# Let's Take vitals!



## WuLabsWuTecH (Jul 21, 2009)

I was originally going to post this in BLS discussion, and then I realized that taking vitals is part of ALS as well!

So here's what I'm thinking.  A lot of EMTs/Medics seem to be able to take vitals faster than I can.  I'm wondering how someone can count pulse, auscultate/palpate a BP, and count respirs at the same time!  Perhaps I just don't have that kind of mental capacity?

For me I do vitals like this:
Pulse (30 seconds)
Breaths (30 seconds)
Set up and take BP (a minute or so)
Pulseox (15 seconds)
Glucose (a minute)

but I've seen some people do everything except the glucose in about a minute.

Any tips/secrets of the trade?


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## M1ke10191 (Jul 21, 2009)

For pulse and resp I do 15x4, and you can put their hand up to their chest to do pulse, then going right into respirations. Other than that idk how to make anything quicker.


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## PapaBear434 (Jul 21, 2009)

Keep in mind, some of them may be "faking it" with some of the more stable patients.  They look at how they are breathing, and just say "Respiration 16."  They take a pulse for 10 or 15 seconds, multiply it by 4, and round it up.  They take a BP extremely quick, and maybe it's accurate.  

Take your time, and get better at it organically.  It's better to be accurate that quick.


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## Sasha (Jul 21, 2009)

> Any tips/secrets of the trade?



Use the auto BP, it takes a pulse too!!!!

I kid, I kid.  

One thing I learned is that respirations are sometimes hard to count when the patient is breathing so shallowly you have to check a pulse to make sure they haven't died, I find a stethescope is useful for counting the resps for these patients. Before anyone jumps in for the kill, the only patients I have had like that were hospice patients with a DNR at an old job. On the off chance you run into one of those... there's a tip! 

There's also nothing wrong with clipping on the pulse ox and leaving it on. No need for this timed thing.


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## marineman (Jul 21, 2009)

Clip the pulse ox on first then while it's getting a reading check a manual pulse so you can ensure that it matches the pulse ox. That will cut out a few seconds of waiting.

On stable patients with a regular pulse you can count for 10 seconds and multiply by 6. However on stable patients there's not that much going on that you can probably spare the time to do it right.

Another shortcut is to put the pulse ox on, then check a BP. Once you've been doing it for a while you will be able to get a rough estimate on the pulse rate while listening to the BP. If your estimate is pretty close to the reading on the pulse ox go with that.

Final option that I know of if put the cardiac monitor on, take about 5 seconds to make sure the pulse matches the monitor and you're in business. 

Overall, there is no excuse for taking shortcuts. Correct readings are more important than the speed that you get it done. In time you will just learn a smooth progression to do everything and you will become more efficient.


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## ResTech (Jul 21, 2009)

I always count the pulse for 15 x4... after you count so many you dont even have to do the math... you just automatically know the rate based on the number you get.

Same for resp... 15 x4... if its hard to count based on chest wall movement, sometime placing your hand on the abd works.


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## CAOX3 (Jul 21, 2009)

Pink, warm and dry.  

Those are the extent of my vitals on the majority of my patients.


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## JPINFV (Jul 21, 2009)

Pulse/Resp: 15 seconds.

BP: Once I get the first set I'll normally leave the cuff attached, but deflated, if I'm going to grab another one. I just move the handle (I have a trigger grip) out of the way.


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## timmy84 (Jul 22, 2009)

Do it anyway you feel comfortable doing it.  Just remember to prioritize.  Don't fake it.  With time you will get your own 'groove' and streamline the process to yourself.


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## WuLabsWuTecH (Jul 22, 2009)

I figured I'd get faster at it, and I definately have, but over a year on the job and a lot of the other guys still do it in a quarter of the time it takes me!


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## CAOX3 (Jul 22, 2009)

WuLabsWuTecH said:


> I figured I'd get faster at it, and I definately have, but over a year on the job and a lot of the other guys still do it in a quarter of the time it takes me!



Is is a race?  

Who cares if they do it faster, remember the turtle and the hare?

Just practise.


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## timmy84 (Jul 22, 2009)

WuLabsWuTecH said:


> I figured I'd get faster at it, and I definately have, but over a year on the job and a lot of the other guys still do it in a quarter of the time it takes me!



Faster is not always better...  Don't work towards getting faster, work towards getting better... ^_^


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## WuLabsWuTecH (Jul 22, 2009)

My pusle is always within 2 of what the Pulseox gets, and BP is within 5 of the NIBP so I think that's pretty good especially since those machines are not always accurate and precise.  It doesn't really bother me or anyone else that I take that long to do them as the medic usually working on getting a history or other info.  I just wondered how people were able to do it so much faster!


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## timmy84 (Jul 22, 2009)

WuLabsWuTecH said:


> My pusle is always within 2 of what the Pulseox gets, and BP is within 5 of the NIBP so I think that's pretty good especially since those machines are not always accurate and precise.  It doesn't really bother me or anyone else that I take that long to do them as the medic usually working on getting a history or other info.  I just wondered how people were able to do it so much faster!



Just has to do with how many times you do it.  The first two years I worked at the hospital my floor did not have a dynamap.  When you take 15 sets of vitals at the start of shift, an additional 10 sets through the rest of the shift, and multiply that by 5 :censored::censored::censored::censored:s a week... well thats about 125 sets of v/s a week.  I went from taking 5 minutes per pt to 4 min per patient by the time we got a nifty v/s machine.  Now I can get T/P/NIBP/SpO2 in less than 30 seconds while I count the respiration rate.  I can get in and out in less than a minute.  I still have to take manual v/s when I get 'strange' results from the machine, or when the the Dynamap comes up missing or has a dead battery.  I timed myself during my class last week.  I averaged about 5 min again (out of practice I suppose).


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## medic417 (Jul 22, 2009)

CAOX3 said:


> Pink, warm and dry.
> 
> Those are the extent of my vitals on the majority of my patients.



So the Paramedic does all the real patient assessment which includes vitals?  If not you are a fraud and should not be in EMS.  Patients can appear fine in the early stages of many serious events and the vitals can be the first or only indication that they are in trouble.  Do your job or get out.


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## WuLabsWuTecH (Jul 22, 2009)

Its possible he works for an IFT where not much happens and on emergency calls the medic has to take baseline vitals as part of SOP.  Or he's a part of an IFT and just uses the last set of vitals that the nrse had on the chart.  I've seen that happen way too many times...  Personally, I don't care if I saw the nurse take vitals and her machine read out a BP before I left, I take my own.

@Timmy
Speaking of machines, I do use the machine, but I take baseline vitals by hand.  I've learned that machines can be very wrong and I trust my own hands, and eyes more.  call me old fashioned but I've had experiences where the machine did us no favors.


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## Sasha (Jul 22, 2009)

> Its possible he works for an IFT where not much happens and on emergency calls the medic has to take baseline vitals as part of SOP. Or he's a part of an IFT and just uses the last set of vitals that the nrse had on the chart. I've seen that happen way too many times... Personally, I don't care if I saw the nurse take vitals and her machine read out a BP before I left, I take my own.



When teching patients on IFT I will use the nurses PTA and take my own. I also flip through the chart to get a feel for what their vitals generally are. Nothing like getting a 110/60, thinking it's fine, and they are normally in the 150s or vice versa!


