# Taking Vitals in the Rig--Training



## skyemt (Dec 9, 2007)

hi all...

i'm putting together a training for our emt-b's, involving taking groups of four out at a time in the rigs to practice taking vitals...

has anyone had experience doing drills involving taking vitals?

any suggestions on how to make the best use of the time would be appreciated.

thanks.


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## emtangie850 (Dec 9, 2007)

In regards to hearing(during blood pressure); the best advice I have is to have a good stethoscope! Also stress firm pressure on the arm, if the lights and siren are on- have the driver turn off the siren until the BP is done (if able). 

In regards to seeing the guage, I like to remove it from the patient & clip it to my sleeve or to the blanket- helps visually. 

If possible have the "patients" go through different sinerio's because we all know that every patient is different! Everyone reacts differently. Background noise is definatly a distraction and problem when taking vitals! 

Hope that helps! 

-Angela


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## princess (Dec 10, 2007)

This is a great idea sky!  We do the same thing with our students.  Have them spend as much time in the unit as possible - repeat, repeat, repeat!  My students have told me that these drills have helped them greatly.


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## firecoins (Dec 10, 2007)

teach them to palpate a bp.  At least if they can not hear, the can still get something ...provided the bp is high enough to palp it.


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## natrab (Dec 10, 2007)

I also find it helps to hold their arm so it's not touching the gurney or gurney rail.  When it's touching the vibrations from the rig can make it almost impossible to hear.  You can hold your steth to their arm while holding their arm up while you take a bp.


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## Airwaygoddess (Dec 10, 2007)

I think that is a great idea!  on our training rigs we have converted the sirens to sound on the "inside of the pt. care compartment" ( not to freak out our neighbors! ^_^) and also have our radios on so they can also hear the radio traffic.  It really does help the students!


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## emtangie850 (Dec 10, 2007)

natrab said:


> I also find it helps to hold their arm so it's not touching the gurney or gurney rail.  When it's touching the vibrations from the rig can make it almost impossible to hear.  You can hold your steth to their arm while holding their arm up while you take a bp.




That reminds me... I usually rest their arm on my lap or leg.


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## BossyCow (Dec 10, 2007)

If someone is having a difficult time, I try to work it out step by step with them.  I've found most often the scope is either in the wrong spot or not being pressed hard enough to the arm.


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## emtwacker710 (Jan 10, 2008)

I like this thread, my squad does this often and it really helps, take out the EMT's in small groups, 4 like you said sounds good, and have one of them be the pt. then drive them around all sorts of roads, dirt, paved, crappy ones with a lot of potholes, curvy ones, just so they get used to it because you never know what kind of roads you will be on (if your even on a road lol) another good thing to do is do that same thing, but but a CPR dummy on the stretcher and have them practice CPR while driving on all those roads...hope that helps..


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## EMT19053 (Jan 10, 2008)

At our state conference we had a ccemt-p that talked about taking a bp in the back of moving rig. He says that the bell end (small end) should be used versus the diaphram end (large end) when you take a bp whether in the back of a rig or not. He said you can pick up that the heartbeat a little sooner on the systolic and a little later on the diastolic. He also said it is actually a more accurate pressure. What does everyone think?


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## skyemt (Jan 10, 2008)

you know, i saw a presentation by Bob Page about this... he was saying the right way to do it was the bell (on stethoscopes that had it), because they pick up the frequencies of the korotkoff sounds better...

basically implying that using the diaphragm was really not the best way to do it...

but that is how we learned it in class...

Paramedics, please speak about this...


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## EMT19053 (Jan 10, 2008)

skyemt said:


> you know, i saw a presentation by Bob Page about this... he was saying the right way to do it was the bell (on stethoscopes that had it), because they pick up the frequencies of the korotkoff sounds better...
> 
> basically implying that using the diaphragm was really not the best way to do it...
> 
> ...



Yep, Bob Page was the speaker I heard this from too. Probably the same presentaion you heard. I think it was called "What's Up With This". He also talked about paradigms, it basicly means that we always do things the way we were taught instead of thinking outside the box and giving new ideas and techniques a chance. I thought it was an excellent presentation. I recommend it to anyone who has a chance to sit in on one of Bob Pages' presentations.


