Help with manual vitals?

[Mitchellmvhs]

Hey everyone I was looking to see if I could get some suggestions on taking manual BLS vitals.

I honestly always feel embarrassed to ask, but I really want to be a good EMT. I work in Orange County on a BLS ambulance and have about 6 months experience now. I’ve done both some 911, but primarily IFT. Some patients I have no problems getting vitals on, but some I really struggle with or don’t feel entirely confident with what I’m getting.

There have been pt’s ive taken who are perfectly stable, but I still for the life of me can’t auscultate a BP or even struggle to find their radial pulse. I know if you can’t hear it, palpate. But there are times I struggle to even do that. I even bought myself a Littman Cardio III stethoscope, because I hated using the garbage ones my company supplies, but even with it I still struggle sometimes.
My current method of taking BP’s in the back of the rig is to fully extend the pt’s arm if they can, palpate for the brachial and then place the steth on it. Anyone have any suggestions so I can confidently get them everytime? I genuinely ALWAYS take manual vitals on my pt’s regardless if it’s a boring IFT because I really want to get better.

I just got hired for transfer at AMR riverside and I’m going to try to get on an ALS 911 car with a medic and I really want to have my vitals dialed before I do more 911 and have more serious calls. Any input or tips and tricks I would really appreciate.

 

[Akulahawk]

Extend the arm until it's about as straight as it'll go but don't hyperextend the elbow. Then palpate the biceps tendon and place the diaphragm just medial to that. Otherwise there's a little depression inline with that tendon and put the diaphragm midline to the tendon with the top of the steth head touching the joint line (maybe bias a little toward medial side) and you should be good to go. Another thing is to lift the arm off the stretcher and kind of suspend it using your knee/leg. This helps isolate it from the road noise so you'll be hearing less of it. Another tip is to make sure that the diaphragm you're using is the "active" one so gently tap on it to make sure you're hearing/using the correct side (if yours is a double sided steth). Every so often you'll hear more of a "pressure" rather than a "tap" sound. The hardest thing to do is not move your fingers while doing the vitals because you will easily hear the creaking of your joints over nearly everything else. Been there, done that... about 23k times over my career before becoming an ED RN and letting the machine do most of that work for me.

 

[Ensihoitaja]

To add to what Akulahawk said, try palpating for a brachial pulse. Once you find it, put the stethoscope on top of that and you'll hear anything there is to hear. It's also a handy spot to check pulses on restrained patients.

 

[Akulahawk]

To add to what Akulahawk said, try palpating for a brachial pulse. Once you find it, put the stethoscope on top of that and you'll hear anything there is to hear. It's also a handy spot to check pulses on restrained patients.

I did not mention this because if you can palpate the brachial pulse, this is what you do! The stuff I mentioned is what you can try if you cannot palpate the brachial pulse. You're still listening to that artery but you're using an alternate method of locating an appropriate place to listen.

 

[planetmike]

It can help to lift your own legs up off the floor of the ambulance to isolate road noise. Try placing them on the stretcher's lower frame. It's a skill that you have to practice at, with lots of different patients. So keep at it.

 

[Jambow]

I agree, feet off the floor and resting on the bottom frame of the stretcher
Get vitals while sitting still if possible
Once you have a good baseline then you know what to listen for
Move the diaphragm medial / more to the inside of the arm, normally works for me
Radials - I generally grip the wrist with firm but gentle pressure then release pressure gradually
until I can feel the pulse. Works sometimes.
Too tight can completely restrict the radial artery, to loose may not compress it enough
Vary the pressure and think of your fingers as a NIBP cuff (the way I think of it)
Like you said practice on everyone, it will come with time
I work doing stress testing now, and get blood pressures with people walking on a treadmill
New people really struggle with this skill