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## exodus (Jul 22, 2009)

Sasha said:


> When teching patients on IFT I will use the nurses PTA and take my own. I also flip through the chart to get a feel for what their vitals generally are. Nothing like getting a 110/60, thinking it's fine, and they are normally in the 150s or vice versa!



Pretty much the same. I use a machine to get an idea of where I'm at.


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## marineman (Jul 22, 2009)

On IFT I will use a previous set of vitals but on the computer reports we fill out we have to put times next to every set of vitals, there is a PTA option that I use. We also must put who took the vitals and for that I list nursing home staff or wherever they came from. I do the same thing for 911 calls where first responders have vitals ready for me, I get my own set and put theirs in as PTA and give credit to whatever agency took them. Taking previous vitals and calling them your own is lazy and poor patient care, if it's one of those "boring" IFT's that everyone seems to hate what do you do with all your time that you can't do your one tiny little job correctly. 

A few tricks to be more efficient at collecting your own set is one thing but advice to completely not do your job is unacceptable.


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## WuLabsWuTecH (Jul 22, 2009)

Yes, when I did long IFTs I would take baseline by hand and immediately first vitals by monitor (NIBP, Pulse, SpO2)  If they matched, then vitals every 15 minutes by monitor and at the top of the hour I'd do another one by hand.  If something started to deviate, I'd do it by hand.

Now that I work 911, we almost never have to take vitals more than once since transport times are so short so I'll just take baseline by hand.

If my old school vitals differ from the new-tech vitals, my old school one takes precedence.


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## marineman (Jul 22, 2009)

Unless our transport time is less than 5 minutes QA gets all over us if we don't get at least 2 sets of vitals. Also if the reading the monitor gets is always recorded in my report, if it's way off of my manual readings I fill out a faulty equipment report and in my report I document the report number and any additional follow up done. I like to leave a mile long paper trail of anything that inhibits patient care and when it makes it's way into a PCR things tend to get fixed quicker than otherwise. Seems they're afraid of something going to court and having several documented areas that equipment was faulty and finding they didn't correct it.


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## CAOX3 (Jul 22, 2009)

medic417 said:


> So the Paramedic does all the real patient assessment which includes vitals?  If not you are a fraud and should not be in EMS.  *Patients can appear fine in the early stages of many serious events and the vitals can be the first or only indication that they are in trouble.  Do your job or get out.*



Actually, I dont work with a medic.   

Was that your attempt at educating me?  Thanks for the in depth description of the disease process.

 I think I'll be o.k.


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## WuLabsWuTecH (Jul 23, 2009)

marineman said:


> Unless our transport time is less than 5 minutes QA gets all over us if we don't get at least 2 sets of vitals. Also if the reading the monitor gets is always recorded in my report, if it's way off of my manual readings I fill out a faulty equipment report and in my report I document the report number and any additional follow up done. I like to leave a mile long paper trail of anything that inhibits patient care and when it makes it's way into a PCR things tend to get fixed quicker than otherwise. Seems they're afraid of something going to court and having several documented areas that equipment was faulty and finding they didn't correct it.



You guys require vitals every 5 minutes even on stable patients?  We were taught 15 and that's usually what we go with on stable patients.  And good for you in documenting faulty equipment as a barrier to patient care.  My old private company was very good about fixing things so I never had the problem.  Currently the FD i'm on checks things very regularly and we have spares of almost everything so if something is bad we switch it out right away and it gets fixed right away.  (Yes, for those of you who are wondering we carry two monitors on the rig.  Excessive?  Maybe, but they also serve as our defibrillators and when you're defibing someone is not the time you want to figure out that you've run your monitor batt pretty dry and you'll either need to change batteries which takes time, or you'll need to do without, which is bad for the patient.  It doesn't take up much space and its out of the way with our MCI stuff.  Ok, end preempting comments about having two of everything)



CAOX3 said:


> Actually, I dont work with a medic.
> 
> Was that your attempt at educating me?  Thanks for the in depth description of the disease process.
> 
> I think I'll be o.k.



Well I hope you mean that you'll be ok b/c you're the ranking guy on the rig and you make your partner take vitals.  Because if not, one of these days one of the members in the group you describe as "the majority of your patients" will keel over and you will have no idea how to explain what just happened!  At best, that can turn into a red faced moment, at worst... well...

I hope you are being facetious here (its hard to tell via internet) and if you are this does not apply to you but I do want to put it out there for others reading this whi might be thinking vitals aren't worth taking. Because it's a very bad mentality to get in that "I'm too good to take vitals" or "Taking vitals is not important."  Is your JOB to do so.  Now I know medics that won't do it if basics are around but they still know vitals are important and they need to get someone to get them.  Even if you are the ranking member on the rig, you need to practice to keep up your skills.  There might be a double critical victim MVA that you respond to.  Are we going to wait 15 minutes for the other rig to show up, or are we going to split these patients among us.  Obviously the latter, which means, guess what!  It's your turn to take vitals on your own guy!

I routinely don't work in EMS or take vitals for 3-4 months at a time due to school.  That first shift back is a tough one.  I still remember how to do what in a given situation, but taking vitals can take a lot more time than it usually does.


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## CAOX3 (Jul 23, 2009)

WuLabsWuTecH said:


> Well I hope you mean that you'll be ok b/c you're the ranking guy on the rig and you make your partner take vitals.  Because if not, one of these days one of the members in the group you describe as "the majority of your patients" will keel over and you will have no idea how to explain what just happened!  At best, that can turn into a red faced moment, at worst... well...
> 
> I hope you are being facetious here (its hard to tell via internet) and if you are this does not apply to you but I do want to put it out there for others reading this whi might be thinking vitals aren't worth taking. Because it's a very bad mentality to get in that "I'm too good to take vitals" or "Taking vitals is not important."  Is your JOB to do so.  Now I know medics that won't do it if basics are around but they still know vitals are important and they need to get someone to get them.  Even if you are the ranking member on the rig, you need to practice to keep up your skills.  There might be a double critical victim MVA that you respond to.  Are we going to wait 15 minutes for the other rig to show up, or are we going to split these patients among us.  Obviously the latter, which means, guess what!  It's your turn to take vitals on your own guy!
> 
> I routinely don't work in EMS or take vitals for 3-4 months at a time due to school.  That first shift back is a tough one.  I still remember how to do what in a given situation, but taking vitals can take a lot more time than it usually does.



Did I say vitals werent important?  

By the way pink, warm and dry are vital signs.


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## WuLabsWuTecH (Jul 23, 2009)

CAOX3 said:


> Did I say vitals werent important?
> 
> By the way pink, warm and dry are vital signs.


What I was saying was that the quantitative vital signs are just as important if not more important than the qualitative ones.

Please do tell me that SOMEONE on the rig gets those?


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## Hockey (Jul 23, 2009)

I had a student with me and he swore he was the next best thing to god.  Well we had a DOA and he walked in with a BP cuff and asked what can he do.  Partner who is a medic, asked well what would his BP be (Kind of sarcastically and theres more to it so don't freak)?  He said "Oh, let me check".  Put the BP cuff on and thats when we had to interrupt him and give him a lesson on what happens when you die.


SUPPOSEDLY he did this once before and kept saying "I can't hear anything" with another crew but who knows


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## CAOX3 (Jul 23, 2009)

WuLabsWuTecH said:


> What I was saying was that the quantitative vital signs are just as important if not more important than the qualitative ones.
> 
> Please do tell me that SOMEONE on the rig gets those?



