No come on discussion is a good teaching tool.
This is an educational thread as long as some of us can stay away from name calling,
Let's Take vitals!
- Thread starter WuLabsWuTecH
- Start date
No come on discussion is a good teaching tool.
This is an educational thread as long as some of us can stay away from name calling,
medic417
The Truth Provider
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Nothing educational about promoting not taking at least 1 set of vitals all patients. Even in the ER they will do at least 2 sets. 1 set during triage and a second set prior to discharge even on Doctor confirmed BS patients. It is part of doing a proper assessment.
Sasha
Forum Chief
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Educational only worksif the person is open to being educated and you are not. No matter what anyone says you refuse to see another side.
Shishkabob
Forum Chief
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PS people--- Don't be lazy and use the monitor for your pulse or PulseOx for your heart rate.
JPINFV
Gadfly
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Anyone who uses a pulse ox for the heart rate has no business using a pulse ox. The pulse on the pulse ox is for correlation, not documentation.
You are right I am definitely the problem with EMS.
You want to weed out people who don't belong in EMS, get started it will be a long time before you get to me.
You could be right, I am a little thick headed. I actually enjoy traditional education and often take classes not required. No I am not a fan of training at all, to any extent.
That does not change the fact that I am not the only one here who hasn't done a complete set of vitals on every patient just the only one with enough sac to admit it.
medic417
The Truth Provider
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Your right there are other lazy people as well, but they are smart enough to not admit it and look the part of a fool.
WuLabsWuTecH
Forum Deputy Chief
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Chances are that there is SOMETHING wrong with them. Yes there are some that call 911 just for kicks, but usually there is at least a MINOR condition wrong with them. Like I said before, my partner had a patient who was sleepy from meds, then just keeled over. BP would have helped him there but he never took a baseline (he actually was getting to it but he was using the NIBP on the monitor and had to change out the batteries first...)
I'm guessing that I've had a lot more anatomy and physiology that you have since I am premed and a biomedical engineer and on my way to hopefully one day being able to call myself a doctor. I understand how epi increases blood pressure (vasoconstriction of the extremities, increase on cardiac output), I understand the hormones that regulate reabsorption of fluids from the collecting duct in a nephron (in the kidneys) and that vasopressin (or ADH as some of you older folks may have learned it) will increase blood pressure.
I also know that I'm about 6 years out from getting an MD and that even when I do, I will NEVER be able to estimate a BP on someone by looking at them. I might be able to say they look normal, but I will not be able to with 100% accuracy tell you who is about to drop from hypoperfusion and who is about to blow an aneurysm just from looks. If doctors could do that, they would teach that in medical school and eliminate the auscultating a BP portion of a physical exam.
So you don't have to transfer care to a nurse? Around here if the triage is full, we still have to wait for a nurse to give report to her and transfer care to her. If she wants to put them in the waiting room until triage clears a spot for her to take vitals, that's up to her.
Now if she just sticks them in a chair and doesn't take vitals, that's all the more reason for you to have taken them! If something were to go wrong, YOU are now the ONLY guy that could have caught it.
Yes I agree, this is good discussion and it should help educate new basics that getting ALL the vitals are ALWAYS important. There's no reason not to. Tell me this, sure, you're great and know when you need and don't need vitals (at least according to you). Why not take them? What are you doing that's so important that you can't stop for 2-3 minutes and take a bp?
Agreed! Although I will admit on longer transport IFT, I will use the monitor for BP and pulse so I can remain seated and safe. I'll still get up to take manual vitals once an hour and whenever anything seems kooky.
Shishkabob
Forum Chief
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Except a monitor with leads alone doesn't tell you the pulse... just as a PulseOx doesn't tell your the rate.
WuLabsWuTecH
Forum Deputy Chief
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I can count on one hand the number of times I (or between my partner and me) did not take a full set of vitals.
1) Lady who was cold and wearing thick, ski-jacket stype winter coat with also a sweatshirt under it. Said she was cold and asked us to skip the bp. Pt refused which is her right, so I skiped it.
2) Child, could not get accurate reading on pulse-ox.
3) Massive stabbing injuries to carotid artery and jugular vein. Bleeding control came first and ensuring airway intact. We got bp, pulse, respirs, but forgot about the pulseox. It was in our bag and no one could reach it anyway due to holding bleeding control.
4) Transport time of less than a minute. We decided just to go since it seemed to be a BS case so we could get ourselves back in service sooner and on the off chance it wasn't BS we'd already be at the hospital. I got pulse, SpO2, and estimated respirs, but not a bp on this one.
So if you do it but don't admit it its OK?
It has nothing to do with being lazy, as I stated before I don't have to look and feel busy to justify my role.
I don't have to perform anything to feel like I am doing my job, some people need a ride they get a ride. Others need transport they receive that.
There is a difference between sick and not sick whether you think I have the ability to differentiate between the two is irrelevant.
Do you always revert to name calling?
WuLabsWuTecH
Forum Deputy Chief
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A pulse ox estiamtes the rate right? Based on the intervals between peak absorption?
And a monitor with leads can easily tell you the rate right? Since you know that each grid is ## ms, can't you count the number of R peaks, divide by the number of boxes, and multiply by the time per box?
Shishkabob
Forum Chief
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PulseOx won't tell your if the pulse is regular or irregular, just that there is one.
