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Everyone's Guide to Medical Equipment - Part 2 - Starter Kit

cyberkIn the first article in this series we looked at the various kind of medical equipment that medical personnel use to help diagnose, monitor, support and treat us. In this one we’ll look at the instruments that every physician relies on and take a look at the ancestors of some of them.

A 2002 study of what doctor’s carried in their bags for house calls in Sweden found that “All General Practitioners had a stethoscope, a sphygmomanometer, an otoscope and sterile injection syringes at their disposal on house calls and they used them frequently. Only 57% took a blood glucose sensor with them and 25% took the medical records on home visits. Though only 50% always carried all of the most common emergency drugs with them, almost 100% of GPs had administered all of them in the previous 12 months.” It’s also fair to assume that they had a clinical thermometer, a first aid kit, a watch, a notebook, a pen and a cellphone. They might also have an ophthalmoscope.

A United Kingdom medical student’s starter kit also includes: steel tuning forks; a reflex hammer set; a quick release tourniquet; an examination pen torch; spills (for holding down a patient’s tongue); a dental mirror; a goniometer; a tape measure and non-allergenic gloves. You’d also expect to find scales and a height measuring gauge in the doctor’s clinic. We’ll take a closer look at some of the more specialized instruments, tackling a few today and covering the others tomorrow. Here’s what we’ll cover:

  • Blood glucose sensor: Used to measure the concentration of glucose in the blood, which is especially important in detecting and treating diabetes.
  • Clinical thermometer: Used to determine body temperature, particularly when fever, hyperthermia or hypothermia are suspected.
  • Dental mirror: Used to check the condition of the teeth, gums, tongue, tonsils and mouth lining.
  • Goniometer: Used to measure angles, generally when determining the range of motion of a limb.
  • Injection syringes: Used to administer medications directly into the blood stream.
  • Ophthalmoscope: Used to examine the eye. Its use is crucial in determining the health of the retina and the vitreous humor, the transparent fluid that fills the eye.
  • Otoscope: Used to examine the outer and middle ear.
  • Reflex hammer set: Used to test deep tendon reflexes. This is an important part of neurological physical examinations, aimed at detecting abnormalities in the central or peripheral nervous system.
  • Sphygmomanometer: Used to measure blood pressure.
  • Stethoscope: Used for listening to the internal sounds of the body, particularly lung and heart sounds.
  • Tourniquet: A constricting or compressing device that is used to control blood circulation to an extremity for a period of time.
  • Tuning forks: Used to check the range of frequencies that a patient can hear or sense.
  • Cellphone: An increasingly important tool for everyone. A “smart” phone, such as an iPhone, can be used to record notes, sounds, photos, videos and to access huge amounts of reference information via the Internet.

Blood Glucose Sensor
An essential tool in the prevention, diagnosis and treatment of diabetes, the Blood glucose monitor has made it possible to get an almost immediate readout of a patient’s blood glucose level. Prior to the invention of this tool, physician’s had to wait for the results of clinical measurements obtained from a patient’s blood sample. Advanced electronics and better sensor technology have brought a wide range of blood glucose monitors to the market, including:

  • Alternate site testing: the use of blood drops for from other places than the finger, usually the palm or forearm.
  • No coding’ systems: Older systems required ‘coding’ (matching calibration) of the strips to the meter. This carried a risk of ‘miscoding’, which can lead to inaccurate results. Some systems are now “autocoded”, where technology is used to code each strip to the meter and some are manufactured to a single code, thereby avoiding the risk of miscoding.
  • Multi-test’ systems: These systems use a cartridge or a disc containing multiple test strips.
  • Downloadable’ meters: Most newer systems come with software that allows the user to download meter results to a computer. It can then be used, together with health care professional guidance, to enhance and improve diabetes management.
  • Continuous blood glucose monitors (CGM): These devices can determine blood glucose levels on a continuous basis (generally every few minutes). They use a disposable glucose sensor placed just under the skin, a link from the sensor to a transmitter which communicates to a radio receiver that is often worn like a pager (or insulin pump). It displays blood glucose levels on a practically continuous manner, as well as monitoring rising and falling trends.