Yes we obtain vitals, including the ones I mentioned.


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## Sasha (Jul 23, 2009)

CAOX3 said:


> Did I say vitals werent important?
> 
> By the way pink, warm and dry are vital signs.



But shouldn't be the only vital signs you take which was stated in your previous post.



CAOX3 said:


> Pink, warm and dry.
> 
> Those are the extent of my vitals on the majority of my patients.


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## medic417 (Jul 23, 2009)

CAOX3 said:


> Yes we obtain vitals, including the ones I mentioned.



Not according to your earlier post I replied to.  So which post is a lie?  This one or the the other one?  

Yes skin condition is part of a proper exam but it does not replace the BP's pulse, lung/heart sounds, etc.  You said all you do is skin condition on most patients as such you fail either in the field or as a liar on the internet.


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## CAOX3 (Jul 23, 2009)

Sasha said:


> But shouldn't be the only vital signs you take which was stated in your previous post.



Every patient that initiates the 911 system needs a complete set of vital signs?  State why please?

We allow people to sit in ER waiting rooms for 8 hours, but because they dialed 911 they need a blood pressure every five minutes?


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## CAOX3 (Jul 23, 2009)

medic417 said:


> Not according to your earlier post I replied to.  So which post is a lie?  This one or the the other one?
> 
> Yes skin condition is part of a proper exam but it does not replace the BP's pulse, lung/heart sounds, etc.  You said all you do is skin condition on most patients as such you fail either in the field or as a liar on the internet.



Well you told me didnt you.  

A complete set of vital signs is taken when its warranted.


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## Sasha (Jul 23, 2009)

Uh excuse me?

When are they not warranted?  Stop.  Being lazy and do your job. You are an emt, what else is there for you to do? No wonder emts get no respect with posts like this






CAOX3 said:


> Well you told me didnt you.
> 
> A complete set of vital signs is taken when its warranted.


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## exodus (Jul 23, 2009)

CAOX3 said:


> Every patient that initiates the 911 system needs a complete set of vital signs?  State why please?
> 
> We allow people to sit in ER waiting rooms for 8 hours, but because they dialed 911 they need a blood pressure every five minutes?



yes everyone deserves a complete set of vitals. Every 5 minutes? no... But why? Because they really may be an underlying cause of problems which may not be symptomatic yet. I had a patient the other day who has an hx of HTN and is morbidly obese. His BP was in the 80/xx's but was completely asymptomatic. If I only looked at him in terms of how he looked, skin signs. There's a good possibility something would have happened to him.

And honestly? Really! It takes less than two minutes to get a full set of vitals. I can understand fluffing things like Resp's for ER Discharge IFT's. But fluffing anything on 911 is unacceptable.


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## WuLabsWuTecH (Jul 23, 2009)

CAOX3 said:


> Every patient that initiates the 911 system needs a complete set of vital signs?  State why please?
> 
> We allow people to sit in ER waiting rooms for 8 hours, but because they dialed 911 they need a blood pressure every five minutes?



State why please?  I'm starting to think you're not being sarcastic.  A stable patient gets vitals (a full set, including the ones that have numbers and that you may need to do math for) upon arrival to establish baseline.  Then every 15 minutes.  The 5 minute vitals are for unstable patients.

And people who sit in ER waiting rooms have been TRIAGED by a nurse.  Guess what?  The triage nurses take vitals, including the fancy ones with numbers!


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## WuLabsWuTecH (Jul 23, 2009)

exodus said:


> yes everyone deserves a complete set of vitals. Every 5 minutes? no... But why? Because they really may be an underlying cause of problems which may not be symptomatic yet. I had a patient the other day who has an hx of HTN and is morbidly obese. His BP was in the 80/xx's but was completely asymptomatic. If I only looked at him in terms of how he looked, skin signs. There's a good possibility something would have happened to him.
> 
> And honestly? Really! It takes less than two minutes to get a full set of vitals. I can understand fluffing things like Resp's for ER Discharge IFT's. But fluffing anything on 911 is unacceptable.



Exodus, I have to disagree with you here.  Even ER discharges and IFTs need a baseline vital.  I have never not taken baseline after my first week on the job when my partner was in the back and I was driving IFT to dialysis.  The PT went unconscious on him and he told me to divert code to the nearest ER.  He started freaking out b/c he got abnormally high BP and wasn't sure if that was normal for the patient or if it was something wrong and had to look through charts to figure it out.


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## exodus (Jul 24, 2009)

WuLabsWuTecH said:


> Exodus, I have to disagree with you here.  Even ER discharges and IFTs need a baseline vital.  I have never not taken baseline after my first week on the job when my partner was in the back and I was driving IFT to dialysis.  The PT went unconscious on him and he told me to divert code to the nearest ER.  He started freaking out b/c he got abnormally high BP and wasn't sure if that was normal for the patient or if it was something wrong and had to look through charts to figure it out.



I get baseline with everyone. I said the only vital I can see fluffing being acceptable is the RR with a stable patient on something like an ER discharge.


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## CAOX3 (Jul 24, 2009)

Sasha said:


> Uh excuse me?
> 
> When are they not warranted?  Stop.  Being lazy and do your job. You are an emt, what else is there for you to do? No wonder emts get no respect with posts like this




When are they not warranted?   I repeat JUST BECAUSE SOMEONES INITIATES 911 DOES NOT MAKE THEM SICK.

Thats why EMTs don't get any respect?  Who doesn't get any respect? EMS as a whole does not get any respect because we have providers out there who think its ok to tape ASA to someones forehead and so on, I dont realy need to go there you get the picture.

Lazy? Yes I'm lazy cause I can determine who needs a complete set of vitals signs and who doesn't?

*Wululabswuthech*

Again you are assuming that every patient I come in contact with is sick. I am more then competent enough to distinguish who needs a blood pressure.

*Exodus*

You have a problem with me not taking a blood pressure on someone who isn't sick but think its completely OK to "fluff vitals"  or better stated falsify a medical record. I don't fluff anything,  if I don't take a pressure one isn't written.

Both of your examples are ridiculous, dialysis patients are sick and so are severely obese patients.

As far as the ER, them recording vital signs is a liability issue, so when you keel over and die after waiting eight hours for treatment, they can say well we took his vital and he was stable.


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## Sasha (Jul 24, 2009)

> When are they not warranted? I repeat JUST BECAUSE SOMEONES INITIATES 911 DOES NOT MAKE THEM SICK.



And you determine if they are sick by doing an assesment. An assesment includes a full set of vitals! Blood pressure, pulse, temp, the works!


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## CAOX3 (Jul 24, 2009)

Anyway....


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## Sasha (Jul 24, 2009)

CAOX3 said:


> Anyway....



Anyway what? What else do you have to do back there? Nothing! You are an EMT, your whole job is to take vitals and shuttle them to the ER. Don't get lazy and possibly hurt your patients. If you can't bring yourself to take five minutes out of your hospital ride to grab a blood pressure, lung sounds, pulse rate, temp, BGL (and that's if you are slow.) then you should reconsider your position. You don't run a wheel chair van, you run on an ambulance where the patients expect care. Care does not include you sitting on your butt not doing anything because you believe it's a waste of time.

Only a foolish person belives that they can look at a patient and tell that they are sick.


