
Diafragma plano
O “pau para toda obra”. Excelente para todos os sons e sopros. Melhor para as
freqüências mais altas (como um fraco sopro diastólico de regurgitação aórtica).
Também ideal para identificar a divisão de sons, cliques sistólicos e sons de
ejeção. Tem 4,76 cm de diâmetro.
Cabeza doble
Diafragma corrugado
Com capacidade de amplificação. Excelente para um apanhado geral de sons.
Especialmente indicado para os sons de sopros e de galope de baixa freqüência.
Tem 4,76 cm de diâmetro.
Campana
Fornece detecção e clareza excelentes para sons de baixa e média
freqüência (como o galope fraco ou ronco diastólico). Tem 2,79 cm
de diâmetro.
Ajuste das extremidades auriculares
Os novos estetoscópios Harvey foram feitos para propiciar o máximo em
capacidade de ajuste para o conforto pessoal e para a adaptação acústica.
A. Selecione o tamanho correto e a textura das extremidades
auriculares. Para propiciar uma excelente vedação
acústica, são fornecidos dois tamanhos de extremidades
auriculares, “macia” e “dura”. Escolha o tamanho que
melhor vedar o canal do ouvido externo e que for mais
confortável. Como regra geral, o tamanho maior é o
melhor para a maioria das pessoas.
B. Para ajustar o
ângulo da
bifurcação binaural,
segure a mola com
uma mão e gire
cada haste binaural
até o que o ângulo
correto seja
alcançado.
C. Os tubos binaurais
devem apontar
levemente para a
frente quando
penetrarem o canal
do ouvido.
33
Page 18
D. Para reduzir a
tensão da mola,
segure cada tubo de
ouvido pela curva e
puxe delicadamente
para os lados.
E. Para aumentar a
pressão da mola,
aperte os tubos de
ouvido um em
direção ao outro.
Simplesmente pressione o disco do diafragma para fora do anel de
C.
metal e substitua com um disco novo. Enrosque o anel de volta à
porção torácica.
Cuidados e manutenção
•
É importante limpar e desinfetar o estetoscópio para evitar a contaminação
cruzada.
•
Os tubos de ouvido e o tubo podem ser limpos esfregando com álcool ou água e
sabão suave.
•
As extremidades auriculares podem ser retirados para uma limpeza mais
completa com álcool ou água e sabão suave.
•
Substituição do diafragma: em circunstâncias normais de uso, raramente há
necessidade de remover o aro e o diafragma para a limpeza. O exterior do
diafragma pode ser limpo com álcool ou água e sabão suave. No entanto, se
precisar remover o diafragma:
Segure a campana e a parte da torre com uma mão e
A.
pressione a parte de trás do diafragma. Prenda firmemente o
anel roscado do diafragma com a outra mão e gire o anel no
sentido anti-horário para afrouxá-lo.
B.
Separe o anel roscado da parte da torre.
34
Garantia
O estetoscópio Harvey DLX é acompanhado por uma garantia de dez anos contra
defeitos de peças e de fabricação. Se houver algum defeito de material ou de mão
de obra, a Welch Allyn consertará ou substituirá o produto gratuitamente.
Esta garantia não cobre danos causados por transporte, falta de cuidado evidente
ou abuso.
Remeta a unidade para reparos para qualquer um dos Centros de Serviço Welch
Allyn abaixo:
• In Japan, send to IMI Co., 3-3-12 Ryutsu-danchi, Koshigaya-shi Saitama, 343 Japan.
35
Page 19
Informações para encomendas
Todos os estetoscópios e peças de acessórios da Welch Allyn podem ser
adquiridas junto a um distribuidor autorizado em sua região. Telefone
diretamente para a Welch Allyn para obter o nome do revendedor
mais próximo.
Cabeçote triplo Harvey DLX, tubo negro
Cabeçote duplo Harvey DLX, tubo negro
Kit de acessórios
Extremidades auriculares duras, extra-grande
Extremidades auriculares duras, grande
Extremidades auriculares macias, grande
Extremidades auriculares macias, média
Conjunto de haste binaural e mola
Tubo, negro
Conjunto de porção torácica pediátrico
Conjunto de porção torácica plano
Porção torácica com campana
Conjunto de porção torácica corrugado
Somente o disco do diafragma plano
Somente o disco do diafragma corrugado
Conjunto de porção torácica corrugado
Auscultation of the Heart
Preparing for the Exam
Auscultation of the heart can be mastered. Develop a pattern or
sequence which becomes like second nature. The room should
be quiet and free of distractions. The patient should be
comfortable and disrobed properly to enable adequate contact
Supine
between the stethoscope and skin. A complete exam should
include listening to the patient while in the following positions:
supine, left lateral recumbent and sitting, as well as listening
over the point of maximum impulse of the left ventricle. The
standing and squatting positions are frequently utilized. Also
listen rou-tinely over areas on the neck, back, and abdomen.
