Let's Take vitals!

Why in the world would we not want to take vitals? It helps us know what is going on with the PT, or at least give as much information as possible to the ER.

I think taking good vitals is essential. And at least for me, not a simple task. I have only been doing the job a few weeks though. In school I was not the greatest with BP, but that has been getting better with the combination of more careful technique and a better scope.

Lung sounds I am having a hard time with en route. Somtimes what I hear is very faint. But I am honest about it no matter how stupid I feel. And I do feel incredibly stupid.

But anyway, vitals! Sasha is 100 percent correct.
 
Sasha said:
Anyway what? What else do you have to do back there? Nothing! You are an EMT, your whole job is to take vitals and shuttle them to the ER. Don't get lazy and possibly hurt your patients. If you can't bring yourself to take five minutes out of your hospital ride to grab a blood pressure, lung sounds, pulse rate, temp, BGL (and that's if you are slow.) then you should reconsider your position. You don't run a wheel chair van, you run on an ambulance where the patients expect care. Care does not include you sitting on your butt not doing anything because you believe it's a waste of time.

Only a foolish person believes that they can look at a patient and tell that they are sick.
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Oh and I thought me and you were cozying up to each other.

Excuse me? I owe you no justification as to how I treat my patients or what is required of me.

You cant even explained to me why? Because isn't a reason and care isn't determined by how busy I look to my patient.

Actually an good provider can determine some amount of severity based on patient appearance and the need for further assessment, contrary to popular belief sick people usually look sick.

I don't just do everything because something may turn up, that isn't how it works. If I walk into an ER drunk I don't get a 12 lead and a cat scan because I may have an underlying condition. Thats ridiculous.

We have removed patient assessment and replaced it with flow charts of what we are supposed to do, its bull shiit. If you cant adequately assess your patient then get out, a monkey can take a blood pressure and a pulse. their is no substitution for the human element.

Sorry if you cant accept the fact that I can admit what more then a few providers here would agree with but are to afraid to admit.

Your problem is you cant see anything but black an white, its either right or wrong with you. There is no gray. The fact is there is more gray then anything else, you will realize this as you move on in your career.

I am also glad you do vital on all your IFT patients they are considerably more sick then the majority of the patients I see.
 
SeeNoMore said:
Why in the world would we not want to take vitals? It helps us know what is going on with the PT, or at least give as much information as possible to the ER.

I think taking good vitals is essential. And at least for me, not a simple task. I have only been doing the job a few weeks though. In school I was not the greatest with BP, but that has been getting better with the combination of more careful technique and a better scope.

Lung sounds I am having a hard time with en route. Sometimes what I hear is very faint. But I am honest about it no matter how stupid I feel. And I do feel incredibly stupid.

But anyway, vitals! Sasha is 100 percent correct.
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Are you having problems hearing them or distinguishing one from the other. Or are you just doing it because they told you to? Do yourself a favor and learn the meaning and what the presence or absence of such lung sounds mean.

There are many websites that have audible recording of different lung sounds and the only way you will master a BP is by practice, don't use the BP machines as a substitute because you are having a hard time, that machine will ultimately let you down.

As far as the discussion between me and Sasha, I do take vital signs I just don't feel the need to take a BGL on everyone or a BP on a guy who wants a ride to the hospital so he comes up with some cockamamie story about how he has a history of cardiac arrest and it happened this morning now he wants to get it checked out and can I give him Valium for that so it doesn't happen again.

Or a guy who witnessed a squirrel being hit by a car could I take him to the hospital so he can talk to someone about it.

The woman who's friend died yesterday in the same house as her and wants to be checked out to make sure she didn't catch what killed her friend.

I like the young guy who has a seizure with one eye open but then it miraculously stops when he hears the sound of change hitting the ground.

Or the ones that call 911 cause their their neighbors Christmas lights are to bright and he thinks they have done permanent damage to his eyesight.

They guy who has recently had a heart translplant and does not think its working any more, but he has no scar on his chest.

Or the wonam has a pain in her elbow and when I ask how long its been going on she says since she fell in grammer school. she is 68.

And the best of all time drum role please, The guy who believes he has caught mental retardation because he sat next to a retarded guy on the bus yesterday.

Trust me I know when to take a blood pressure.

I also when one isnt required.
 
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CAOX3 said:
Are you having problems hearing them or distinguishing one from the other. Or are you just doing it because they told you to? Do yourself a favor and learn the meaning and what the presence or absence of such lung sounds mean.

There are many websites that have audible recording of different lung sounds and the only way you will master a BP is by practice, don't use the BP machines as a substitute because you are having a hard time, that machine will ultimately let you down.