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## SeeNoMore (Jul 24, 2009)

Why in the world would we not want to take vitals? It helps us know what is going on with the PT, or at least give as much information as possible to the ER. 

I think taking good vitals is essential. And at least for me, not a simple task. I have only been doing the job a few weeks though. In school I was not the greatest with BP, but that has been getting better with the combination of more careful technique and a better scope.  

Lung sounds I am having a hard time with en route. Somtimes what I hear is very faint. But I am honest about it no matter how stupid I feel. And I do feel incredibly stupid. 

But anyway, vitals! Sasha is 100 percent correct.


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## CAOX3 (Jul 24, 2009)

Sasha said:


> Anyway what? What else do you have to do back there? Nothing! You are an EMT, your whole job is to take vitals and shuttle them to the ER. Don't get lazy and possibly hurt your patients. If you can't bring yourself to take five minutes out of your hospital ride to grab a blood pressure, lung sounds, pulse rate, temp, BGL (and that's if you are slow.) then you should reconsider your position. You don't run a wheel chair van, you run on an ambulance where the patients expect care. Care does not include you sitting on your butt not doing anything because you believe it's a waste of time.
> 
> Only a foolish person believes that they can look at a patient and tell that they are sick.



Oh and I thought me and you were cozying up to each other. 

Excuse me? I owe you no justification as to how I treat my patients or what is required of me. 

You cant even explained to me why?  Because isn't a reason and care isn't determined by how busy I look to my patient.

Actually an good provider can determine some amount of severity based on patient appearance and the need for further assessment, contrary to popular belief sick people usually look sick.  

I don't just do everything because something may turn up, that isn't  how it works.  If I walk into an ER drunk I don't get a 12 lead and a cat scan because I may have an underlying condition. Thats ridiculous. 

We have removed patient assessment and replaced it with flow charts of what we are supposed to do, its bull shiit.  If you cant adequately assess your patient then get out, a monkey can take a blood pressure and a pulse. their is no substitution for the human element.

Sorry if you cant accept the fact that I can admit what more then a few providers here would agree with but are to afraid to admit.

Your problem is you cant see anything but black an white, its either right or wrong with you.  There is no gray.  The fact is there is more gray then anything else, you will realize this as you move on in your career.

I am also glad you do vital on all your IFT patients they are considerably  more sick then the majority of the patients I see.


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## CAOX3 (Jul 24, 2009)

SeeNoMore said:


> Why in the world would we not want to take vitals? It helps us know what is going on with the PT, or at least give as much information as possible to the ER.
> 
> I think taking good vitals is essential. And at least for me, not a simple task. I have only been doing the job a few weeks though. In school I was not the greatest with BP, but that has been getting better with the combination of more careful technique and a better scope.
> 
> ...



Are you having problems hearing them or distinguishing one from the other.  Or are you just doing it because they told you to? Do yourself a favor and learn the meaning and what the presence or absence of such lung sounds mean.

There are many websites that have audible recording of different lung sounds and the only way you will master a BP is by practice, don't use the BP machines as a substitute because you are having a hard time, that machine will ultimately let you down.

As far as the discussion between me and Sasha, I do take vital signs I just don't feel the need to take a BGL on everyone or a BP on a guy who wants a ride to the hospital so he comes up with some cockamamie story about how he has a history of cardiac arrest and it happened this morning now he wants to get it checked out and can I give him Valium for that so it doesn't happen again.  

Or a guy who witnessed a squirrel being hit by a car could I take him to the hospital so he can talk to someone about it.

The woman who's friend died yesterday in the same house as her and wants to be checked out to make sure she didn't catch what killed her friend.

I like the young guy who has a seizure with one eye open but then it miraculously stops when he hears the sound of change hitting the ground.

Or the ones that call 911 cause their their neighbors Christmas lights are to bright and he thinks they have done permanent damage to his eyesight.

They guy who has recently had a heart translplant and does not think its working any more, but he has no scar on his chest.

Or the wonam has a pain in her elbow and when I ask how long its been going on she says since she fell in grammer school. she is 68.

And the best of all time drum role please, The guy who believes he has caught mental retardation because he sat next to a retarded guy on the bus yesterday.

Trust me I know when to take a blood pressure.

I also when one isnt required.


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## VentMedic (Jul 24, 2009)

CAOX3 said:


> Are you having problems hearing them or distinguishing one from the other. Or are you just doing it because they told you to? Do yourself a favor and learn the meaning and what the presence or absence of such lung sounds mean.
> 
> There are many websites that have audible recording of different lung sounds and the only way you will master a BP is by practice, don't use the BP machines as a substitute because you are having a hard time, that machine will ultimately let you down.
> 
> ...


 


CAOX3 said:


> Trust me I know when to take a blood pressure.
> 
> I also when one isnt required.


 
If you blew off all of those patients as BS and not requiring at least a set of vitals for your documentation, I would say you don't know when not to take a BP. You will also look pretty stupid handing in your cert to your state board when anyone of these patients has a severe medical problem that requires emergent attention right after you drive off in your ambulance without even touching the patient. Let's see, how many headlines have we had this past year where that has happened to someone in EMS? It is a shame some waste so much time trying to get out of work.


----------



## VentMedic (Jul 24, 2009)

CAOX3 said:


> *Actually an good provider can determine some amount of severity based on patient appearance and the need for further assessment, contrary to popular belief sick people usually look sick. *
> *Wow! That's not a good or intelligent statement at all. It also shows you lack of knowledge of many medical conditions.*
> 
> *I don't just do everything because something may turn up, that isn't how it works. If I walk into an ER drunk I don't get a 12 lead and a cat scan because I may have an underlying condition. Thats ridiculous. If your complaint is chest pain or shortness of breath or if anything was found suspicious on an assessment, yes you may get a workup especially if you have a hx of alcohol abuse. BTW, it is CT Scan and not cat scan like in the comic books.*
> ...


----------



## exodus (Jul 24, 2009)

CAOX3 said:


> When are they not warranted?   I repeat JUST BECAUSE SOMEONES INITIATES 911 DOES NOT MAKE THEM SICK.
> 
> Thats why EMTs don't get any respect?  Who doesn't get any respect? EMS as a whole does not get any respect because we have providers out there who think its ok to tape ASA to someones forehead and so on, I dont realy need to go there you get the picture.
> 
> ...


n tenchar
Bolded.


----------



## rescue99 (Jul 24, 2009)

Last I knew vitals are not only necessary but are in virtually all protocols, including return home transports. Barring and AOX4 patient absolutely refuses and you document the event or some strange circumstance of the call prohibits a complete set, it takes just a moment. NO COAX3, a a 12 lead on a drunk isn't always needed and a glucose check on a broken ankle isn't either. Are they sometimes? YEP! The question is....are "baseline" vitals and assessment necessary on all patients? The answer to that is real simple....ummm, yeah they are!


----------



## SeeNoMore (Jul 24, 2009)

CAOX3, I certainly don't doubt your abilities. At this point though I would side with taking vitals all the time, but I am very new. 

BP is not a problem area, but I do want to keep in good practice to make sure I am absolute as possibile. 

For lung sounds I generally do not have a problem hearing them, but usually (especially if its a bumpy ride) I am less confient than I would like in what I am hearing. I think this will improve once I have heard more wheezing, crackles etc. Websites with lung sounds are a good idea though.


----------



## VentMedic (Jul 24, 2009)

SeeNoMore said:


> CAOX3, I certainly don't doubt your abilities. At this point though I would side with taking vitals all the time, but I am very new.


