Need Help Doing Trip Sheet

[EMTprincess33]

Hey guys, i have my first phyic call and i really have NO clue what to write in my trip sheet. The patient wouldn't let me take his vitals so i didn't get any. (got yelled at by the hospital nurse for not getting vitals) basically we used a stair chair to get him out of the house, then loaded him onto the stretcher, didn't restrain him at all. Just tried to keep him calm, When i tried to get a BP he got loud with me thinking i was restraining him so i didn't try again, the entire 25 min trip to the hospital we just talked about god, and church, so What do i write in my report? Help please? Thanks

 

[Imacho]

First ask FTO or sups. But, the picture should be seen by someone that was not there.

 

[ATrain]

You might be better served to ask your partner or supervisor how to write the report.

But, as a note on them refusing vitals, you really can't say anything more than they refused. You can't force it on them, or it's battery.

 

[Anjel]

Most of my psych pts refuse.

I document that they refused. Then document what I can see.

Respiration rate. GCS. Skin condition. Pupils if I can. Pain scale.

 

[Screwby]

As said above, just grab all the vitals you can. Something is better than saying "sorry no vitals for you" because the nurses or doctors will remember you as the guy who can't get vitals. Respiration, pupils, palpate the BP in the wrist when you get pulses and write BP/palp so you have something to show them. Anything to show you at least tried. Invest in a clip on pulse oximeter for those patients that are hard to pulse or need a little coaxing. Make it seem fun/cool that you are going to use your neat clip on pulse ox reader...

 

[Tigger]

As said above, just grab all the vitals you can. Something is better than saying "sorry no vitals for you" because the nurses or doctors will remember you as the guy who can't get vitals. Respiration, pupils, palpate the BP in the wrist when you get pulses and write BP/palp so you have something to show them. Anything to show you at least tried. Invest in a clip on pulse oximeter for those patients that are hard to pulse or need a little coaxing. Make it seem fun/cool that you are going to use your neat clip on pulse ox reader...

How does one get a blood pressue (even by palp) without the use of a BP cuff, as with the OP?

Also the pulse readings on a cheap, clip-style pulse ox are notoriously inaccurate. Without taking someone's pulse with my own hands first, I would not put any faith into the number that comes up on that. Any movement whether it be patient or ambulance is apt to alter the reading.

 

[Veneficus]

Why would anyone think lesser of a provider who was not able to get vitals on a psych patient who refused?

Having calm psych patients explode on scene or in the back of an ambulance for something as simple as a set of vitals is not the best idea in the world.

I invite any hospital provider who takes issue with that to wrestle with a psych patient in the back of the squad or on scene.

 

[Screwby]

How does one get a blood pressue (even by palp) without the use of a BP cuff, as with the OP?

Also the pulse readings on a cheap, clip-style pulse ox are notoriously inaccurate. Without taking someone's pulse with my own hands first, I would not put any faith into the number that comes up on that. Any movement whether it be patient or ambulance is apt to alter the reading.

The O2 saturation tool is iffy but I've found the pulse to be pretty damn accurate. The O2 goes goofy if the patient isn't still or ride is bumpy and it shifts on the finger. If you palpate the BP you find pulse in radial or femoral artery it's at least an 80 systolic, Brachial is at least a 70 systolic, and a carotid is at least a 60 systolic. So you take a radial pulse then you know the patient is at least 80/palp and so on. This is the way I was taught to at least have a base line on hard to get vitals on an emergent patient in the field. Am I not remembering this correctly? And I always note in narrative what the situation was...

 

[Screwby]

Why would anyone think lesser of a provider who was not able to get vitals on a psych patient who refused?

Having calm psych patients explode on scene or in the back of an ambulance for something as simple as a set of vitals is not the best idea in the world.

I invite any hospital provider who takes issue with that to wrestle with a psych patient in the back of the squad or on scene.

I agree 100%...but you know as much as I do that even when you are in the right, even when you did all you could, that there are always those people in the hospital that shake their head and look at you like your an idiot. Every part of me want's to say "jump in and let me see you do it on this roller coaster ride w/o your fancy automated machines!" Where would that get me but in an argument? That's why I try to at least have something, anything, even the smallest bit of vital info so I'm not labeled "that EMT". I help, I explain, I by all means "kiss ***" if needed, because I know when I walk into the ER that my relationship with the staff there can make or break a good shift...