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## micsaver (Oct 6, 2008)

*Vitals on the move*

I just finished my first EMT shift (16hrs). It was great getting to know the ins and outs of the ambulance, working the stretcher and moving the pt. The one thing I was having the biggest issue with was getting a BP or Pulse on the moving bus. 

Tips I have picked up so far from the thread are:

1. Try to properly place the Pt's arm so that you can get good placement of the scope.

2. If you can't get a beat it's possible the scope is in the wrong spot or not pressed firm and flush to the pulse point.

My question is on the 3rd tip....   Has anyone tried using the Bell instead of the diaphragm of the scope to get a BP on while moving in the ambulance?


Also, I was having issues getting a pulse. I was told to count it out for 30 seconds and X it by 2. Every time we hit a bump i would lose it. Any recommendations? 

And while I'm at it any recommendations for getting a respiration rate on someone you can't see the chest rise? actually I guess I just figured that one out...duh just listen with the scope. Any other thoughts?


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## Hastings (Oct 6, 2008)

Count pulse for 15 and multiply by 4.

Remember to place your hand on the chest while taking respirations (disguise as taking pulse) so you can go off the movement of your hand.


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## traumateam1 (Oct 6, 2008)

This Bob Page fellow you speak of.. does he have a website where you can listen to his presentations online?
Thanks!


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## JPINFV (Oct 6, 2008)

For taking a pulse/B/P wait for a stoplight or smooth part of the road (you'll eventually learn what parts are essentially impossible to take a set of V/S due to road conditions). Some of the units (Leader ambulace type 2s) that we had digital clocks that could be set to a chronograph mode. I found it easier to watch that for the 30 seconds while counting instead of watching my watch.


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## Ridryder911 (Oct 6, 2008)

traumateam1 said:


> This Bob Page fellow you speak of.. does he have a website where you can listen to his presentations online?
> Thanks!



There is not a "listen" lecture but you can find Bob lecturing about the nation. He primarily speaks about cardiology and now speaks quite a bit as a CCEMT/P instructor, when he is not working in Springfield, MO. 

His website is http://www.multileadmedics.com/aboutus.htm

I got to know Bob, when he used to lecture and teach to the flight nurses and medics. He is known in EMS as being a great guy and has now authored ECG books that are very good to learn from as well. 

R/r 911


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## BossyCow (Oct 6, 2008)

Try nodding your head with each beat as you count the pulse. It gives you a sense of the tempo. Course this is fun when the hr is irregular.. lol. 

As to respirations, tell the pt you are checking hr. and listen 10 secs for hr and 10 secs for resp. Remember, it's not so important that you accurately tell the difference between a pulse of 64, 68, and 66 but is it 36 or 206? Does it stay about the same or get faster or slower?


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## sixmaybemore (Oct 6, 2008)

BossyCow said:


> Try nodding your head with each beat as you count the pulse. It gives you a sense of the tempo. Course this is fun when the hr is irregular.. lol.
> 
> As to respirations, tell the pt you are checking hr. and listen 10 secs for hr and 10 secs for resp. Remember, it's not so important that you accurately tell the difference between a pulse of 64, 68, and 66 but is it 36 or 206? Does it stay about the same or get faster or slower?



If you're counting a HR that's in SVT, how in the world do you keep up? 

I know that's probably a stupid question, but it's a scenario that's on my checklist of "how do you". Manually counting a HR of say, 289, is hard to keep up with IME.


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## Hastings (Oct 6, 2008)

sixmaybemore said:


> If you're counting a HR that's in SVT, how in the world do you keep up?
> 
> I know that's probably a stupid question, but it's a scenario that's on my checklist of "how do you". Manually counting a HR of say, 289, is hard to keep up with IME.



From a practical point of view, if the heart is beating so fast that you can't count it, you're going to immediately recognize that the CC is probably due at least in part to the extremely fast heart rate, at which point you're going to get them on an EKG and let the machine give you an estimate. Feeling for a pulse is great for a first impression. And the first impression of a pulse too fast for me to count is "holy crap, that's fast. This looks like a cardiac issue. Let's get them on the EKG immediately."

You can try to estimate and multiply, but in the end, as BLS, it's acceptable to say to the paramedic, hey, the heart rate was so tachy that I was unable to get an accurate measure. Auscultating may help. With children that have naturally high HRs, I often just feel/listen for a shorter amount of time and then just do more multiplication.