The great majority prefer to examine the patient from the
Left Lateral
Recumbent
right side.
Sites of Auscultation
There are specific sites on the chest wall most principally
used for cardiac auscultation.
1. Aortic Area (Base Right)
Located at the 2nd intercostal space to the right of the
sternum. Sounds and murmurs of the aortic valve and
aorta are well heard in this area. Aortic events are often
also well heard at the Apex.
2. Pulmonic Area (Base Left)
Located at the 2nd intercostal space to the left of the
sternum. Sounds and murmurs from the pulmonic
valve are usually best heard in this area, or at the 3rd
left sternal border.
Sitting
37
Page 20
3. Left Sternal Border
Located at the 3rd intercostal space to the left of the sternum.
Usually the best area to detect aortic diastolic murmurs.
4. Right Sternal Border
Located at the 3rd intercostal space to the right of the sternum.
The best area to detect the “right-sided” aortic diastolic murmur.
5. Lower Left Sternal Border (Tricuspid Area)
Located at the 4th left intercostal space. Good for evaluation of the
first heart sound, systolic clicks, gallops and tricuspid murmurs.
6. Between the Lower Left Sternal Border and Apex
Especially good for sounds and murmurs of mitral valve origin.
Base Right
(Aortic Area)
Base Left
(Pulmonic Area)
7. Apex (Mitral Area)
Normally located at the 5th left
intercostal space in the midclavi-cular line. Usually best for
identification of sounds and
murmurs (both systolic and
diastolic) of mitral valve origin.
Aortic ejection sounds are often
discernible here.
Right
Sternal
Border
Left Lower
Sternal Border
(Tricuspid Area)
Left
Sternal
Border
Apex
(Mitral Area)
In the normal sequence of auscultation, Dr. Harvey suggests that one
routinely begin at one area and then carefully explore the other areas.
He begins at the lower left sternal border (LLSB), where an overview of
the heart sounds and murmurs is obtained. He then listens specifically to
the various auscultatory events in the area, enabling best analysis and
sound identification. The majority of heart sounds and murmurs can
be heard at more than one area. Use both the diaphragm and bell
chestpieces over these areas.
38
aorta
Heart Sounds
and Murmurs
The first and second heart
sounds are vibrations
produced by the closure of
valves. The way in which
superior
vena cava
pulmonary artery
right atrium
inferior
vena cava
pulmonary
vein
left atrium
mitral valve
aortic valve
left ventricle
we identify these sounds
evolves around the two
phases of the cardiac
tricuspid valveright ventricle
pulmonic
valve
cycle. The term “systole”
refers to the phase when the ventricles contract and the mitral and
tricuspid valves close. This produces the first heart sound or S
.
1
“Diastole” refers to the relaxation phase when the ventricles are
filling and pulmonic and aortic valves have closed. The second
sound (S2) denotes the end of systole and is caused by closure of
the aortic and pulmonic valves.
Murmurs result from the turbulence of blood flow through the
heart. They can be normal (innocent murmurs) or significant and
related to abnormal pathology of the valves and/or ventricles.
Systolic murmurs occur when the heart contracts (systole).
Diastolic murmurs occur in diastole. The accurate detection and
identification of normal and abnormal heart sounds and murmurs
will put you on the track to diagnosing the presence of heart disease.
39
Page 21
The Flat Diaphragm
The Corrugated Diaphragm
The flat diaphragm is the “workhorse” chestpiece and should be
used on every patient. This chestpiece serves to filter out the lower
frequencies and accent the higher range. The degree of pressure exerted
on the diaphragm will directly impact the frequencies attenuated.
As an example, to detect the faintest high-frequency murmur of aortic
regurgitation, the patient should be sitting, leaning forward with breath
held in deep expiration. The diaphragm should be positioned over the
3rd left sternal border and very firm pressure applied.
Sufficient pressure should be used to leave a temporary
imprint of the diaphragm on the chest wall. If firm
pressure is not exerted, a faint grade 1 or 2 aortic or
pulmonic murmur might be overlooked.
Conversely, by using very light pressure on the
diaphragm, low frequencies such as a gallop or diastolic
rumble can be “brought out.” The key is to use varying degrees of pressure
in order to tune in the various heart sounds.
The flat diaphragm is also the chestpiece of choice in the detection
and analysis of normal and abnormal breath and lung sounds.
Be sure to listen over all areas of the precordium:
40
LLSB
(tricuspid area)
Apex
(mitral area)
(pulmonic area)
(aortic area)
The original corrugated diaphragm has a unique principle of circular
convex ridges. It is at first surprising to many that this diaphragm
can not only amplify heart sounds and murmurs, but when used
properly often leads the examiner to pick up the faintest low frequency
gallop or diastolic rumble. It is excellent for the “overview” (or “overlisten”). As an initial move, place the corrugated chestpiece over the
lower left sternal border; very light pressure is recommended. In fact,
the weight of the stethoscope alone usually produces the proper amount
of pressure, as well as contact with the chest wall to best amplify a low
frequency gallop or rumble. The hand is often not necessary to exert
pressure, although varying degrees can be utilized if desired.