As far as the discussion between me and Sasha, I do take vital signs I just don't feel the need to take a BGL on everyone or a BP on a guy who wants a ride to the hospital so he comes up with some cockamamie story about how he has a history of cardiac arrest and it happened this morning now he wants to get it checked out and can I give him Valium for that so it doesn't happen again.

Or a guy who witnessed a squirrel being hit by a car could I take him to the hospital so he can talk to someone about it. Witnessing something disturbing can trigger many emotions. Instead of just blowing him off why not ask if a friend can stay with him or take him to a clinic? As well stressful events can raise BP so one should be taken just for documentation purpose and to see if the stressors hasn't triggered something more.

The woman who's friend died yesterday in the same house as her and wants to be checked out to make sure she didn't catch what killed her friend. Ever hear about Influenza A, TB, Meningitis? We (and the Department of Public Health) insist the housemates of those come to the hospital or clinic for followup.

I like the young guy who has a seizure with one eye open but then it miraculously stops when he hears the sound of change hitting the ground. You do realize there are many different types of seizures?


Or the ones that call 911 cause their their neighbors Christmas lights are to bright and he thinks they have done permanent damage to his eyesight. People who are photosensitive do feel that way and it may be a fairly sudden onset from a new med or medical condition.

They guy who has recently had a heart translplant and does not think its working any more, but he has no scar on his chest. Maybe he has his terminology confused. We also do a lot of heart surgery by minimally invasive means and video cams. So don't be surprised if you don't always see a big sternotomy scar when they say then just had heart surgery. Of course for the heart transplant you would know by his meds also.

Or the wonam has a pain in her elbow and when I ask how long its been going on she says since she fell in grammer school. she is 68. But what made her call today? What is different? She is just giving you a history and may be just trying to be a good historian which is rare.

And the best of all time drum role please, The guy who believes he has caught mental retardation because he sat next to a retarded guy on the bus yesterday. So what is causing his AMS? Has he not been taking his meds? Or, is something else askew like electrolytes? Psych disorder not yet identified?
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CAOX3 said:
Trust me I know when to take a blood pressure.

I also when one isnt required.
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If you blew off all of those patients as BS and not requiring at least a set of vitals for your documentation, I would say you don't know when not to take a BP. You will also look pretty stupid handing in your cert to your state board when anyone of these patients has a severe medical problem that requires emergent attention right after you drive off in your ambulance without even touching the patient. Let's see, how many headlines have we had this past year where that has happened to someone in EMS? It is a shame some waste so much time trying to get out of work.
 
CAOX3 said:
Actually an good provider can determine some amount of severity based on patient appearance and the need for further assessment, contrary to popular belief sick people usually look sick.
Wow! That's not a good or intelligent statement at all. It also shows you lack of knowledge of many medical conditions.

I don't just do everything because something may turn up, that isn't how it works. If I walk into an ER drunk I don't get a 12 lead and a cat scan because I may have an underlying condition. Thats ridiculous. If your complaint is chest pain or shortness of breath or if anything was found suspicious on an assessment, yes you may get a workup especially if you have a hx of alcohol abuse. BTW, it is CT Scan and not cat scan like in the comic books.

We have removed patient assessment and replaced it with flow charts of what we are supposed to do, its bull shiit. If you cant adequately assess your patient then get out, a monkey can take a blood pressure and a pulse. their is no substitution for the human element. So your service doesn't trust you to assess so they have given you recipes to follow instead of assessments and yet you are speaking about knowing when to take vitals or BS patients?

Sorry if you cant accept the fact that I can admit what more then a few providers here would agree with but are to afraid to admit. I accept the fact that you are making broad statements about areas of medicine you know very little about.

Your problem is you cant see anything but black an white, its either right or wrong with you. There is no gray. The fact is there is more gray then anything else, you will realize this as you move on in your career. I was about to say the same for you. When you ASSUME you can eyeball someone and determine if they are sick enough or worthy of your attention, you need to move on.

I am also glad you do vital on all your IFT patients they are considerably more sick then the majority of the patients I see.
At least we agree there.
[/qoute]

Now, aren't you an EMT-B? You seem to believe you can determine who is worthy of healthcare and who is not? 120 hours of first-aid training and you know all about medical calls?
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CAOX3 said:
When are they not warranted? I repeat JUST BECAUSE SOMEONES INITIATES 911 DOES NOT MAKE THEM SICK.

