Taking Vitals in the Rig--Training

[skyemt]

hi all...

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

has anyone had experience doing drills involving taking vitals?

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

thanks.

 

[emtangie850]

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

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

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

Hope that helps!

-Angela

 

[princess]

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

 

[firecoins]

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

 

[natrab]

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

 

[Airwaygoddess]

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

 

[emtangie850]

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

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

 

[BossyCow]

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

 

[emtwacker710]

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

 

[EMT19053]

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

 

[skyemt]

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

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

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

Paramedics, please speak about this...

 

[EMT19053]

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

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

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

Paramedics, please speak about this...

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

 

[micsaver]

Vitals on the move

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

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

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

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

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


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

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

 

[Hastings]

Count pulse for 15 and multiply by 4.

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

 

[traumateam1]

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

 

[JPINFV]

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

 

[Ridryder911]

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

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

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

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

R/r 911

 

[BossyCow]

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

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

 

[sixmaybemore]

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

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

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

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

 

[Hastings]

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

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

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

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