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## sixmaybemore (Oct 6, 2008)

Hastings said:


> From a practical point of view, if the heart is beating so fast that you can't count it, you're going to immediately recognize that the CC is probably due at least in part to the extremely fast heart rate, at which point you're going to get them on an EKG and let the machine give you an estimate. Feeling for a pulse is great for a first impression. And the first impression of a pulse too fast for me to count is "holy crap, that's fast. This looks like a cardiac issue. Let's get them on the EKG immediately."
> 
> You can try to estimate and multiply, but in the end, as BLS, it's acceptable to say to the paramedic, hey, the heart rate was so tachy that I was unable to get an accurate measure. Auscultating may help. With children that have naturally high HRs, I often just feel/listen for a shorter amount of time and then just do more multiplication.



Thank you. That was helpful to me.


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## SmokeyBear (Oct 6, 2008)

This works for me:
1) take the initial BP on scene giving you a "starter"-if its an ER see #3
2) agree w/ *Hastings* Count pulse for 15 and multiply by 4.
3) I invested in an auto-cuff....saves ALOT of headache. Quick, easy and accurate  But make sure you clean them well 

4) if you're partnered with a medic then use the stats from the LP12. This saves alot of headache as well. If the medic wants stats NOW while applying the the leads see #3


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## BossyCow (Oct 7, 2008)

SmokeyBear said:


> 3) I invested in an auto-cuff....saves ALOT of headache. Quick, easy and accurate  But make sure you clean them well



There's a whole thread devoted to how inaccurate these are.


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## mycrofft (Oct 7, 2008)

*Wear crepe soled shoes and thick socks to limit conducting noise off floor.*

I had a coworker who would raise his feet off the floor of the noisy modular on rattly roads. Close our mouth; it's an instinct we use to hear faint sounds better, but it will let more ambient noise into your head. Also, even if you have a cruddy scope, buy earpieces which you find will effectively seal your ear canal. In fact, buy a few so you can carry some right next to your spare oxygen yoke regulator O-rings. No matter what scope you wind up with, fish them out of your bat-belt and whip 'em on. (I like floppy black rubbery ones but they tend to degrade quickly). And tell your nattering patient and coworkers to "dou-zo, yaka-mashii" (or "quieta su boca, por favor" as you prefer).

Hmm. Wonder if anyone makes a rubber buffer to put between a cot's (litter's) wheels and the floor, and the litter catch holding the whole thing still?

sidebar: Also works in reverse. My acquantance who worked SWAT etc did the same to cushion footfalls for sneaking around. Just the socks helps, oddly enough.


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## SmokeyBear (Oct 7, 2008)

BossyCow said:


> There's a whole thread devoted to how inaccurate these are.



I use them in nursing school, many hospitals/nursing homes use them, several of my rotations use them and I have found the ones I have used to be just as accurate as taking them by hand--especially on obese patients  Some are not as accurate as others but, I definitely will not say they *ALL* are inaccurate. I will not venture to say that *ALL *_manual cuffs_ are completely accurate or even BETTER--would you? I would also not venture as far to say that the people taking manual blood pressures are completely accurate either--especially on bumpy roads, screaming patients et al.  Point is, there are devices out there that can make an EMT's life easier and provide better service for the patient. There are 100s of autocuffs out there and I would never be as bold to say that they are *ALL* innaccurate. I have *had no problems *with my autocuff matching within 1 or 2 numbers, or even exactly with whats on the LP12. I will continue to use them and the manual ones from time to time (to keep my skills sharp) as well.

Some agencies/stations may even have a list of approved devices, submitter could check with his supervisor and find out


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## Ridryder911 (Oct 7, 2008)

Want to know what they call those that use automatic BP machines for the baseline? .. 






Defendants. 


*As well, one can only use the 15 second method if the rate is regular!* One should be taking an apical if it is too fast. Again, something that should had been taught and discussed as according to the Basic EMT curriculum. 

R/r 911


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## SmokeyBear (Oct 7, 2008)

Ridryder911 said:


> *As well, one can only use the 15 second method if the rate is regular!* One should be taking an apical if it is too fast. Again, something that should had been taught and discussed as according to the Basic EMT curriculum.
> 
> R/r 911



True Indeed.


