# Nurse on a Stick



## namaste1967 (Oct 2, 2005)

A question, even though to some, maybe a dumb one............hospitals use the automatic bp, pulse, & pulse ox machine  (nurse on a stick), why hasn't that become a piece of equipment on an ambulance?? Our rigs have GPS and all the lastest technology.........


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## smileyyemtb76 (Oct 2, 2005)

I think we don't have those on our trucks, because there is too much room for malfunction.  And out there on the road in an emergency situation, you can't afford to get the wrong vitals.  Many times I will get called to a nursing home, and the nurse has just taken vitals with the "nurse on the stick" and then I take em, and bp is off by 10 or 20.  My partner will recheck, and we will get the same thing. In someone with chest pain, that 10 or 20 is the difference between Nitro or no Nitro.


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## Wingnut (Oct 2, 2005)

Also in our profession we need to be VERY proficient at taking vitals the good old fashioned way. We cannot be dependant on the machines.

If we got busted using one of the machines during class/lab, clinical, etc..we would be kicked out. Never happened, but they sure did seem serious


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## namaste1967 (Oct 2, 2005)

> *If we got busted using one of the machines during class/lab, clinical, etc..we would be kicked out. *


In one of my ER clinicals, that's all they would let me use.........also on one of my ride-a-longs, the medic had the bp cuff hooked up to the zoles and was taking "auto vitals" that way. Is that SOP for medics?
I guess I thought that since hospitals relied so much on them, that they may have been more accurate.........that's what I get for thinkin'!!


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## TTLWHKR (Oct 2, 2005)

Too much room for error.


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## namaste1967 (Oct 2, 2005)

> _Originally posted by TTLWHKR_@Oct 2 2005, 06:19 PM
> *Too much room for error.*


I'm curious why hospitals rely so much on them..........


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## MMiz (Oct 2, 2005)

There is a huge difference between a hospital and an ambulance.

The company I work for provides medics BP cuffs on their Lifepak 12s, yet almost every medic takes the baseline vitals by hand.  The machines still aren't good enough to always get a good and consistent set of vitals.  Once you have the baseline you may have it take the BP automatically every 5 minutes, but I'd never rely on a baseline BP from a machine.

At the hospital the patient is in their bed in a nice quiet environment.  That's not the same thing in the back of a moving ambulance.  Even at the hospital one out of ever 10 BPs is crazy-off.  That's why most units keep their BP kits on the cot, even if you dont take in your jump bag.  As far as the NHs go, their BPs are almost always off.  I always take my own BP at the hospital or NH before we get in the ambulance or transport.  Then I take one in the back of the ambulance as we're pulling away.

Also, it's expensive.  Why pay for an expensive piece of equipment that has a high error rate when a $20-$150 BP cuff can do it accurately (with a trained EMT) and will last longer?

Just like my trucks GPS isn't always right or perfect, the same goes for the auto BP cuff


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## rescuecpt (Oct 2, 2005)

> _Originally posted by namaste1967_@Oct 2 2005, 07:57 AM
> * A question, even though to some, maybe a dumb one............hospitals use the automatic bp, pulse, & pulse ox machine  (nurse on a stick), why hasn't that become a piece of equipment on an ambulance?? Our rigs have GPS and all the lastest technology......... *


We have the automatic BP, pulse, and pulse ox (one unit) made especially for ambulances.  Works well on our long transports, but we (my squad) requires the EMTs to take at least two manual readings per transport (and of course make sure the machine is inline with the manual and vice versa) - the State only requires 1 reading, whether manual or automatic.

I love the machine for when I'm not in a rig with an ALS seat - I can hook it up on the far arm, leave it there, and let it do its thing (I can set it for every 5 minutes, 10 minutes, etc) while I start a line in the close arm, do exams, monitor the Zoll or Lifepak, etc.  When I'm riding an emergent ALS call alone, which happens a lot, it's an extra pair of hands.


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## Jon (Oct 2, 2005)

> _Originally posted by namaste1967_@Oct 2 2005, 04:53 PM
> *
> 
> 
> ...


 My medic school required that we document 25 sets of vitals (manually) by patient #, along with 20 12-leads, 15 O2 applications, etc.... Basic stuff, so they could document we were able to do that.

Otherwise, they didn't care.

Most places using something other than a LP10 for a defib have a BP cuff and Pulse ox intergrated.

Most places have no problem using the intergrated stuff, but you MUST verify it manually.