Thats why EMTs don't get any respect? Who doesn't get any respect? EMS as a whole does not get any respect because we have providers out there who think its ok to tape ASA to someones forehead and so on, I dont realy need to go there you get the picture.

Lazy? Yes I'm lazy cause I can determine who needs a complete set of vitals signs and who doesn't?

Wululabswuthech

Again you are assuming that every patient I come in contact with is sick. I am more then competent enough to distinguish who needs a blood pressure.

Exodus

You have a problem with me not taking a blood pressure on someone who isn't sick but think its completely OK to "fluff vitals" or better stated falsify a medical record. I don't fluff anything, if I don't take a pressure one isn't written.
Fluffing means estimating. If I have pt being discharged from the ER that is stable, and is going home. I have no problem estimating something like RESPIRATORY RATE. It is fairly easy to estimate and usually accurate on a stable patient. If I don't take a BP and have a damn good reason, I get written up for not completely a patient assessment because our company expects the EMT's to give the PT FULL CARE. It is not OUR job to decide if it's an emergency to them. It's our JOB to get them to the ER (Or home) a full report.

Both of your examples are ridiculous, dialysis patients are sick and so are severely obese patients.
No crap they're sick. And guess what? I get FULL (bls) vitals EVERY SINGLE TIME!


As far as the ER, them recording vital signs is a liability issue, so when you keel over and die after waiting eight hours for treatment, they can say well we took his vital and he was stable.
Look in your EMT book for the definition of Trending. And yes, even as a basic, I have used trending before to determine things happening with the pt.
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n tenchar
Bolded.
 
Last I knew vitals are not only necessary but are in virtually all protocols, including return home transports. Barring and AOX4 patient absolutely refuses and you document the event or some strange circumstance of the call prohibits a complete set, it takes just a moment. NO COAX3, a a 12 lead on a drunk isn't always needed and a glucose check on a broken ankle isn't either. Are they sometimes? YEP! The question is....are "baseline" vitals and assessment necessary on all patients? The answer to that is real simple....ummm, yeah they are!
 
CAOX3, I certainly don't doubt your abilities. At this point though I would side with taking vitals all the time, but I am very new.

BP is not a problem area, but I do want to keep in good practice to make sure I am absolute as possibile.

For lung sounds I generally do not have a problem hearing them, but usually (especially if its a bumpy ride) I am less confient than I would like in what I am hearing. I think this will improve once I have heard more wheezing, crackles etc. Websites with lung sounds are a good idea though.
 
SeeNoMore said:
CAOX3, I certainly don't doubt your abilities. At this point though I would side with taking vitals all the time, but I am very new.
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Since you are a new EMT-B you should take vitals and do your assessment. You should also follow your protocols and seek advice from your supervisiors, training officers and Medical Director when you are in doubt. Remember this is an anonymous forum and not all advice you get here will be "quality". Do not think that an EMT-B cert prepares you with the knowledge to do an adequate medical assessment to make judgments about many of the patients you will see. The EMT-B curriculum does not even give you enough anatomy, physiology or pathophysiology for you to even know all the possibilities of what could be happening to that patient. The EMT-B is primarily a first aid course.

However, that doesn't mean you won't learn more if you continue your education. Once you have started to advance your training and education, you can come back and re-read this thread and see how irresponsible some of the statements are from one forum member.
 
VentMedic said:
If you blew off all of those patients as BS and not requiring at least a set of vitals for your documentation, I would say you don't know when not to take a BP. You will also look pretty stupid handing in your cert to your state board when anyone of these patients has a severe medical problem that requires emergent attention right after you drive off in your ambulance without even touching the patient. Let's see, how many headlines have we had this past year where that has happened to someone in EMS? It is a shame some waste so much time trying to get out of work.
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I just think you like to argue.

Really are those the best you could come up with.

The roommate died from a fall, photosensitive maybe if I hadn't been there 10 times for them beating each other in the street and sz's rectified by the sound of quarters hitting the ground?

Sixty year old elbow pain, no the pain didn't change just the reason for her dialing 911.

Do you always twist the story? Or do you just do that on the road so your service can charge for an ALS assessment? I think that may be against the law.

Actually its computerized axial tomography, any way.

They are all transported if they choose to go, they go. We don't have a do not transport protocol.

Yes as I stated before I am not under the impression the more busy I look the more I am doing for my patient.

No one is denied medical care they are all taken to the hospital to wait their ten to fifteen hours in the waiting room.

Anyway nice talking to you Vent as always the pleasure has been all mine.
 
