A simulator-based study of in-flight auscultation

Area of Science:

• Aeromedical Evacuation
• Medical Device Technology
• Clinical Auscultation

Background:

• Stethoscopes are vital for en route care in aeromedical evacuations.
• This study compared an electronic stethoscope (Litmann 3000) with a conventional one (Litmann Cardiology III) for detecting pathologic heart and lung sounds during simulated flights.

Purpose of the Study:

• To compare the diagnostic capability of electronic versus conventional stethoscopes for heart and lung sounds in a simulated aeromedical evacuation setting.

Main Methods:

• A mannequin simulator (SimMan) was used to mimic various abnormal heart and lung sounds.
• Five practitioners performed auscultations during a simulated flight, assessing conditions like crackles, wheezing, lung silence, and murmurs.
• Diagnostic accuracy was compared using the McNemar test.

Main Results:

• For lung sounds, the electronic stethoscope achieved correct diagnoses in 18/20 cases, compared to 10/20 with the conventional stethoscope (P = 0.013).
• For cardiac sounds, correct diagnoses were made in 4/15 cases with the electronic stethoscope versus 0/15 with the conventional stethoscope (P = 0.13).

Conclusions:

• Flight practitioners demonstrated improved lung auscultation accuracy with the amplified electronic stethoscope during simulated aeromedical evacuations.
• The electronic stethoscope offered no significant advantage over the conventional one for diagnosing heart sounds in this context.