Clinical Thermometer
The clinical thermometer is generally the first or second instrument that children associate with a doctor, along with the stethoscope. “Most medical thermometers may be used to take oral, axillary, vaginal, or rectal temperatures. Early temperature measuring devices suffered from the disadvantage that they were also barometers, i.e. sensitive to air pressure. In about 1654 Ferdinando II de’ Medici, Grand Duke of Tuscany, made sealed tubes part filled with alcohol, with a bulb and stem, the first modern-style thermometer, depending on the expansion of a liquid, and independent of air pressure.” – Wikipedia. Many people experimented with different liquids, but it wasn’t until Daniel Gabriel Fahrenheit started manufacturing thermometers filled with mercury (in 1724) that a single scale was established. Fahrenheit based his scale on the freezing and boiling points of water, making it possible for others to produce exactly the same temperature (at sea level) and calibrate instruments that would all produce the same reading.

Clinical thermometers have a little kink in the column of mercury that causes it stay put at the highest measured temperature to allow the doctor to take it out of a patient’s mouth, or other bodily cavity, clean and read it. Shaking the thermometer makes the column of mercury rejoin the bulk of the fluid stored in the bulb at the base of the thermometer – the part put in the mouth, held under the tongue.

Mercury thermometers have largely been replaced with electronic (digital readout) thermometers that use thermistors to sense the temperature. There are also thermometers based on liquids other than mercury, such as heat-sensitive liquid crystals. The latest development is the digital Infrared, contact or non-contact, thermometer, also called a scanner thermometer. The non-contact type is especially useful for measuring the temperature of infants or skin temperatures near a wound or burn.

Ophthalmoscopes use a concave mirror to focus a beam of light that the physician shines into a patient’s eye to illuminate the inner parts. It also has a magnifying lens to allow the physician to make a more detailed examination than would be possible with the naked eye. There are two kinds of opthalmoscope: direct and indirect.

The direct ophthalmoscope is an instrument about the size of a small flashlight with several lenses that can magnify up to about 15 times. it is the type that is most commonly used during a routine physical examination. An indirect ophthalmoscope has a light attached to a headband, in addition to a small handheld lens. It provides a much wider view of the inside of the eye, or the periphery of the retina. It can be either monocular or binocular. More advanced versions use a small videocamera that can be linked to recording apparatus, or directly to a computer.

Otoscopes (sometimes called auroscopes) consist of a head, which contains an electric light source and a low power magnifying lens, mounted on a handle. The front end of the otoscope has an attachment for disposable plastic ear speculums. “The examiner first straightens the ear canal by pulling on the ear lobe and then inserts the ear speculum side of the otoscope into the external ear. The examiner can then look through a lens on the rear of the instrument and see inside the ear canal. Otoscopes are used to diagnose infections of the middle and outer parts of the ear. They can also be used for examining patients’ noses and (with the speculum removed) upper throats.

Many models have a detachable sliding rear window which allows the examiner to insert instruments through the otoscope into the ear canal, such as for removing earwax (cerumen). Most models also have an insertion point for a bulb capable of pushing air through the speculum (called a pneumatic otoscope). This puff of air allows an examiner to test the mobility of the tympanic membrane.

Things To Come
It’s worth noting that, with a little training, any of the instruments we’ve covered so far could be manipulated by almost anyone. The output (readings, images or video) could easily be linked to a computer, and hence through the Internet (or a dedicated network) to a remote physician or medical specialist as a part of a general purpose telehealth system.

We’ll carry on looking at the rest of these basic medical instruments tomorrow, covering the reflex hammer set, sphygmomanometer, stethoscope, tourniquet and tuning forks.

Related Articles: Part 1 – Basics

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