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## SmokeyBear (Oct 7, 2008)

Ridryder911 said:


> Want to know what they call those that use automatic BP machines for the baseline? ..
> Defendants.




Thats nice  And what are they called when hospitals and nursing homes use them all the time? "Experts?" A good lawyer will dissect any and everything...including baselines read from a manual cuff during lights and sirens. Wouldn't you if you were paid by the hour?



Still using them.



> Again, something that should had been taught and discussed as according to the Basic EMT curriculum.



Since I can count on you to dissect every post with such vigilance combined with your assumption that none of us knows the basics, I will indeed _try_ make sure to mention *every possible variable* in the future  *takes a bow


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## micsaver (Oct 9, 2008)

I did a BP tonight using the Bell of the scope. I was amazed by the sound I could hear as the blood whooshed while the cuff deflated. The beginning of the systolic sound was WAY MORE obvious than when I would listen with the diaphragm. I was so excited that I tried it again. Same result. Awesome.

Thanks for all your tips for getting a BP in a noisy environment and while on the moving ambulance. The other thing that I found was a bit off with my technique was the pressure of my auscultation. I really needed to press a bit more against the arm/artery to get good sounds.


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## Ridryder911 (Oct 9, 2008)

SmokeyBear said:


> Thats nice  And what are they called when hospitals and nursing homes use them all the time? "Experts?" A good lawyer will dissect any and everything...including baselines read from a manual cuff during lights and sirens. Wouldn't you if you were paid by the hour?
> 
> 
> 
> ...




Almost all  hospitals has policies describing that automated blood pressure cuffs should NOT be used on patients that have extreme movement or equipment that interferes with the working of the equipment. 

As well, if you read most manufactures books it is recommended that one always obtain a baseline blood pressure before relying upon an automated blood pressure machine. Even the manufacture(s) disclaims themselves on dangerous readings that a manual should be obtained. 

There are too many well documented instances that the machine gave false information and it was depended upon and poor outcome came from the result of it. 

One can acclaim all they want, it is usually standard medical care to always attempt manual on critical patients.


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## traumateam1 (Oct 9, 2008)

*Ugh....*



Ridryder911 said:


> Almost all  hospitals has policies describing that automated blood pressure cuffs should NOT be used on patients that have extreme movement or equipment that interferes with the working of the equipment.
> 
> As well, if you read most manufactures books it is recommended that one always obtain a baseline blood pressure before relying upon an automated blood pressure machine. Even the manufacture(s) disclaims themselves on dangerous readings that a manual should be obtained.
> 
> ...



I have never, ever, ever used an automated BP cuff before for my p/t assessments. I have not and will not use them. Technology is great.. but I do as much manual vitals, and p/t assessment as possible. Obviously somethings like BGL, 3-12 lead, SpO2, etc aren't manual... they are automatic, but things like using the SpO2 for a pulse reading, and automatic BP cuffs and whatnot, is a big no no. (In my opinion!)


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## Hastings (Oct 9, 2008)

Ironically, the only times I've attempted to use an auto-BP cuff (when we couldn't get a manual BP for some reason), the damn thing wouldn't work for some reason. Something would come unplugged, it wouldn't inflate, or it simply broke. 

So I don't know how accurate they are. I just know they're not worth the effort.


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## rhan101277 (Oct 9, 2008)

Yeah everyone wants a easy way out I guess with those electronic one's.


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## traumateam1 (Oct 9, 2008)

*Just a rant...*



Hastings said:


> Ironically, the only times I've attempted to use an auto-BP cuff (when we couldn't get a manual BP for some reason), the damn thing wouldn't work for some reason. Something would come unplugged, it wouldn't inflate, or it simply broke.
> 
> So I don't know how accurate they are. I just know they're not worth the effort.



That's why I don't like them. Not reliable, not accurate (most of the times) and to finicky. Imagine trying 3 times with the auto, then having to switch to the manual. Now you've wasted a lot more time than you would have if you just used the manual from the beginning. Not to mention how unprofessional it looks. And so what.. you use the auto for 6 months then all of a sudden you go to use the auto and it breaks down.. then you fumble trying to get a manual BP because you haven't used one in so long. Just bad news all together.
Another thing.. (lol).. with all the auto BP cuffs I've had experience with.. if there is an error, it usually will continue going down until it reaches a systolic of around 50-60 then it will say error, so then you have to redo it all  over again. If you are using the manual one, and the pt moves or coughs or whatever.. at least you are human and are able to realize that, and continue going.. or you just pump it up again 20 mmHg.
I just don't like them.. as you can tell.


