EMT Wrist Watch - Taking Pulse with No Second Hand

planetmike

planetmike

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Legit question: How do you take manual vital signs without a second hand? Check pulse and respirations for 15 seconds, multiply by 4?
 
Without a second hand, how do you know you're measuring 15 seconds in the first place?

Just get a watch that shows the seconds (whether analog with a seconds hand, or digital Timex or whatever), not exactly hard to find or expensive..
 
I have a watch that displays seconds. I just wait for a convenient 1/4 minute mark and count for 15 seconds. IOW, start at 15 seconds, count until I see "30" on the watch, or whatever other convenient start/finish points are. The other way I count a pulse is I get my pocket pulse oximeter and turn that on and wait for a short time for the device to stabilize. Then I have the pulse-ox and pulse rate.
 
Slip on pulse ox. LOL

Usually just palpate radial and after a few seconds think to myself, gee that is really fast, or gee that is really slow, or gee there are funny beats, or gee I feel nothing which means it could be one of the aforementioned or it could be an absent pulse. At any time with any of the above, the monitor goes on and I confirm or rule out my gees.

If pulse feels "normal" rate and strength, then I guesstimate 15-20 seconds and write a number fairly close. If it is 84 and I guesstimated 86 or 88, is there a clinical significance worthy of concern?
 
planetmike said:
Legit question: How do you take manual vital signs without a second hand? Check pulse and respirations for 15 seconds, multiply by 4?
Click to expand...

Or check pulse for 6 seconds and multiply by 10 to get in the ballpark.
 
When I actively worked in EMS I had a watch with a second hand, it was a requirement. I’d count for 15 seconds and then multiply by 4.

A month or so ago I went to take someone’s pulse, turned my watch towards me, and realized it didn’t display seconds. I quietly put on the pulse on and relied on what the pulse ox said.
 
Best not to overthink this -- too fast / too slow, weak/strong, regular/ irregular (irregularly irregular?). That plus CC, HPI and PMH are more important than a watch.
 
I'm not sure why my question was bumped over into its own thread, but whatever.

In my EMT classes, we emphasize that students should have a non-digital watch so they can take vital signs the old-fashioned way. Is this one of those ideas that in the real world, it doesn't matter, trust the technology? Monitor, pulse ox, patient's apple watch.
 
planetmike said:
In my EMT classes, we emphasize that students should have a non-digital watch so they can take vital signs the old-fashioned way.
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What do you mean? as long as your watch has a way to count seconds (either via a second hand or a digital seconds counter), does it really matter what type of watch you have?
 
In EMT class, the emphasis would be on the values associated with vital signs -- e.g., pulse and respiratory rates. In medic school and the real world, the character of those vitals is often more important than the rate. How respirations look and how the pulse feels can give responders broader impressions of presenting problems than just the numbers you're writing on a PCR.
 
For the purpose of actually taking a pulse rate manually, what I wrote is what I do. That being said, I rarely evaluate a pulse that way, rather I feel for fast/slow/regular/irregular/quality and that can be done in seconds and I don't actually care much exactly how fast the rate is. That being said, if I have to, I do know how to do it.

These days, that's what the finger pulse-ox or my monitor is for.

Interestingly enough, I had a patient in my ED the other day who had a bit of a soft BP. He was an adult to be sure, but a little guy. So, we checked for a pedal pulse and that was strong. Although he was sick, he didn't likely need pressors yet as he had a good very distal pulse and was likely perfusing reasonably well despite the absolute numbers. I know it's not pulse rate related but the overall concept is the same. Feel for the pulse, note character and fast/slow rate and put that in with the rest of your clinical decision-making and go from there.
 
planetmike said:
I'm not sure why my question was bumped over into its own thread, but whatever.
Click to expand...
It began in an off-topic and became a topic, therefore it was split off into its own thread.
 
planetmike said:
Legit question: How do you take manual vital signs without a second hand? Check pulse and respirations for 15 seconds, multiply by 4?
Click to expand...
I have a pretty accurate counting ability in my head. So I'd just count the seconds if needed. And I have tested I am accurate.

Edit: I do have a second hand and do use it, but it is an option for me. I just like watching the seconds go by. ADHD likes moving things.
 
Our state EMT skills testing doesn't allow any digital devices at the testing sites. That's probably where the non-digital watch came from. Since Covid, testing sites are no longer regional state-run, so it is a bit less of a requirement" to have a second hand.
 
planetmike said:
Our state EMT skills testing doesn't allow any digital devices at the testing sites. That's probably where the non-digital watch came from. Since Covid, testing sites are no longer regional state-run, so it is a bit less of a requirement" to have a second hand.
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iu

Normally I wouldn't ask this (out of respect for your privacy), but what state is saying this? because this sounds like a misinterpretation of a state regulation.

I've NEVER kicked a student out of testing for wearing a digital watch. never heard that they weren't permitted. cell phones, sure. smart watches, of course. laptops/tablets, duh. but a <$15 k-mart wrist watch that tells time, and that's all it does? that's a new one. We required all students to have a wrist watch, but I can't remember the last time I wore an analog watch. In fact, I am pretty sure I don't own one (maybe my fancy expensive one, but I haven't worn that in years, and there is no way I would take that to an EMS shift).
 
DrParasite said:
I've NEVER kicked a student out of testing for wearing a digital watch. never heard that they weren't permitted. cell phones, sure. smart watches, of course. laptops/tablets, duh. but a <$15 k-mart wrist watch that tells time, and that's all it does? that's a new one. We required all students to have a wrist watch, but I can't remember the last time I wore an analog watch. In fact, I am pretty sure I don't own one (maybe my fancy expensive one, but I haven't worn that in years, and there is no way I would take that to an EMS shift).
Click to expand...
Do they still have K-Marts in your neck of the woods?
 
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