Blood pressure
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DrParasite
The fire extinguisher is not just for show
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1) have you had your ears checked? serious question, as if you have a physical disability that needs to be corrected, no "tips" will help.
2) How well do you know A&P? the reason i ask is many people put the head of the scope in the wrong area...
many people put the scope directly in the bend of the elbow, and have trouble hearing; if you look at the picture above, you will see there is no artery there (it merges about an inch up on the humerus), , which would explain the lack of sounds. Try moving the head of your scope a half inch to the left or right. Or, more importantly, place the head of your scope in the correct location before you inflate the cuff, so you know you can hear something, so when you start taking the BP, you "should" hear something.
3) practice more, on good healthy people. everyone you know, everyone you work with, family members, etc. When I was first learning, I would practice on my coworkers. We've all been there. Some people are harder to hear, but often it's a technique issue, not a device/scope issue.
I've been doing this for a bit now, so it's very rare that I can't get a BP... not that I'm 100% accurate, or will never have issues, and my hearing has gotten worse since I've gotten older, but if you improve your technique, you will likely hear the Korotkoff sounds
2) How well do you know A&P? the reason i ask is many people put the head of the scope in the wrong area...
many people put the scope directly in the bend of the elbow, and have trouble hearing; if you look at the picture above, you will see there is no artery there (it merges about an inch up on the humerus), , which would explain the lack of sounds. Try moving the head of your scope a half inch to the left or right. Or, more importantly, place the head of your scope in the correct location before you inflate the cuff, so you know you can hear something, so when you start taking the BP, you "should" hear something.
3) practice more, on good healthy people. everyone you know, everyone you work with, family members, etc. When I was first learning, I would practice on my coworkers. We've all been there. Some people are harder to hear, but often it's a technique issue, not a device/scope issue.
I've been doing this for a bit now, so it's very rare that I can't get a BP... not that I'm 100% accurate, or will never have issues, and my hearing has gotten worse since I've gotten older, but if you improve your technique, you will likely hear the Korotkoff sounds
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You essentially have the gold standard of stethoscopes.
Practice!
If all else fails there are a variety of electronic stethoscopes you can try.
Practice!
If all else fails there are a variety of electronic stethoscopes you can try.
CCCSD
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Have you worked with your Instructors on this? Every question you post is something your school should be asked.
Well, I’m 18 and every ear exam I’ve had has been perfect, so I don’t think that is the problem. Yes, I know it doesn’t go in the center. I always put it in the area where I expect the brachial artery to be.
I’m certified and have been for months. There are no instructors to ask.
If you’re still having this much trouble understanding the material, reread your book, or retake the class. I’ve been reading the questions you’re asking and this is stuff that should have been discussed in your class. Either you weren’t paying attention and managed to somehow pass anyways, or you had poor instructors who didn’t go over the material well and just taught you how to pass the test.
NomadicMedic
I know a guy who knows a guy.
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A lot of these skills are simply repetition. The more blood pressures you take, the better off you’ll be. After taking a dozen or so you’ll recognize exactly where you need to put the bell of your stethoscope and what a blood pressure will sound like to you. Everybody’s a little bit different.
My suggestion is take the blood pressure of everyone in your family, everyone at your place of employment, any chance you get… Go get those blood pressures. Practice breeds competency with the simple, repetitive skills.
My suggestion is take the blood pressure of everyone in your family, everyone at your place of employment, any chance you get… Go get those blood pressures. Practice breeds competency with the simple, repetitive skills.
NomadicMedic
I know a guy who knows a guy.
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I’d also be a little concerned about how much material you were really taught versus how much of your instruction was simply designed to have you pass the test. Taking an EMT class isn’t like taking a social studies test where you just have to remember some dates and simple facts and regurgitate them onto a test paper. This job involves critical, thinking meshed with a constellation of psychometric skills. The skills of assessments, decision-making and treatment all come in to play. You need to be able to master these domains to be able to function as a competent EMT. If any are lacking, you’ll have a bad day .
I don’t think I need to retake the class. I was one of the top in my class, and passed national registry with only a few questions over the minimum, and I was paying attention in class. I’m not stupid. The questions I have asked are more advanced questions. I could be asking way more simple questions.
Actually the questions you have been asking are not that advanced. I never said you were stupid, but you might not have retained all the information you think you have. Every one. Of your posts asking questions has been people telling you to ask your instructors. That’s not a sign of us not wanting to help, it’s a big flashing sign telling you that these are not the advanced questions you think they are. Please review your book and ask your coworkers for help. They would be your best resources for these types of questions.
CCCSD
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Yep. You’re asking really basic level questions. If you think they are “advanced”, you weren’t paying attention. If you were “top of the class”, I’d ask for a refund.
It’s your patients we are concerned about.
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Have you been practicing on yourself, family, and friends? Can you ask your former school for another clinical rotation and spend the entire shift working on skills?
It really is just repetition.
Some potential issues:
1. Improper Positioning of the Stethoscope; Make sure the stethoscope's bell or diaphragm is placed firmly and directly over the brachial artery, just under the cuff and slightly towards the inner aspect of the arm.
2. Stethoscope Issues: Check if your stethoscope is functioning properly. Ensure the ear tips are securely attached, the tubing isn’t cracked, and the chest piece isn’t loose. Also, make sure the stethoscope is switched to the correct mode (bell or diaphragm) as needed.