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## Hastings (Oct 9, 2008)

I know this wasn't the original purpose of the thread, but just a quick story while we're on the subject.

Due to wait times of 6 months for a general checkup at my previous doctor, we decided to find a new one. Well, the whole family started going to this new place. My mum got one doctor, I got another. She came home after the first appointment and tells me the doctor wants to see her back due to hypertension. I take her blood pressure. It's perfect. She goes back. She comes back and tells me that it was high again, and they want to start her up on blood pressure medicines. Again, I check her. It's fine. I tell her, mom, your blood pressure is fine. This has never even come up before. I've taken your blood pressure many times, and it's never been as high as they're claiming it is. Then I ask her, how are they taking it? That blood pressure machine, she says.

Well mom, your doctor wants to load you up on blood pressure medicines because a machine told them your blood pressure was high. Did they take it manually to confirm? No, they didn't. Mmk mom. You're not taking any medication. You don't have hypertension. Tell them to check manually next time they bring it up. She does. That's strange, your blood pressure is perfect.


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## traumateam1 (Oct 9, 2008)

Hastings said:


> I know this wasn't the original purpose of the thread, but just a quick story while we're on the subject.
> 
> Due to wait times of 6 months for a general checkup at my previous doctor, we decided to find a new one. Well, the whole family started going to this new place. My mum got one doctor, I got another. She came home after the first appointment and tells me the doctor wants to see her back due to hypertension. I take her blood pressure. It's perfect. She goes back. She comes back and tells me that it was high again, and they want to start her up on blood pressure medicines. Again, I check her. It's fine. I tell her, mom, your blood pressure is fine. This has never even come up before. I've taken your blood pressure many times, and it's never been as high as they're claiming it is. Then I ask her, how are they taking it? That blood pressure machine, she says.
> 
> Well mom, your doctor wants to load you up on blood pressure medicines because a machine told them your blood pressure was high. Did they take it manually to confirm? No, they didn't. Mmk mom. You're not taking any medication. You don't have hypertension. Tell them to check manually next time they bring it up. She does. That's strange, your blood pressure is perfect.



Interesting eh? Thank God for technology.. but some technology should stay at home, literally. Auto BP cuffs are good for pt's with confirmed hypertension, and they need to keep an eye on it at home. But it's *not* to be used by medical professionals in the field.. because you get false readings like Hastings example. 

Anyways.. I think I kinda side tracked this thread.. so time to get back on subject.

Cheers!


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## reaper (Oct 9, 2008)

traumateam1 said:


> Interesting eh? Thank God for technology.. but some technology should stay at home, literally. Auto BP cuffs are good for pt's with confirmed hypertension, and they need to keep an eye on it at home. But it's *not* to be used by medical professionals in the field.. because you get false readings like Hastings example.
> 
> Anyways.. I think I kinda side tracked this thread.. so time to get back on subject.
> 
> Cheers!



As I have stated before, there is nothing wrong with NIBP technology. It all comes down to operator error!


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## EMTWintz (Oct 10, 2008)

If they are having difficulty hearing the bp, they make a double earpiece steth that way the student and teacher can listen. Helped out the ones on our squad know what to listen for.


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## SmokeyBear (Oct 10, 2008)

Ridryder911 said:


> Almost all  hospitals has policies describing that automated blood pressure cuffs should NOT be used on patients that have extreme movement or equipment that interferes with the working of the equipment....



So hospitals use them, as you claim, when "not moving" so to end this little debate of ours...you _*dont*_ have to use an auto cuff while the van is moving or even *IN* the van. On the contrary, you can use them on scene (just like a manual) and it takes seconds. 



Ridryder911 said:


> Almost all  hospitals has policies describing that automated blood pressure cuffs should NOT be used on patients that have extreme movement or equipment that interferes with the working of the equipment....There are too many well documented instances that the machine gave false information and it was depended upon and poor outcome came from the result of it..