Since you are a new EMT-B  you should take vitals and do your assessment.  You should also follow your protocols and seek advice from your supervisiors, training officers and Medical Director when you are in doubt.  Remember this is an anonymous forum and not all advice you get here will be "quality".   Do not think that an EMT-B cert prepares you with the knowledge to do an adequate medical assessment to make judgments about many of the patients you will see.   The EMT-B curriculum does not even give you enough anatomy, physiology or pathophysiology for you to even know all the possibilities of what could be happening to that patient.  The EMT-B is primarily a first aid course. 

However, that doesn't mean you won't learn more if you continue your education.  Once you have started to advance your training and education, you can come back and re-read this thread and see how irresponsible some of the statements are from one forum member.


----------



## CAOX3 (Jul 24, 2009)

VentMedic said:


> If you blew off all of those patients as BS and not requiring at least a set of vitals for your documentation, I would say you don't know when not to take a BP. You will also look pretty stupid handing in your cert to your state board when anyone of these patients has a severe medical problem that requires emergent attention right after you drive off in your ambulance without even touching the patient. Let's see, how many headlines have we had this past year where that has happened to someone in EMS? It is a shame some waste so much time trying to get out of work.



I just think you like to argue.

Really are those the best you could come up with.  

The roommate died from a fall, photosensitive maybe if I hadn't been there 10 times for them beating each other in the street and sz's rectified by the sound of quarters hitting the ground? 

Sixty year old elbow pain, no the pain didn't change just the reason for her dialing 911.

Do you always twist the story?  Or do you just do that on the road so your service can charge for an ALS assessment?  I think that may be against the law.

Actually its computerized axial tomography, any way.

They are all transported if they choose to go, they go. We don't have a do not transport protocol.

Yes as I stated before I am not under the impression the more busy I look the more I am doing for my patient.

No one is denied medical care they are all taken to the hospital to wait their ten to fifteen hours in the waiting room.

Anyway nice talking to you Vent as always the pleasure has been all mine.


----------



## CAOX3 (Jul 24, 2009)

VentMedic said:


> Since you are a new EMT-B  you should take vitals and do your assessment.  You should also follow your protocols and seek advice from your supervisiors, training officers and Medical Director when you are in doubt.  Remember this is an anonymous forum and not all advice you get here will be "quality".   Do not think that an EMT-B cert prepares you with the knowledge to do an adequate medical assessment to make judgments about many of the patients you will see.   The EMT-B curriculum does not even give you enough anatomy, physiology or pathophysiology for you to even know all the possibilities of what could be happening to that patient.  The EMT-B is primarily a first aid course.
> 
> However, that doesn't mean you won't learn more if you continue your education.  Once you have started to advance your training and education, you can come back and re-read this thread and see how irresponsible some of the statements are from one forum member.



WRONG! My EMT class required both Anatomy and Physiology a semester of both taught by real professors and counting for real credits and such.

Again you group everyone together and twist the story to benefit your argument,  you have a bad habit of that.


----------



## JPINFV (Jul 24, 2009)

The scary thing is that your medical director and QI/QA departments are allowing you to get by without doing your job properly. Don't you think that there's liability issues for EMS not taking vital signs? What is the nureses reaction when you give report at the hospital and you can't even give a single vital sign? Do they really buy this, "Well, the patient didn't *look* sick, so I didn't really do my job," bull?


----------



## VentMedic (Jul 24, 2009)

CAOX3 said:


> I just think you like to argue.
> 
> Really are those the best you could come up with.


 
Truthfully I would love to know your real name and where you work so I can forward your posts to your medical director. 

It is time this profession moves forward and weeds out those who don't belong in EMS. 



> WRONG! My EMT class required both Anatomy and Physiology a semester of both taught by real professors and counting for real credits and such.
> 
> Again you group everyone together and twist the story to benefit your argument, you have a bad habit of that.
> 
> And that isn't arguing, that is stating a fact.


 
Wow! A whole semester! You must be just like a doctor now. And you haven't even gone past EMT-B.


----------



## CAOX3 (Jul 24, 2009)

JPINFV said:


> The scary thing is that your medical director and QI/QA departments are allowing you to get by without doing your job properly. Don't you think that there's liability issues for EMS not taking vital signs? What is the nureses reaction when you give report at the hospital and you can't even give a single vital sign? Do they really buy this, "Well, the patient didn't *look* sick, so I didn't really do my job," bull?



No because when I call my report in for someone one who called 911 because they were scared of the dark, they go to chairs not to triage.


----------



## CAOX3 (Jul 24, 2009)

VentMedic said:


> Truthfully I would love to know your real name and where you work so I can forward your posts to your medical director.
> 
> It is time this profession moves forward and weeds out those who don't belong in EMS.
> 
> Wow! A whole semester! You must be just like a doctor now. And you haven't even gone past EMT-B.



Almost my friend


----------



## VentMedic (Jul 24, 2009)

CAOX3 said:


> Almost my friend


 
Try another two years of education so you can at least get your Paramedic patch and then you can have an idea of where you come off sounding like a real screw up who is too lazy to take a set of vitals.

You might even get over THINKING you are a doctor.


----------



## medic417 (Jul 24, 2009)

Ignorance is bliss.  Since some are not taking complete vitals they are not doing a proper assessment they can happily say their patients are complete BS.  

There are patients that are abusing the ambulance but w/o a true assessment you do not know.  In fact if the only medical education you have is as a basic you do not even come close to the knowledge or ability to determine they are complete BS.  

Do not get lazy.  You may safely transport 999 patients that you called BS on and did piss poor exam of then get 1 patient that you decide is BS and they die when had you done a proper assessment you would have realized they needed ALS.  They die and you live with the knowledge that you killed them because you were to lazy to do your job.


----------



## CAOX3 (Jul 24, 2009)

Let me just explain myself for the people who like to jump into the middle of a thread.

I do take vitals when required, OK its amazing this thread has got more play then the one where the medics taped ASA to the guys forehead and blew off the fact that he was an overdose.

I should absolutely turn in my certification because I didn't take vitals on the guy who called 911 from the ER waiting room, and then walked outside and down the street, because he didn't want to wait anymore and he thought coming in on a stretcher would have him looked at quicker.

Please


----------



## CAOX3 (Jul 24, 2009)

VentMedic said:


> Try another two years of education so you can at least get your Paramedic patch and then you can have an idea of where you come off sounding like a real screw up who is too lazy to take a set of vitals.
> 
> You might even get over THINKING you are a doctor.



I think Im a doctor? No I think Im a taxi driver.


----------



## medic417 (Jul 24, 2009)

CAOX3 said:


> Let me just explain myself for the people who like to jump into the middle of a thread.
> 
> I do take vitals when required, OK its amazing this thread has got more play then the one where the medics taped ASA to the guys forehead and blew off the fact that he was an overdose.
> 
> ...



Every..........never mind you won't listen so no point in dealing with you.  I do ask you quite posting crap that will lead to causing new EMTs to develop bad habits like you are promoting here.


----------



## CAOX3 (Jul 24, 2009)

medic417 said:


> Every..........never mind you won't listen so no point in dealing with you.  I do ask you quite posting crap that will lead to causing new EMTs to develop bad habits like you are promoting here.



No come on discussion is a good teaching tool.

