# Looking for tips



## namaste1967 (Nov 10, 2005)

Any good tips or tricks for taking good, acurate VS while BOUNCING around in the back of a rig???? I find this to be one of the hardest parts of the job...............


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## bravofoxtrot (Nov 10, 2005)

Get a good stethoscope, it'll help. Also biting down on your teeth and forcing your feet against the gurney seems to help get rid of some of background noise.


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## CaptainPanic (Nov 10, 2005)

My instructor taught me these:

put your knee next to the gurney, foot flat on flor leg is bent at 90 degrees. put pts hand on your knee, and hold the arm as still as possible while palpating. Your leg should absorb most of the vibration. Also get a good scope. Im asking for a Littman for my b-day/Christmas in hopes that I might get one.  

Also our instructor made us get in his diesel truck, roll windows down, stereo playing, and take turns doing baseline vitals while driving around town and on backroads. (This was frustrating to say the least but at least we learned what to listen for through all the background noise.)

And practice, practice, practice. (My dad was a guinea pig for 4 months solid.)

-CP


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## namaste1967 (Nov 10, 2005)

I'm pretty comfortable with the b/p's...........I'm having a little trouble with pulse and respirations. Seems like every time I find the pulse while bouncing around, I loose it or the count gets screwed up because a huge bump............or here in detroit, ALOT of HUGE bumps!!!   Same with Respirations.


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## Jon (Nov 10, 2005)

I was taught to lift up my heels... leave only the toes of my boots on the floor. This seems to help when trying to ascualtate a B/P in a noisy enviroment.

Jon


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## hfdff422 (Nov 21, 2005)

Use your pulse-ox unit for the pulse, as for respirations, there is no easy way to tell when they are breathing nromally unless they are in a c-collar. If they are not breathing normally, it becomes much easier to tell.


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## ffemt8978 (Nov 21, 2005)

> _Originally posted by hfdff422_@Nov 21 2005, 08:08 AM
> * Use your pulse-ox unit for the pulse, as for respirations, there is no easy way to tell when they are breathing nromally unless they are in a c-collar. If they are not breathing normally, it becomes much easier to tell. *


 I would be careful relying on any electronic equipment to determine a patient's vital signs since several things could affect the accuracy of their readings.  Treat your patient, not your equipment.

I suggest you practice, practice, practice.


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## hfdff422 (Nov 21, 2005)

> _Originally posted by ffemt8978+Nov 21 2005, 02:39 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (ffemt8978 @ Nov 21 2005, 02:39 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-hfdff422_@Nov 21 2005, 08:08 AM
> * Use your pulse-ox unit for the pulse, as for respirations, there is no easy way to tell when they are breathing nromally unless they are in a c-collar. If they are not breathing normally, it becomes much easier to tell. *


I would be careful relying on any electronic equipment to determine a patient's vital signs since several things could affect the accuracy of their readings.  Treat your patient, not your equipment.

I suggest you practice, practice, practice. [/b][/quote]
 That goes without saying, but it is very likely that you already have a "hands on" set of baseline vitals, I was merely suggesting it was a simple way to monitor vitals while enroute. The pulse-ox is something that all techs that have access to should have very specific training on, especially its limitations (CO being the big one). The first contact I would make with a patient would be their radial pulse- depending on the circumstance. You can tell so much from that hands-on contact.


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## ffemt8978 (Nov 22, 2005)

I've seen too many EMT's rely on the automatic equipment for their vital signs, without doing a manual set first.


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## hfdff422 (Nov 22, 2005)

I have only been at this a short while and am still amazed at the amount of shortcuts I have seen others take. I totally agree that there is nothing more important in our job than direct patient contact.


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## Jon (Nov 24, 2005)

> _Originally posted by hfdff422_@Nov 21 2005, 10:08 AM
> * Use your pulse-ox unit for the pulse, as for respirations, there is no easy way to tell when they are breathing nromally unless they are in a c-collar. If they are not breathing normally, it becomes much easier to tell. *


 Trick for resperations - take their wrist, and take their pulse. When you take the pulse, position their arm over their chest, so you can fell their chest rise (This works for guys, not so much for girls)

Jon


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## Wingnut (Nov 24, 2005)

> _Originally posted by MedicStudentJon+Nov 24 2005, 01:02 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ Nov 24 2005, 01:02 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-hfdff422_@Nov 21 2005, 10:08 AM
> * Use your pulse-ox unit for the pulse, as for respirations, there is no easy way to tell when they are breathing nromally unless they are in a c-collar. If they are not breathing normally, it becomes much easier to tell. *


Trick for resperations - take their wrist, and take their pulse. When you take the pulse, position their arm over their chest, so you can fell their chest rise (This works for guys, not so much for girls)

Jon [/b][/quote]
 One of my preceptors told me to try that, works great!


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## trauma1534 (Nov 25, 2005)

This works for me... first of all, STAY AWAY from the cheap stethescopes!  THEY ARE NO GOOD TO YOU IN THE TRUCK!!!  I have a Littman Master Cardiology, and I love it.  Try listening to lung sounds and counting what you hear for the resps.  Listen to the heart, count the beats... or use a pulse ox, but check it against the patient's radial pulse at first to make sure that the pulse ox is getting an acurate reading.  Lastly, you can always palpate a B/P.  Good Luck!


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## ResTech (Nov 30, 2005)

The only real tip I can give is experience. From years of taking vital signs you will learn to distinguish the tone of pulsation from the background noise. It will stick out the more you do it. I to place the patients arm on my leg. 