This chestpiece is also capable of identifying higher
frequencies such as a diastolic blow of aortic
regurgitation; firm pressure on the stethoscope is
used, although the flat diaphragm is best for this.
Because the corrugated chestpiece amplifies, it can
aid those who have some hearing loss. Also, it may
help in better detection of faint heart sounds and
murmurs in those patients who have emphysema, are obese, or have
increased musculature development of the chest wall over the heart.
The corrugated piece detects and amplifies the characteristic normal
sounds S1, S2, as well as the S3and S4diastolic gallops, ejection sounds
and prosthetic valve sounds.
Use this piece routinely on each patient examined and then switch to
the bell and flat diaphragm to further analyze the various heart sounds
and murmurs.
41
Page 22
The Bell
The bell is particularly useful in detecting faint, low-frequency
sounds and murmurs. Very light pressure with the bell, barely
making an air seal with the skin of the chest wall, is required for
correct auscultation.
The bell on the Harvey Stethoscopes is specifically sized to fit between the
ribs making an air seal, and fitting into spaces that the diaphragm cannot.
This is particularly necessary when examining patients with bony chests
and poor muscular development. The bell is also sized to fit into areas of
the neck, such as:
A—suprasternal notch, B—supraclavicular fossae, and C—carotid artery.
A
In order to accentuate or “bring out” the faint atrial or ventricular
diastolic gallop, 3rd heart sound, or diastolic rumble of mitral stenosis, you
D
42
B
C
will need to find the point of
E
maximal intensity of the left
ventricle. This maneuver is
accomplished by using one’s
index finger and 3rd finger to
palpate, as shown in Figure D.
The bell is also best suited to pick up the low-frequency third (S
) and
3
fourth (S4) heart sounds. S3is usually a left ventricular sound which
occurs in early diastole and is best heard over the LLSB and Apex. In
normal individuals under 35 years of age, the S
called “physiologic.” In the abnormal, it is called an S
can be normal and is
3
(ventricular)
3
gallop. S3is a filling sound caused by blood rapidly filling and striking
the ventricle in early diastole.
Helpful Hints
Remember the great majority of patients having cardiovascular disease
can be diagnosed in your office or at the bedside. The stethoscope is
your most important instrument used in the physical exam to make this
possible. The key to successful cardiac auscultation will be your ability
to correctly characterize, interpret and identify the various heart sounds
and murmurs.
Grading the Loudness of Murmurs (Systolic I-VI, Diastolic I-IV)
Grade I:Very faint, must concentrate on several cycles to hear. Not
heard immediately.
Grade II:A faint murmur but discernible immediately upon listening.
Grade III: Intermediate. Louder than a Grade II, but cannot be palpated.
Grade IV: A loud murmur often associated with a palpable thrill.
Grade V:Very loud murmur which requires the stethoscope to be at
least partially in contact with the skin, but not heard off the
chest wall.
Grade VI: A murmur loud enough to hear with the stethoscope not
touching the chest wall.
43
Page 23
Sketching Heart Sounds and Murmurs
A very effective way to improve your auscultatory ability, and
accurately track the progress of a murmur is through sketching.
Note the sketch of a late apical systolic murmur of mitral valve
prolapse as shown below. It is suggested that you put these in your
own records as well as in your write-ups of the patient’s cardiac
exam in hospital charts.
Maneuvers
When applicable, make use of the various simple maneuvers such as
valsalva, handgrip and squatting. For example, with hypertrophic
cardiomyopathy, the systolic murmur may decrease with squatting
and become louder on standing, as shown in bottom sketch on page 44.
In the case of mitral valve prolapse, on squatting the click(s) may move
toward the second heart sound (S2). The murmur may become shorter
in late systole and get louder as systole continues.
This stethoscope also provides for accurate auscultation of the lungs.
The flat diaphragm is usually best for this.
44
SM
S
1
S
2
Mitral valve prolapse
SM
stand
S
S
1
2
SM
squat
Hypertrophic cardiomyopathy
Pediatric Accessories
A pediatric diaphragm chestpiece is included in the Accessory Kit.
The pediatric diaphragm is 3.5 cm in diameter and allows for easier
auscultation of infants and neonates.
45
Page 24
Welch Allyn Worldwide Locations:
Welch Allyn, Inc.
4341 State Street Road P.O. Box 220
Skaneateles Falls, NY 13153-0220
U.S.A.
Telephone: 800-535-6663 (in USA)
or315-685-4100
Fax: 315-685-3361
Welch Allyn, Inc.
95 Old Shoals Road
Arden, NC 28704-9739
U.S.A.
Telephone: 828-684-4895