This is an educational thread as long as some of us can stay away from name calling,


----------



## medic417 (Jul 24, 2009)

CAOX3 said:


> No come on discussion is a good teaching tool.
> 
> This is an educational thread as long as some of us can stay away from name calling,



Nothing educational about promoting not taking at least 1 set of vitals all patients.  Even in the ER they will do at least 2 sets.  1 set during triage and a second set prior to discharge even on Doctor confirmed BS patients.  It is part of doing a proper assessment.


----------



## Sasha (Jul 24, 2009)

Educational only worksif the person is open to being educated and you are not. No matter what anyone says you refuse to see another side.




CAOX3 said:


> No come on discussion is a good teaching tool.
> 
> This is an educational thread as long as some of us can stay away from name calling,


----------



## Shishkabob (Jul 24, 2009)

PS people--- Don't be lazy and use the monitor for your pulse or PulseOx for your heart rate.


----------



## JPINFV (Jul 24, 2009)

Linuss said:


> PS people--- Don't be lazy and use the monitor for your pulse or PulseOx for your heart rate.



Anyone who uses a pulse ox for the heart rate has no business using a pulse ox. The pulse on the pulse ox is for correlation, not documentation.


----------



## CAOX3 (Jul 24, 2009)

VentMedic said:


> Truthfully I would love to know your real name and where you work so I can forward your posts to your medical director.
> 
> It is time this profession moves forward and weeds out those who don't belong in EMS.



You are right I am definitely the problem with EMS. 

You want to weed out people who don't belong in EMS, get started it will be a long time before you get to me.


----------



## CAOX3 (Jul 24, 2009)

Sasha said:


> Educational only works if the person is open to being educated and you are not. No matter what anyone says you refuse to see another side.



You could be right, I am a little thick headed. I actually enjoy traditional education and often take classes not required.  No I am not a fan of training at all, to any extent.

That does not change the fact that I am not the only one here who hasn't done a complete set of vitals on every patient just the only one with enough sac to admit it.


----------



## medic417 (Jul 24, 2009)

CAOX3 said:


> That does not change the fact that I am not the only one here who hasn't done a complete set of vitals on every patient just the only one with enough sac to admit it.



Your right there are other lazy people as well, but they are smart enough to not admit it and look the part of a fool.


----------



## WuLabsWuTecH (Jul 24, 2009)

CAOX3 said:


> When are they not warranted?   I repeat JUST BECAUSE SOMEONES INITIATES 911 DOES NOT MAKE THEM SICK.
> 
> *Wululabswuthech*
> 
> Again you are assuming that every patient I come in contact with is sick. I am more then competent enough to distinguish who needs a blood pressure.



Chances are that there is SOMETHING wrong with them.  Yes there are some that call 911 just for kicks, but usually there is at least a MINOR condition wrong with them.  Like I said before, my partner had a patient who was sleepy from meds, then just keeled over.  BP would have helped him there but he never took a baseline (he actually was getting to it but he was using the NIBP on the monitor and had to change out the batteries first...)



CAOX3 said:


> WRONG! My EMT class required both Anatomy and Physiology a semester of both taught by real professors and counting for real credits and such.



I'm guessing that I've had a lot more anatomy and physiology that you have since I am premed and a biomedical engineer and on my way to hopefully one day being able to call myself a doctor.  I understand how epi increases blood pressure (vasoconstriction of the extremities, increase on cardiac output), I understand the hormones that regulate reabsorption of fluids from the collecting duct in a nephron (in the kidneys) and that vasopressin (or ADH as some of you older folks may have learned it) will increase blood pressure.

I also know that I'm about 6 years out from getting an MD and that even when I do, I will NEVER be able to estimate a BP on someone by looking at them.  I might be able to say they look normal, but I will not be able to with 100% accuracy tell you who is about to drop from hypoperfusion and who is about to blow an aneurysm just from looks.  If doctors could do that, they would teach that in medical school and eliminate the auscultating a BP portion of a physical exam.



CAOX3 said:


> No because when I call my report in for someone one who called 911 because they were scared of the dark, they go to chairs not to triage.



So you don't have to transfer care to a nurse?  Around here if the triage is full, we still have to wait for a nurse to give report to her and transfer care to her.  If she wants to put them in the waiting room until triage clears a spot for her to take vitals, that's up to her.

Now if she just sticks them in a chair and doesn't take vitals, that's all the more reason for you to have taken them!  If something were to go wrong, YOU are now the ONLY guy that could have caught it.



CAOX3 said:


> No come on discussion is a good teaching tool.
> 
> This is an educational thread as long as some of us can stay away from name calling,



Yes I agree, this is good discussion and it should help educate new basics that getting ALL the vitals are ALWAYS important.  There's no reason not to.  Tell me this, sure, you're great and know when you need and don't need vitals (at least according to you).  Why not take them?  What are you doing that's so important that you can't stop for 2-3 minutes and take a bp?



Linuss said:


> PS people--- Don't be lazy and use the monitor for your pulse or PulseOx for your heart rate.





JPINFV said:


> Anyone who uses a pulse ox for the heart rate has no business using a pulse ox. The pulse on the pulse ox is for correlation, not documentation.



Agreed!  Although I will admit on longer transport IFT, I will use the monitor for BP and pulse so I can remain seated and safe.  I'll still get up to take manual vitals once an hour and whenever anything seems kooky.


----------



## Shishkabob (Jul 24, 2009)

Except a monitor with leads alone doesn't tell you the pulse... just as a PulseOx doesn't tell your the rate.


----------



## WuLabsWuTecH (Jul 24, 2009)

CAOX3 said:


> That does not change the fact that I am not the only one here who hasn't done a complete set of vitals on every patient just the only one with enough sac to admit it.



I can count on one hand the number of times I (or between my partner and me) did not take a full set of vitals.

1) Lady who was cold and wearing thick, ski-jacket stype winter coat with also a sweatshirt under it.  Said she was cold and asked us to skip the bp.  Pt refused which is her right, so I skiped it.

2) Child, could not get accurate reading on pulse-ox.

3) Massive stabbing injuries to carotid artery and jugular vein.  Bleeding control came first and ensuring airway intact.  We got bp, pulse, respirs, but forgot about the pulseox.  It was in our bag and no one could reach it anyway due to holding bleeding control.

4) Transport time of less than a minute.  We decided just to go since it seemed to be a BS case so we could get ourselves back in service sooner and on the off chance it wasn't BS we'd already be at the hospital.  I got pulse, SpO2, and estimated respirs, but not a bp on this one.


----------



## CAOX3 (Jul 24, 2009)

medic417 said:


> Your right there are other lazy people as well, but they are smart enough to not admit it and look the part of a fool.



So if you do it but don't admit it its OK?

It has nothing to do with being lazy, as I stated before I don't have to look and feel busy to justify my role.  

I don't have to perform anything to feel like I am doing my job, some people need a ride they get a ride.  Others need transport they receive that.

There is a difference between sick and not sick whether you think I have the ability to differentiate between the two is irrelevant.

Do you always revert to name calling?


----------



## WuLabsWuTecH (Jul 24, 2009)

Linuss said:


> Except a monitor with leads alone doesn't tell you the pulse... just as a PulseOx doesn't tell your the rate.


A pulse ox estiamtes the rate right?  Based on the intervals between peak absorption?

