Let's Take vitals!

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WuLabsWuTecH

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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?
 
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.
 
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.
 
Any tips/secrets of the trade?
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Use the auto BP, it takes a pulse too!!!!

I kid, I kid. :P

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.
 
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.
 
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.
 
Pink, warm and dry.

Those are the extent of my vitals on the majority of my patients.
 
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.
 
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.
 
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!
 
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!
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Is is a race?

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

Just practise.
 
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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!
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Faster is not always better... Don't work towards getting faster, work towards getting better... ^_^
 
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!
 
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!
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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).
 
CAOX3 said:
Pink, warm and dry.

Those are the extent of my vitals on the majority of my patients.
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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.
 
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.
 
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.
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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!
 
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!
Click to expand...

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