3. Cuff Placement and Size: The cuff should be snug but not too tight and positioned correctly – about 2 cm above the elbow with the center of the cuff over the brachial artery. An incorrectly sized cuff (too large or too small) can also cause issues.
4. Inadequate Inflation Level: Ensure that the cuff is inflated sufficiently to occlude blood flow. Typically, this means inflating the cuff to about 20-30 mmHg above the point where the radial pulse disappears.
5. Technique: Double-check your technique. Slowly release the pressure in the cuff (about 2-3 mmHg per second) as releasing too quickly may cause you to miss the sounds.
It really is just repetition.
Some potential issues:
1. Improper Positioning of the Stethoscope; Make sure the stethoscope's bell or diaphragm is placed firmly and directly over the brachial artery, just under the cuff and slightly towards the inner aspect of the arm.
2. Stethoscope Issues: Check if your stethoscope is functioning properly. Ensure the ear tips are securely attached, the tubing isn’t cracked, and the chest piece isn’t loose. Also, make sure the stethoscope is switched to the correct mode (bell or diaphragm) as needed.
3. Cuff Placement and Size: The cuff should be snug but not too tight and positioned correctly – about 2 cm above the elbow with the center of the cuff over the brachial artery. An incorrectly sized cuff (too large or too small) can also cause issues.
4. Inadequate Inflation Level: Ensure that the cuff is inflated sufficiently to occlude blood flow. Typically, this means inflating the cuff to about 20-30 mmHg above the point where the radial pulse disappears.
5. Technique: Double-check your technique. Slowly release the pressure in the cuff (about 2-3 mmHg per second) as releasing too quickly may cause you to miss the sounds.
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In addition to what Matt said above, one of the ways I check for proper placement of the stethoscope head is that I actually feel/palpate the location of the brachial artery. Once I find it, I KNOW exactly where to put the stethoscope head.
One other way I verify that I'm in the right place is that I listen as I inflate the cuff and inflate a little bit slower through the range of about 60-110. Usually I'll hear the tapping sounds. Once I hear that, I again KNOW that the steth is in the right place and I'll inflate the rest of the way and deflate slowly-ish until I start hearing the sounds and deflate a little more quickly until I get down to where I first heard the sounds while inflating. Then I slow down again and note the point where the sounds disappear. At that point, I've gotten a very accurate BP measurement.
One other way I verify that I'm in the right place is that I listen as I inflate the cuff and inflate a little bit slower through the range of about 60-110. Usually I'll hear the tapping sounds. Once I hear that, I again KNOW that the steth is in the right place and I'll inflate the rest of the way and deflate slowly-ish until I start hearing the sounds and deflate a little more quickly until I get down to where I first heard the sounds while inflating. Then I slow down again and note the point where the sounds disappear. At that point, I've gotten a very accurate BP measurement.
I can assure you they are not “really basic” questions. I think a lot of my issue is I know the answer to what I’m asking, but I doubt myself so I ask for reassurance. No, I do not need to “ask for a refund”. **CL edit** And also, there is no need to be concerned about my patients. They’re in as good hands (or possibly better) as your patients. Unless you’re more than an EMT that is.
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Rubicon Bob
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Actually, yes, they are really basic questions
Then you do NOT know the answer
I have met many students/new folks like you
They all had ALL the answers
The majority also share something else, they are no longer in EMS
Not saying you won't make it, but with the attitude you have shown here, I'd say your chances of lasting 5 years (I actually think you are going to have a problem lasting 1 year) in EMS are slim to none.
Came out swinging and didn’t even try to be nice. Lol
DrParasite
The fire extinguisher is not just for show
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Let's review:
Why do you assess peoples pupils with possible head injuries that are fully alert and oriented? this is a pretty basic question
what do you do as far as supplemental o2 when the spo2 and presentation don’t match? this is a pretty basic questions
What should you do as far as supplemental oxygen if a patient has a normal spo2, and no obvious signs of hypoxia/dyspnea, but complains of difficulty breathing? this is a really basic
What do you do if someone has took a BLS medication (Zofran, Benadryl, albuterol etc.) prior to your arrival, but still needs more? this is a medical director question; still basic, but should be directed to your medical director for guidance
I’m having trouble I guess understanding the purpose of some of the history taking at a BLS level this is an extremely basic question
Does all types of shock cause low etco2 or just septic? this is a basic questions
What symptom differences are you going to see in a concussion, vs a subdural hematoma, vs an epidural hematoma, vs a subarachnoid hemorrhage? ok, this is not exactly a basic question, but how do your interventions change based on the location of the blood?
A few questions these are not basic questions, however you would be better off researching the medications in questions, seeing how they work, and what they do.
Questions are not frowned upon, however many of the questions you are asking should have been answered in EMT class. or at the local agency level. or by your medical director. or by doing your own research (IE, looking up the information, not asking others to provide the answers to you).
That doesn’t mean I don’t know the answer. That’s to make sure I’m 100% correct on what I do know. And by the way, you people on here acting like I’m an idiot makes me doubt myself even more.
You’re incorrect on your little “5 years” and “1 year” statement. I won’t have any trouble lasting as long as I want. I will probably be going to AEMT or medic school within a year or two. I work 3 different jobs and have heard nothing but compliments on my skill level.
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