VentMedic said:
Since you are a new EMT-B you should take vitals and do your assessment. You should also follow your protocols and seek advice from your supervisiors, training officers and Medical Director when you are in doubt. Remember this is an anonymous forum and not all advice you get here will be "quality". Do not think that an EMT-B cert prepares you with the knowledge to do an adequate medical assessment to make judgments about many of the patients you will see. The EMT-B curriculum does not even give you enough anatomy, physiology or pathophysiology for you to even know all the possibilities of what could be happening to that patient. The EMT-B is primarily a first aid course.

However, that doesn't mean you won't learn more if you continue your education. Once you have started to advance your training and education, you can come back and re-read this thread and see how irresponsible some of the statements are from one forum member.
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WRONG! My EMT class required both Anatomy and Physiology a semester of both taught by real professors and counting for real credits and such.

Again you group everyone together and twist the story to benefit your argument, you have a bad habit of that.
 
The scary thing is that your medical director and QI/QA departments are allowing you to get by without doing your job properly. Don't you think that there's liability issues for EMS not taking vital signs? What is the nureses reaction when you give report at the hospital and you can't even give a single vital sign? Do they really buy this, "Well, the patient didn't look sick, so I didn't really do my job," bull?
 
CAOX3 said:
I just think you like to argue.

Really are those the best you could come up with.
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Truthfully I would love to know your real name and where you work so I can forward your posts to your medical director.

It is time this profession moves forward and weeds out those who don't belong in EMS.

WRONG! My EMT class required both Anatomy and Physiology a semester of both taught by real professors and counting for real credits and such.

Again you group everyone together and twist the story to benefit your argument, you have a bad habit of that.

And that isn't arguing, that is stating a fact.
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Wow! A whole semester! You must be just like a doctor now. And you haven't even gone past EMT-B.
 
JPINFV said:
The scary thing is that your medical director and QI/QA departments are allowing you to get by without doing your job properly. Don't you think that there's liability issues for EMS not taking vital signs? What is the nureses reaction when you give report at the hospital and you can't even give a single vital sign? Do they really buy this, "Well, the patient didn't look sick, so I didn't really do my job," bull?
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No because when I call my report in for someone one who called 911 because they were scared of the dark, they go to chairs not to triage.
 
VentMedic said:
Truthfully I would love to know your real name and where you work so I can forward your posts to your medical director.

It is time this profession moves forward and weeds out those who don't belong in EMS.

Wow! A whole semester! You must be just like a doctor now. And you haven't even gone past EMT-B.
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Almost my friend :)
 
CAOX3 said:
Almost my friend :)
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Try another two years of education so you can at least get your Paramedic patch and then you can have an idea of where you come off sounding like a real screw up who is too lazy to take a set of vitals.

You might even get over THINKING you are a doctor.
 
Ignorance is bliss. Since some are not taking complete vitals they are not doing a proper assessment they can happily say their patients are complete BS.

There are patients that are abusing the ambulance but w/o a true assessment you do not know. In fact if the only medical education you have is as a basic you do not even come close to the knowledge or ability to determine they are complete BS.

Do not get lazy. You may safely transport 999 patients that you called BS on and did piss poor exam of then get 1 patient that you decide is BS and they die when had you done a proper assessment you would have realized they needed ALS. They die and you live with the knowledge that you killed them because you were to lazy to do your job.
 
Let me just explain myself for the people who like to jump into the middle of a thread.

I do take vitals when required, OK its amazing this thread has got more play then the one where the medics taped ASA to the guys forehead and blew off the fact that he was an overdose.

I should absolutely turn in my certification because I didn't take vitals on the guy who called 911 from the ER waiting room, and then walked outside and down the street, because he didn't want to wait anymore and he thought coming in on a stretcher would have him looked at quicker.

Please
 
VentMedic said:
Try another two years of education so you can at least get your Paramedic patch and then you can have an idea of where you come off sounding like a real screw up who is too lazy to take a set of vitals.

You might even get over THINKING you are a doctor.
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I think Im a doctor? No I think Im a taxi driver.
 
CAOX3 said:
Let me just explain myself for the people who like to jump into the middle of a thread.

I do take vitals when required, OK its amazing this thread has got more play then the one where the medics taped ASA to the guys forehead and blew off the fact that he was an overdose.

I should absolutely turn in my certification because I didn't take vitals on the guy who called 911 from the ER waiting room, and then walked outside and down the street, because he didn't want to wait anymore and he thought coming in on a stretcher would have him looked at quicker.

Please
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Every..........never mind you won't listen so no point in dealing with you. I do ask you quite posting crap that will lead to causing new EMTs to develop bad habits like you are promoting here.
 
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