Jon


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## TTLWHKR (Oct 2, 2005)

> _Originally posted by namaste1967+Oct 2 2005, 05:28 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (namaste1967 @ Oct 2 2005, 05:28 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-TTLWHKR_@Oct 2 2005, 06:19 PM
> *Too much room for error.*


I'm curious why hospitals rely so much on them.......... [/b][/quote]
 Hospitals don't bounce down rough roads.
Ambulances do.


Hospitals machines don't get slammed around.
Ambulance machines do.


Isn't gonna kill ya to auscultate or palpate a BP every 5 or 15 minutes, what ever you're doing. Sure the LP can be used as one, but I would never rely on it, just b/c I don't trust electronic vs. my own touch and hearing.


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## TTLWHKR (Oct 2, 2005)

> _Originally posted by MMiz_@Oct 2 2005, 06:16 PM
> * $20-$150 BP cuff *


 You've paid 150 for a BP cuff?
 :blink:


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## Jon (Oct 2, 2005)

> _Originally posted by TTLWHKR+Oct 2 2005, 08:09 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (TTLWHKR @ Oct 2 2005, 08:09 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-MMiz_@Oct 2 2005, 06:16 PM
> * $20-$150 BP cuff *


You've paid 150 for a BP cuff?
 :blink: [/b][/quote]
 the high-quality multicuff is up there....

Jon


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## TTLWHKR (Oct 2, 2005)

> _Originally posted by MedicStudentJon+Oct 2 2005, 07:17 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ Oct 2 2005, 07:17 PM)</td></tr><tr><td id='QUOTE'>
> 
> 
> 
> ...


the high-quality multicuff is up there....

Jon [/b][/quote]
 The multi-Cuff is also a waste of money... IMO anyway.

NewBorn, Infant, Child, Adult, Large Adult & Thigh...

Why do you need a newborn or Infant BP cuff anyway? A provider who doesn't know how far to go could break a fragile arm...

Would be cheaper to just buy the four large ones separatly. Or on eBay...   Which is what I did. I've also discovered that the more you remove the manometer and bulb, the more easy it is to do so, which means they slip off... fall off.. get broken... get lost... make the rubber frail and crack. Out on a limb, yes, but I've cut off at least three inches on my personal BP cuff b/c the latex free material keeps cracking from all the switching around.


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## MMiz (Oct 2, 2005)

Our units carry something similar to the  Quint Cuff Blood Pressure Kit
http://galls.com/style.html?assort=general...log&style=DD969

I've never used the infant one, but I've seen it used.  For $119 it's a lot of money, but it's nice to have


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## TTLWHKR (Oct 2, 2005)

> _Originally posted by MMiz_@Oct 2 2005, 07:59 PM
> * Our units carry something similar to the  Quint Cuff Blood Pressure Kit
> http://galls.com/style.html?assort=general...log&style=DD969
> 
> I've never used the infant one, but I've seen it used.  For $119 it's a lot of money, but it's nice to have  *


 I'll sell ya one for twenty bucks...


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## KEVD18 (Oct 2, 2005)

short answer, theyre really freakin expensive. not as much an issue with a municipal service running small numbers of rigs. once you start talking the metro transport companies, amr, fallon etc, who have many trucks, several thousand $ per unti, plus the maintenence/calibration and replacements for lost/damaged untis....add these factors to the prteviously stated issues or reliability and a trained emt with a manual cuff and scope sounds like a winner to me


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## Phridae (Oct 3, 2005)

We actually have an automatic BP with a pulse ox. Its a boat anchor really. We hardly ever use it. The machine cannot judge a bump from a beat. At first we were all over this machine. Then we realized that what we got from the machine and what we got from doing it manual were two waaaayyy different things. Now we use the automatic one when someone stops by the station and asks to have their BP checked. Its only good if you're not moving.


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## Margaritaville (Oct 3, 2005)

We have them.

They are hooked to our lifepack 12's from Physio-control. Auto - BP that you can set to register every so many minutes, pulse and PO2.

Our protocols dictate that the first BP and Pulse is done manual. That way you can see if your readings are accurate. It also saves you from looking foolish by being lazy.

Personally, before and after giving meds - I like to check it manually for myself -if time allows. That way you are sure.  Other times if your having your tail handed to you and have no help - Its a great lifesaver.


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## Jon (Oct 3, 2005)

Also, the ones in the Defibs are higher quality... less motion sensitive..... they KNOW we are mobile 

Jon


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## TTLWHKR (Oct 3, 2005)

> _Originally posted by MedicStudentJon_@Oct 3 2005, 08:46 AM
> * Also, the ones in the Defibs are higher quality... less motion sensitive..... they KNOW we are mobile
> 
> Jon *


 Do they?


Jon, have you been talking with the machines again?

<hits him on the nose w/ a rolled up newspaper>  :lol:


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