 

[Medic Tim]

The O2 saturation tool is iffy but I've found the pulse to be pretty damn accurate. The O2 goes goofy if the patient isn't still or ride is bumpy and it shifts on the finger. If you palpate the BP you find pulse in radial or femoral artery it's at least an 80 systolic, Brachial is at least a 70 systolic, and a carotid is at least a 60 systolic. So you take a radial pulse then you know the patient is at least 80/palp and so on. This is the way I was taught to at least have a base line on hard to get vitals on an emergent patient in the field. Am I not remembering this correctly? And I always note in narrative what the situation was...

It is a bad idea to chart something you did when you never did it. PCRs are legal documents. . I have had pts with a bp less than 80 sys have a radial pulse and pts with a high bp and no or faint radial pulse.

 

[Veneficus]

If you palpate the BP you find pulse in radial or femoral artery it's at least an 80 systolic, Brachial is at least a 70 systolic, and a carotid is at least a 60 systolic. So you take a radial pulse then you know the patient is at least 80/palp and so on. This is the way I was taught to at least have a base line on hard to get vitals on an emergent patient in the field. Am I not remembering this correctly? And I always note in narrative what the situation was...

Just so you know, this was an EMS myth that was busted years ago by numerous sources as I recall.

I would never use it, encourage others not to use it, and certainly would not make or support a clinical decision based from it.

I know for billing, 2 sets of vitals signs are required. I also know that employers really get mad when they cannot easily bill. But it is the nature of psych. The call will probably be audited and payment may or may not be made.

But it is the responsibility of the organization to work out billing for transporting psych patients in advance.

From a 911 standpoint, it is probably a loss. Hopefully your organization doesn't actually depend on 911 billing alone. If it does, they should expect a certain level of nonpayment.

 

[Screwby]

I wasn't saying to lie...perhaps I misunderstood the way I was taught? My cert isn't worth faking vitals, I'm saying that worst case scenario you at least had a radial pulse, so BP was at least 80 systol and in narrative and at hospital I explain EXACTLY what and how I arrived at that vital. Maybe I need to dig out my old book because your saying that this method in a worst case scenario is not accurate in the least? Or is it once a great while that this method is way off?
No arguing from me here, I'm a newby open to any criticism! Which is why I joined the forum!

It is a bad idea to chart something you did when you never did it. PCRs are legal documents. . I have had pts with a bp less than 80 sys have a radial pulse and pts with a high bp and no or faint radial pulse.

 

[Medic Tim]

I wasn't saying to lie...perhaps I misunderstood the way I was taught? My cert isn't worth faking vitals, I'm saying that worst case scenario you at least had a radial pulse, so BP was at least 80 systol and in narrative and at hospital I explain EXACTLY what and how I arrived at that vital. Maybe I need to dig out my old book because your saying that this method in a worst case scenario is not accurate in the least? Or is it once a great while that this method is way off?
No arguing from me here, I'm a newby open to any criticism! Which is why I joined the forum!

I understand where you are coming from. I was taught the same thing back when I did my EMT. When I did Medic school I was told not to put any faith in it. In cases when you dont get a bp chart you didn't get one and why. I will reiterate that it is a bad idea to chat a bp if you didn't take one. I may be wrong but I believe the radial pulse = 90sys came from a trauma study in healthy pts(besides the trauma)

 

[STXmedic]

I wasn't saying to lie...perhaps I misunderstood the way I was taught? My cert isn't worth faking vitals, I'm saying that worst case scenario you at least had a radial pulse, so BP was at least 80 systol and in narrative and at hospital I explain EXACTLY what and how I arrived at that vital. Maybe I need to dig out my old book because your saying that this method in a worst case scenario is not accurate in the least? Or is it once a great while that this method is way off?
No arguing from me here, I'm a newby open to any criticism! Which is why I joined the forum!

That method has been proven inaccurate. I sat in on a lecture given by an Army trauma surgeon recently who tore this myth apart, citing numerous sources. The radial pulse being at least 80sys is bogus. We were shown a scatter chart with radials palpated with BPs as low as the mid 50s systolic (obtained by art line).

 

[Screwby]

Thanks for the feedback! Just more knowledge to chart away in my ever expanding and still frighteningly empty EMS brain

 

[usalsfyre]

From a management standpoint there's also an issue of a non-biomedical certified device (personal pulse-ox) being used for patient care.