Since you mentioned "extreme movement" and liability, I suppose you believe that manuals are foolproof? That little "dip" in the road...was it a beat or "just a dip"? Are all the variables/environmental circumstances that come with using manuals to be ignored because of technology prejudice? Or do we just assume they are "always right just because" or because "I remember reading some article that said..?"  Either way, I enjoyed the debate but, they are accepted by my agency and almost every medical service in my area.  I will continue to use the auto cuff and manual as well from time to time  Cheers


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## SmokeyBear (Oct 10, 2008)

traumateam1 said:


> Anyways.. I think I kinda side tracked this thread.. so time to get back on subject.
> 
> Cheers!
> [/FONT]



It did indeed. The guy asked for suggestions, I gave some and it diverted into a discussion on "technology error" vrs. "user error." But, I see nothing wrong with it  Its a lively discussion and everyone is being civil...so far


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## abriggs (Oct 10, 2008)

I hope my instructor has us taking blood pressure in the ambulance. So far, we're not at that stage yet, but I'm addicted to reading everyone's comments and stories about life on the street...


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## BossyCow (Oct 10, 2008)

I think instead of jumping to defend your auto BP, you could for a minute just listen to what is being said. Other threads have discussed this at length and the consensus is that they do have a place. Monitoring a BP that has already been established through manual detection on a stable pt is a perfectly acceptable use of the auto/BP.

I use a lot of technology in the back of the rig. But my SPO2 monitor is always used in conjunction with my observation of the pt. When the SPO2 gives me a HR of 110 and my palp of the pressure is 82, I'm going to go with what my fingers told me, since I know my SPO2 tends to run fast in the HR. Machines are great, but we have to know their shortcomings as well as their expertise.

About the double earred scopes.... awesome.. a bit pricey though.. but nothing beats them in teaching newbies.


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## Airwaygoddess (Oct 10, 2008)

*Pratice Pratice  Pratice....... Always!*

What I have done in the past with students and learning how to listen for vital signs.

As a student you will be able to pratice with your other classmates in the classroom, but what else is needed is to be able to do vital signs in areas with noises.  first get a group of you together and just be on the side walk with street noise.  This is a way to start getting your ears and eyes tuned up for the real world.  Second,  pratice in a moving car getting vital signs, ( a few of you together, and not the driver lol!) this can be done on your off time and also helps with getting more hands on pratice.

Any willing friends and family members that offer take them up on it!!  The more body types to work with the better.

And always remember to use the proper size BP cuff and proper placement of the bp cuff.  "you must use the right size equipment for the right job!!  Good luck, I hope this helps!


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## reaper (Oct 10, 2008)

Airwaygoddess said:


> And always remember to use the proper size BP cuff and proper placement of the bp cuff.  "you must use the right size equipment for the right job!!  Good luck, I hope this helps!



That is the biggest thing to learn. Whether you are obtaining a manual or NIBP, you must make sure you have the right cuff for the Pt. A wrong size cuff will give false readings. This is most true when using a NIBP machine.


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## SmokeyBear (Oct 11, 2008)

BossyCow said:


> I think instead of jumping to defend your auto BP, you could for a minute just listen to what is being said...but we have to know their shortcomings as well as their expertise.



I have listened to what is being said and no offense to anyone, I simply don't agree with the "consensus" so far  You are assuming that I don't know about the pros and cons. I am aware of the shortcomings of autocufffs however,  I am aware of the shortcomings of manuals which noone wishes to discuss. The consensus so far that I have heard on this thread is that *all* autocuffs are inaccurate and that manuals are the _only_ way to go. This is simply not the case.  _I say *take advantage of both*_. Some technology (autocuffs or otherwise) is constantly improving: (SunTech Medical OEM NIBP Technology For EMS Patient Transport Excels Against Recognized Standard Link) I say embrace it.

I am not saying rely ONLY on tech...but why not use both? 




BossyCow said:


> About the double earred scopes.... awesome.. a bit pricey though.. but nothing beats them in teaching newbies.