Systolic B/P is most important and is what treatment is based on 99% of the time unless your looking at pulse pressure (difference between systolic and diastolic) in the case of chest trauma(ie. tamponade). You will want to assess for a falling pulse pressure (SBP and DBP come closer together) sometimes if u suspect fluid is filling the pericardium compressing the heart preventing it from refilling completely. So my point is worry about the systolic part if ur having trouble hearing it - palpate it and realize a palpated pressure is usually around 10 points lower then an auscultated one. 

NIBP is really nice and accurate most of the time. With experience you can rely on pulse ox to monitor heart rate but always feel the pulse for quality since rate isnt the only thing that is important in assessing. As for stethoscopes, I have a Cardiology III and it doesnt impress me. I dont even use it anymore. I think the Master Classic II is better and i can hear just as well with a $10 sprague on the ambulance. But everyone has a preference. Just dont expect to pay $150 on a Littman and have hi-def sound coming through it cause you will be disappointed.


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## emtff99 (Nov 30, 2005)

> _Originally posted by MedicStudentJon_@Nov 24 2005, 12:02 AM
> *
> Trick for resperations - take their wrist, and take their pulse. When you take the pulse, position their arm over their chest, so you can fell their chest rise (This works for guys, not so much for girls)
> 
> Jon *


 I have used this type in the field for quite sometime & have no complaints with it, works great.


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## emtbuff (Dec 1, 2005)

If the pt is a shallow chest breather you can rest your hand up on the shoulder area and feel the chest move.


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## hfdff422 (Dec 1, 2005)

It works well, great tip! Thank you.


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## Jon (Dec 2, 2005)

> _Originally posted by emtbuff_@Dec 1 2005, 02:01 PM
> * If the pt is a shallow chest breather you can rest your hand up on the shoulder area and feel the chest move. *


 Just be careful WHERE you, touch on their "shoulder" - espicially women..... I might get slapped!


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## hfdff422 (Dec 2, 2005)

> _Originally posted by MedicStudentJon+Dec 2 2005, 10:25 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ Dec 2 2005, 10:25 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-emtbuff_@Dec 1 2005, 02:01 PM
> * If the pt is a shallow chest breather you can rest your hand up on the shoulder area and feel the chest move. *


Just be careful WHERE you, touch on their "shoulder" - espicially women..... I might get slapped! [/b][/quote]
 Or worse, being sued is worse than being slapped.


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## emtbuff (Dec 2, 2005)

> _Originally posted by hfdff422+Dec 2 2005, 10:39 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (hfdff422 @ Dec 2 2005, 10:39 AM)</td></tr><tr><td id='QUOTE'>
> 
> 
> 
> ...


Or worse, being sued is worse than being slapped. [/b][/quote]
 Yeah guess you got a point there but if it works it works if not guess you'll just have to strap their arm to their abd/chest area to get the respers.  Other wise you can stand their (or sit) and cross your arms so your wrist with your watch is on top and stare hard at the pts chest/abd area to watch the pt for resperations.  

*Just a side note it doesn't work well one of the nursing students in my class tried to do that and the pt looked at her and asked what she was doing.  Couldn't be any more obviouse.

Heres another tip for those that have to check lung sounds when you get done with lung sounds position your scope over the heart to listen to the heart and while you have the scope resting there you can get your apical pulse rate along with respers.  Jon you just would have to be carefull.


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## TTLWHKR (Dec 3, 2005)

If it's a 302, and the rcving facility is more than 20 minutes away. Tell the police they threatened to kill you, and that they have to do the transport.
Don't report available..

DUNKIN DONUTS TIME!


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## Wingnut (Dec 4, 2005)

Totally off topic~ Emtbuff, I had to laugh, your sig is great up close but from afar, it looks like the medic in the picture has a clown nose. Just thought I'd mention it, it gave me a chuckle. :lol:


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## emtbuff (Dec 5, 2005)

Guess I've never noticed that before.


oh and THANKS for pointing that out wingnut.

Some would probley agree that I am a clown but that is beside the point.  There isn't anything wrong with having a little fun right.


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## TTLWHKR (Dec 5, 2005)

> _Originally posted by Wingnut_@Dec 4 2005, 10:18 PM
> * Totally off topic~ Emtbuff, I had to laugh, your sig is great up close but from afar, it looks like the medic in the picture has a clown nose. Just thought I'd mention it, it gave me a chuckle. :lol: *


 I just noticed that. Funny.


I want an ambulance with my name on it too.


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## Wingnut (Dec 6, 2005)

> _Originally posted by emtbuff_@Dec 5 2005, 04:01 PM
> * Guess I've never noticed that before.
> 
> 
> ...


 Never! I'm all about the fun


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## 40sCutest (Dec 13, 2005)

Now that we've all gotten the funny out of our system...

When I first got out of school everyone made me do everything myself.

They all watched like it was a fun show... I hated that. Still I learned alot. I learned that I could do almost anything, even when I'm frustrated.


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## CaptainPanic (Dec 13, 2005)

TTLWHKR said:
			
		

> I just noticed that. Funny.
> 
> 
> I want an ambulance with my name on it too.


 
Yeah but doesnt it say *LADIES* of EMS??? Are you a lady Alex?? 
	

	
	
		
		

		
			





BTW Id like one but with my real name on it and yes last time I checked I was a lady... 
	

	
	
		
		

		
		
	


	




-CP


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