A monitor with leads will not tell you if there is a physical beat (the pulse), only the electrical activity. If you use just the monitor, and someone goes into "Pulseless Electrical Activity", but you don't check for a physical pulse, you're screwed.
Because you justified it to yourself makes it OK? But when I do it I have blatant disregard for patient care and should hand in my cert?
Be wary no EMS call is bullshiit every patient has a underlying life threatening emergency. :wacko:
medic417
The Truth Provider
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I have never called you a name. If you think my statement applys to you perhaps you need to examine your patient care.
A set of vitals is not busy work it is patient care, it is a medical professionals job.
SeeNoMore
Old and Crappy
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"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."
I feel more ignorant now than I have ever felt in my life, don't worry, I don't see overconfidence as being a problem. But I am enrolled in A & P 1 + 2 and am working hard, well see.
I feel more ignorant now than I have ever felt in my life, don't worry, I don't see overconfidence as being a problem. But I am enrolled in A & P 1 + 2 and am working hard, well see.
I have honestly never read more blatant excuses for not doing one's job. Your partner must also be as bad as you or you would probably not be employed.
I couldn't have said that better myself.
Hopefully your sloppiness is revealed soon enough. Hopefully it is not at the expense of the life of a patient.
So tell me since you are being so blatantly honest, do you turn in a blank report form or do you make up numbers? Does your company bill for what you don't do? Falsifiation of records? Fraud?
How would you know? You don't even take vitals.
I hope the new EMTs are reading this and realize that if they get a partner like you, they need to immediately request a new one. They do not need to learn anything from you because you have little to offer and you have demonstrated that not only on this thread but on countless others. You are probably the best example of some of the worst examples of people working in EMS who has no interest in patient care and does not even understand a rather simple job description that the EMT-B has. Taking responsibility and doing what is required of you seems to mean little to you.
But you said it yourself:
I hope this thread will come to an end because all we are doing is feeding this so called EMT-B and like in many other threads he just wants to argue that patients are BS and waste his time. That also sets you apart from taxi drivers because they do not believe their passengers are a waste of time.
New EMT-Bs: Please understand that not all EMT-Bs out there will be like CAO but if you come across one that blatantly doesn't care or doesn't do his/her job, take notes and get another partner. The notes will be for when he tries to pin all the blame on you later for what he didn't do.
I couldn't have said that better myself.
Hopefully your sloppiness is revealed soon enough. Hopefully it is not at the expense of the life of a patient.
So tell me since you are being so blatantly honest, do you turn in a blank report form or do you make up numbers? Does your company bill for what you don't do? Falsifiation of records? Fraud?
You have just belittled the role of EMT-Bs.
How would you know? You don't even take vitals.
I hope the new EMTs are reading this and realize that if they get a partner like you, they need to immediately request a new one. They do not need to learn anything from you because you have little to offer and you have demonstrated that not only on this thread but on countless others. You are probably the best example of some of the worst examples of people working in EMS who has no interest in patient care and does not even understand a rather simple job description that the EMT-B has. Taking responsibility and doing what is required of you seems to mean little to you.
But you said it yourself:
I hope this thread will come to an end because all we are doing is feeding this so called EMT-B and like in many other threads he just wants to argue that patients are BS and waste his time. That also sets you apart from taxi drivers because they do not believe their passengers are a waste of time.
New EMT-Bs: Please understand that not all EMT-Bs out there will be like CAO but if you come across one that blatantly doesn't care or doesn't do his/her job, take notes and get another partner. The notes will be for when he tries to pin all the blame on you later for what he didn't do.
We all feel that way when we are first starting out. It is what you do with that feeling that counts. By you enrolling in A&P, you will have education to go along with your patient care. You will learn something new every day. Even the most "boring" calls can be your laboratory for learning. The patient is only going to give you a few obvious clues. You will have to find the others on your own by doing a thorough assessment.
WuLabsWuTecH
Forum Deputy Chief
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Yeah, basics here just apply the monitor or 12 lead, we don't interpret so I didn't mean ME persay! I was in the understanding though (and correct me if I am wrong please) that PEA will now show a normal sinus rhythm on the monitor/12 lead?
And yes, that's why i always take a puse by hand. I can feel it, whether it is strong, if it is thready, if we skip a beat here and there. I believe the NIBP will flash a hear symbol whenever it feels a pulse but that still does not tell you whether it is strong, weak, etc.
CAOX3, please go back and read all of my posts in this thread if you do not believe me when I say: I have NEVER called for you to hand in your cert. I'm merely part of a discussion on the opposing viewpoint to yours. In the first three situations, there was no justification needed--it was impossible to do so. In the last situation, the justification wasn't that the patient was BS, but that the hospital was so close delaying transport made no sense. Had he been a critical patient we would have done the same. As I pointed out in the OP (and the original topic of this thread) I cannot take that many vital signs that quickly and I just didn't get around to the BP before we arrived. My radio report consisted of "we'll be getting the vitals that we can between here and there, upon first impression he seems stable, we'll let you know a full set when we get there. Once again, ETA less than a minute, we picked up right around the corner."
When I arrived that obviously wasn't true, I still had to do a BP and I offered to do one for the triage nurse, but she said they had a free bay and not to worry about it. In my PCR, there was no BP - transport time was listed as a barrier to getting the BP. No worries, no problems.