Agree   Most EMT classes should have them already and many of the instructors are generally always willing to help...submitter may be able to borrow one from his/her old instructor ? and use it on his ride alongs in the field. If he/she is past this stage (ride alongs) already then perhaps he can ask his supervisor for some more ride along time so that there are 3 people in the ambulance. I'm assuming however that submitters agency only has 2 per


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## JessEMT983 (Oct 30, 2008)

I wish we could've practiced this way when I took my class. It's harder than people think to take vitals in the back of the rig.Another thing I've found that helps with taking a bp is to keep your feet off of the floor, I usually put mine up on the bottom part of the stretcher. That helps get rid of some of the noise of the moving ambulance.


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## Mercy4Angels (Nov 2, 2008)

skyemt said:


> hi all...
> 
> i'm putting together a training for our emt-b's, involving taking groups of four out at a time in the rigs to practice taking vitals...
> 
> ...



if your an emt and need practice taking vitals you shouldnt be an EMT...


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## BEorP (Nov 2, 2008)

Mercy4Angels said:


> if your an emt and need practice taking vitals you shouldnt be an EMT...



If you can't recognize the need for continual training, practice, and education then you probably shouldn't be in EMS.


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## stephenrb81 (Nov 2, 2008)

Mercy4Angels said:


> if your an emt and need practice taking vitals you shouldnt be an EMT...



Not everybody that touches a stethoscope are magically infused with the ultimate power of 100% accuracy in taking vitals.

Some needs practice to learn to hear past artifact, some must be taught that a "lub-dub" is counted as one beat when feeling a pulse.  *Continuing education* is part of EMS.

Otherwise every Main EMS forum here should be locked with a sticky that basically says "If your in EMS and need any information or further education you shouldn't be in EMS"


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## NRCCEMTP26 (Nov 2, 2008)

Great Idea. I agree that repete skills are critical to newcommers into the busniess. I would add another senerio into the mix, ie: taking vitals on a critical pt and have the pt have a onset of another problem. Kudos to you for doing what should be done


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## NRCCEMTP26 (Nov 2, 2008)

Mercy4Angels said:


> if your an emt and need practice taking vitals you shouldnt be an EMT...



I agree with you very little, mabee the EMT-b's have a very low call volume and cannot pratice all the time. Or the pts that they do run have bounding pulses, normal bps. they need practice with thready pulses and no palp bp. the way i set up stuff for my cc medics is practice pratice and more pratice


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## rhan101277 (Nov 4, 2008)

NRCCEMTP26 said:


> I agree with you very little, mabee the EMT-b's have a very low call volume and cannot pratice all the time. Or the pts that they do run have bounding pulses, normal bps. they need practice with thready pulses and no palp bp. the way i set up stuff for my cc medics is practice pratice and more pratice



I have been doing ok taking vitals during my clinicals.  There was one rather large woman that I couldn't get her pulse, but the medic could.  I guess I needed to place my stethoscope harder against the artery.  Anyhow I did successfully take a pulse on 2 out of 4 patients.  Its harder in the back of the rig bouncing around.  Also the medic recommended taking them before you get underway, unless they are in bad shape.  I am going to get me a stethoscope with squishy ear pieces to help drown out the background noise, now I have the ones with the hard ear pieces.


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## poppawilly (Nov 13, 2008)

something i was told and works well is lift your feet off the bus floor.  put your toes on cot rail.  works well for obtaining manual blood pressure


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## Tincanfireman (Nov 17, 2008)

The OP referred to skill training involving vital signs inside a unit.  Absent a few diversions regarding auto/manual devices and an interesting idea involving thick socks, how about the idea of training your folks on using sites other than the left arm?  If your -I or -P partner is trying to get a line in the left A/C, can you work around them to get a B/P on the right side?  Could you restrict them to the C/C area and make them work "upside down"? How about the fact that you can successfully get a B/P on the foot?  If it's in the scope of their practice (assuming these are new folks), have they ever spiked a bag while moving, without being told ahead of time that their partner was going to need one?  Are they allowed to do BGL's?  Do they know that it's less painful for the patient to use the side of the finger rather than the fingertip, and how to do one in the back without polkadotting the floor with those pretty red drops?  These are all things that I've seen new people fumble with from time to time, and I hope that they spawn some further ideas for you.


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## Tincanfireman (Nov 17, 2008)

Tincanfireman said:


> and how to do one in the back


 
I was referring to the back of the unit, not the back of the patient...


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