And a monitor with leads can easily tell you the rate right?  Since you know that each grid is ## ms, can't you count the number of R peaks, divide by the number of boxes, and multiply by the time per box?


----------



## Shishkabob (Jul 24, 2009)

WuLabsWuTecH said:


> A pulse ox estiamtes the rate right?  Based on the intervals between peak absorption?
> 
> And a monitor with leads can easily tell you the rate right?  Since you know that each grid is ## ms, can't you count the number of R peaks, divide by the number of boxes, and multiply by the time per box?



PulseOx won't tell your if the pulse is regular or irregular, just that there is one.

A monitor with leads will not tell you if there is a physical beat (the pulse), only the electrical activity.  If you use just the monitor, and someone goes into "Pulseless Electrical Activity", but you don't check for a physical pulse, you're screwed.


----------



## CAOX3 (Jul 24, 2009)

WuLabsWuTecH said:


> I can count on one hand the number of times I (or between my partner and me) did not take a full set of vitals.
> 
> 1) Lady who was cold and wearing thick, ski-jacket stype winter coat with also a sweatshirt under it.  Said she was cold and asked us to skip the bp.  Pt refused which is her right, so I skiped it.
> 
> ...




Because you justified it to yourself makes it OK?  But when I do it I have blatant disregard for patient care and should hand in my cert? 

Be wary no EMS call is bullshiit every patient has a underlying life threatening emergency. :wacko:


----------



## medic417 (Jul 24, 2009)

CAOX3 said:


> So if you do it but don't admit it its OK?
> 
> It has nothing to do with being lazy, as I stated before I don't have to look and feel busy to justify my role.
> 
> ...



I have never called you a name.  If you think my statement applys to you perhaps you need to examine your patient care.  

A set of vitals is not busy work it is patient care, it is a medical professionals job.


----------



## SeeNoMore (Jul 24, 2009)

"Do not think that an EMT-B cert prepares you with the knowledge to do an adequate medical assessment to make judgments about many of the patients you will see. The EMT-B curriculum does not even give you enough anatomy, physiology or pathophysiology for you to even know all the possibilities of what could be happening to that patient. The EMT-B is primarily a first aid course."

 I feel more ignorant now than I have ever felt in my life,  don't worry, I don't see overconfidence as being a problem. But I am enrolled in A & P 1 + 2 and am working hard, well see.


----------



## VentMedic (Jul 24, 2009)

I have honestly never read more blatant excuses for not doing one's job.  Your partner must also be as bad as you or you would probably not be employed.   



CAOX3 said:


> You are right I am definitely the problem with EMS.


 
I couldn't have said that better myself. 



CAOX3 said:


> You want to weed out people who don't belong in EMS, get started it will be a long time before you get to me.


 
Hopefully your sloppiness is revealed soon enough. Hopefully it is not at the expense of the life of a patient.

So tell me since you are being so blatantly honest, do you turn in a blank report form or do you make up numbers? Does your company bill for what you don't do?  Falsifiation of records?  Fraud? 



> It has nothing to do with being lazy, as I stated before I don't have to look and feel busy to justify my role.


You have just belittled the role of EMT-Bs. 



> Be wary no EMS call is bullshiit every patient has a underlying life threatening emergency


 
How would you know? You don't even take vitals. 

I hope the new EMTs are reading this and realize that if they get a partner like you, they need to immediately request a new one. They do not need to learn anything from you because you have little to offer and you have demonstrated that not only on this thread but on countless others. You are probably the best example of some of the worst examples of people working in EMS who has no interest in patient care and does not even understand a rather simple job description that the EMT-B has. Taking responsibility and doing what is required of you seems to mean little to you. 

But you said it yourself:


CAOX3 said:


> No I think Im a taxi driver.


 
I hope this thread will come to an end because all we are doing is feeding this so called EMT-B and like in many other threads he just wants to argue that patients are BS and waste his time.  That also sets you apart from taxi drivers because they do not believe their passengers are a waste of time.  

New EMT-Bs: Please understand that not all EMT-Bs out there will be like CAO but if you come across one that blatantly doesn't care or doesn't do his/her job, take notes and get another partner.  The notes will be for when he tries to pin all the blame on you later for what he didn't do.


----------



## VentMedic (Jul 24, 2009)

SeeNoMore said:


> I feel more ignorant now than I have ever felt in my life, don't worry, I don't see overconfidence as being a problem. But I am enrolled in A & P 1 + 2 and am working hard, well see.


 
We all feel that way when we are first starting out. It is what you do with that feeling that counts. By you enrolling in A&P, you will have education to go along with your patient care. You will learn something new every day. Even the most "boring" calls can be your laboratory for learning. The patient is only going to give you a few obvious clues. You will have to find the others on your own by doing a thorough assessment.


----------



## WuLabsWuTecH (Jul 24, 2009)

Linuss said:


> PulseOx won't tell your if the pulse is regular or irregular, just that there is one.
> 
> A monitor with leads will not tell you if there is a physical beat (the pulse), only the electrical activity.  If you use just the monitor, and someone goes into "Pulseless Electrical Activity", but you don't check for a physical pulse, you're screwed.



Yeah, basics here just apply the monitor or 12 lead, we don't interpret so I didn't mean ME persay!  I was in the understanding though (and correct me if I am wrong please) that PEA will now show a normal sinus rhythm on the monitor/12 lead?

And yes, that's why i always take a puse by hand.  I can feel it, whether it is strong, if it is thready, if we skip a beat here and there.  I believe the NIBP will flash a hear symbol whenever it feels a pulse but that still does not tell you whether it is strong, weak, etc.



CAOX3 said:


> [/B]
> 
> Because you justified it to yourself makes it OK?  But when I do it I have blatant disregard for patient care and should hand in my cert?
> 
> Be wary no EMS call is bullshiit every patient has a underlying life threatening emergency. :wacko:



CAOX3, please go back and read all of my posts in this thread if you do not believe me when I say: I have NEVER called for you to hand in your cert.  I'm merely part of a discussion on the opposing viewpoint to yours.  In the first three situations, there was no justification needed--it was impossible to do so.  In the last situation, the justification wasn't that the patient was BS, but that the hospital was so close delaying transport made no sense.  Had he been a critical patient we would have done the same.  As I pointed out in the OP (and the original topic of this thread) I cannot take that many vital signs that quickly and I just didn't get around to the BP before we arrived.  My radio report consisted of "we'll be getting the vitals that we can between here and there, upon first impression he seems stable, we'll let you know a full set when we get there.  Once again, ETA less than a minute, we picked up right around the corner."

When I arrived that obviously wasn't true, I still had to do a BP and I offered to do one for the triage nurse, but she said they had a free bay and not to worry about it.  In my PCR, there was no BP - transport time was listed as a barrier to getting the BP.  No worries, no problems.


----------



## CAOX3 (Jul 24, 2009)

VentMedic said:


> I have honestly never read more blatant excuses for not doing one's job.  Your partner must also be as bad as you or you would probably not be employed.  .



OK, thats professional and intelligent insult my partner also. If you cant have a cilvil conversation with a person that has a differing viewpoint then yours with, you shouldnt be the self proclaimed mayor of EMT city.



VentMedic said:


> I couldn't have said that better myself.
> 
> Hopefully your sloppiness is revealed soon enough. Hopefully it is not at the expense of the life of a patient..



You can assure yourself of that.



VentMedic said:


> So tell me since you are being so blatantly honest, do you turn in a blank report form or do you make up numbers? Does your company bill for what you don't do?  Falsifiation of records?  Fraud?..



If you read the post you would no the answer to that. 

Fraud would be an ALS work up for the guy who thought he caught mental retardation, but I bet your a pro at turning all your BLS calls in to ALS complaints to justify the twelve medics you have going to every medical.



VentMedic said:


> You have just belittled the role of EMT-Bs..



I belittle EMTs? What do you call what you do?



VentMedic said:


> I hope the new EMTs are reading this and realize that if they get a partner like you, they need to immediately request a new one. They do not need to learn anything from you because you have little to offer and you have demonstrated that not only on this thread but on countless others. You are probably the best example of some of the worst examples of people working in EMS who has no interest in patient care and does not even understand a rather simple job description that the EMT-B has. Taking responsibility and doing what is required of you seems to mean little to you..



Your breaking my heart. I have plenty of interest in patient care, when a patient requires it. 



VentMedic said:


> I hope this thread will come to an end because all we are doing is feeding this so called EMT-B and like in many other threads he just wants to argue that patients are BS and waste his time.  That also sets you apart from taxi drivers because they do not believe their passengers are a waste of time. .



So now your an expert on taxi drivers also?



VentMedic said:


> New EMT-Bs: Please understand that not all EMT-Bs out there will be like CAO but if you come across one that blatantly doesn't care or doesn't do his/her job, take notes and get another partner.  The notes will be for when he tries to pin all the blame on you later for what he didn't do.



You my friend remind me of someone who would leave their partner holding the bag, to protect his coveted position. The difference bwetween me and you is I work in EMS I am not defined by it. I am not perfect far from it.  Ask my wife 

Twelve years and no problems yet,  actually a few awards and accommodations.

You seem to be a expert on me and my actions.  I will keep you in mind to pen my biography. 

The problem is you haven't met to many people in EMS that don't hang on your every word especially an EMT and that bothers you.  

If I need mentoring I get that from the many providers that work in my service.  I don't need your approval.

Now back to the discussion, you still havent explained to me why a complete set of vital signs is needed for someone with an ingrown hair.


----------



## medic417 (Jul 24, 2009)

CAOX3 said:


> Now back to the discussion, you still havent explained to me why a complete set of vital signs is needed for someone with an ingrown hair.



Actually several of us have but you have chosen to ignore.


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## VentMedic (Jul 24, 2009)

*CAOX3,*
Your remarks are too pathetic to even comment on. 

*My advice for others is don't feed this troll anymore. He won't stop even though he has no point to make.*

*For the newcomers*, there are serveral other good posts here for you to get information from. Don't fall into the bad habits CAOx3 has given examples of and advance your education. Please do not remain an EMT-B for 12 years if you want a *career* in EMS. However, when you are an EMT-B, don't become complacent, disgruntled, lazy and need to constantly seek excuses to not do patient care. Do the job and do it well or don't do it at all.


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## CAOX3 (Jul 24, 2009)

medic417 said:


> Actually several of us have but you have chosen to ignore.



No what you told me was just do my job, what else do I have to do as an EMT and I am lazy, a detriment to my field, and pretty much a just some derelict of EMS.  Good thing I have thick skin.

What you fail to explain is why everyone needs a complete set of vitals signs without twisting the examples I gave to benefit your argument.


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## CAOX3 (Jul 24, 2009)

VentMedic said:


> *CAOX3,*
> Your remarks are too pathetic to even comment on.
> 
> *My advice for others is don't feed this troll anymore. He won't stop even though he has no point to make.*
> ...



Does that mean your not going to address my points


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## CAOX3 (Jul 24, 2009)

This will be my last post here at EMTLIFE the name calling and derogatory statements allowed here, have turned what used to be a very informative place into a site for a few un policed members to promote their personal agendas, without threat of discipline. It is a place I no longer choose to visit.

I have met some very nice people here to those I wish good luck.

I hope in the future this site returns to the educational tool it used to be.

Take care,

CAOX3


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## exodus (Jul 24, 2009)

I didn't see one post name calling. And if there is one, report it and boss man will take care of it...

Why is everyone getting pissed off? Because you are refusing to get vitals on every patient. Who cares if you don't think they're needed? It takes 2 minutes to get a baseline. Just do it, you don't have the medical knowledge to rule anything out.


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## TransportJockey (Jul 24, 2009)

Sasha said:


> Use the auto BP, it takes a pulse too!!!!
> 
> I kid, I kid.
> 
> One thing I learned is that respirations are sometimes hard to count when the patient is breathing so shallowly you have to check a pulse to make sure they haven't died, I find a stethescope is useful for counting the resps for these patients. Before anyone jumps in for the kill, the only patients I have had like that were hospice patients with a DNR at an old job. On the off chance you run into one of those... there's a tip!


I've had those patients before. On a four hour transfer I'm just thankful that they were still breathing when we got them home


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## rescue99 (Jul 24, 2009)

Actually COAX3, 

Vent is correct... Medicare/Medicaid/insurance fraud would be falsely documenting care or treatment not rendered. We're responsible for not only what we do...but for the things we do no do as well. When we falsify what we are supposed to do, we cheat not just the patient out of good care but, compromise the integrity of the profession.


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## akflightmedic (Jul 24, 2009)

CAOX3 said:


> This will be my last post here at EMTLIFE the name calling and derogatory statements allowed here, have turned what used to be a very informative place into a site for a few un policed members to promote their personal agendas, without threat of discipline. It is a place I no longer choose to visit.
> 
> I have met some very nice people here to those I wish good luck.
> 
> ...



Clap Clap Clap....I always love the dramatic exits.


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## medic417 (Jul 24, 2009)

akflightmedic said:


> Clap Clap Clap....I always love the dramatic exits.



And this years award for best exit goes to...................................


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## medic417 (Jul 24, 2009)

Sadly CAO has bragged on other sites about getting people riled here and  even bragged about getting some banned.  Now he is trying to act like a victim when called out for a dangerous practice in hopes Vent, myself and others will get banned.  But I am sure the mods will see through his game.


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## VentMedic (Jul 24, 2009)

medic417 said:


> Sadly CAO has bragged on other sites about getting people riled here and even bragged about getting some banned. Now he is trying to act like a victim when called out for a dangerous practice in hopes Vent, myself and others will get banned. But I am sure the mods will see through his game.


 
It is also sad that he knew what he was doing and has done this before on a couple of other threads, which I did get warnings for from the mods for telling him to knock off promoting bad and dangerous practice.   I believe he knew what he was doing or stating he was doing was wrong but just wanted to create a mess.  That is not a good example for the many young people we have here who are just starting out.  

However, I will still stick by my message to not stay at EMT-B if you want a career in EMS or anything.  You must continue your education and that begins the minute your EMT class ends.


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## Shishkabob (Jul 24, 2009)

VentMedic said:


> You must continue your education and that begins the minute your EMT class ends.



Or 5 months later like me


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## WuLabsWuTecH (Jul 24, 2009)

Linuss said:


> Or 5 months later like me



Hey, at least you have a job now right?



jtpaintball70 said:


> I've had those patients before. On a four hour transfer I'm just thankful that they were still breathing when we got them home



And to get us back on track, I love the stethoscope idea from sasha for counting respirs.

Also, anyone ever use a doppler steth?  We carry one, but it seems like a messy proposition to me!


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