Obtaining pulse.

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atlasD

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This might be a silly question but they pop up soon after class...

When counting the pulse, why is it we count until 30 seconds then double instead of counting to 15 then quadruple. I understand if its to determine regularity, but if the pt is stable - Why not?

Is doubling typically protocol or is it just how it is taught in EMTB Brady?

7.5 = 11
15 = 20
30 = 42

Hell, if just playing stable frequent flyer medical taxi - why not 7.5(approx)?
 
30 seconds will get you a fairly accurate number for pulse and breathing rate. If you note any irregularity, you can then extend another 30 for a full 1 min count. You can be "off" by quite a bit if you use a quicker count than that... The shortest amount of time I'll use (ever) is 15 seconds, but I usually go 30.

As far as doing 15 seconds or 30 seconds... doubling is easy math... Double it if you're doing 30 seconds, double again if you're counting for 15... Do note that if you're off by just one beat @ 15 seconds, your math will be "off" by 8 for an actual per/min pulse rate. At 30 seconds... that's just two beats/min.

Another way to look at it is:

If I'm counting for 15 seconds, all I really am looking for is fast/slow, regular/irregular. Nothing more definitive than that. If I'm counting for 30 seconds, I'm going for accuracy. At a first pulse check (couple seconds), all I'm looking for is presence of a pulse, and way too fast/way too slow.
 
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Who is EMTB Brady?

Why not 20x3? Or 5x12? Maybe 1x60?

When you're working in the field, you'll learn real fast what needs to be done. If you spend your time finding a pulse or BP, you'll find yourself at the ER and nothing on your assessment.
 
VCEMT said:
Who is EMTB Brady?

Why not 20x3? Or 5x12? Maybe 1x60?

When you're working in the field, you'll learn real fast what needs to be done. If you spend your time finding a pulse or BP, you'll find yourself at the ER and nothing on your assessment.
Click to expand...
Field experience is a wonderful teacher for what needs to be done in the moment...
 
VCEMT said:
Who is EMTB Brady?

Why not 20x3? Or 5x12? Maybe 1x60?

When you're working in the field, you'll learn real fast what needs to be done. If you spend your time finding a pulse or BP, you'll find yourself at the ER and nothing on your assessment.
Click to expand...

Are you suggesting that we don't need accurate counts of pulse, breaths and BP as long as they appear normal on first look?
 
On myself.. At rest, I have a fever, so it's going to be higher than normal.

10 x 6 - 102

15 x 4 - 102

20 x 3 - 102

30 x 2 - 104

60 x 1 - 106


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On a patient, if they're with in a realm of what I consider stable, I count for 30 x 2 on the pulse; and one minute on respiration. On a patient that I consider unstable, I count both for one minute. It's not absolute, something x something will most always be a little higher or lower than a full minute.
 
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ngbacon said:
Are you suggesting that we don't need accurate counts of pulse, breaths and BP as long as they appear normal on first look?
Click to expand...

Negative Ghostrider, that is what you are suggesting. I am stating that, if you spend too much time on vitals, you're going to be at the ER with no info to give.
 
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I just count to 6 and put a 0 behind it, so if I count 8 beats in a six second time frame there's 80 beats per min.

or just stick a pulse ox on them and there ya go :P
 
what, I said OR
 
I do 15 x 4 (just double twice) for pulse and resp. Yes, it means that you end up with all of your vitals being in multiples of 4, which doesn't bother me too much. If I end up with respirations "in the middle" (i.e. I started counting on expiration and the clock stops on a full inspiration), I'll sometimes call that a "half," which usually means a quick scribbled multiplication on my leg (let's see, 4.5 times 4, etc etc).

30s is okay too IMO but in most cases I doubt I'd be willing to sit there doing a full minute on each, for a marginal increase in accuracy and maybe even a decrease (in the case of difficult vitals -- variable or easy-to-miss beats, respirations that keep changing due to speech, etc.). Plus you start to get the funny eye if you stare at someone's chest for a minute.
 
15x4 is my traditional way...

SpO2 is a quick way to do it... but i'd rather go by feel
 
30x2 is easier to calc than 15x4.
 
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I was taught 15x4 if regular, and 60x1 if it is irregular. Occasionally, and I mean occasionally, if I am first on scene and doing a rapid "is this person alive" assessment I will do 6x10 just to get a ball park estimate, but I always get a second one counting longer. For resperations 30x2 if stable, 60x1 if unstable.

An even bigger fail than just using the pulse ox is assuming the number of QRS complexes on the EKG is the same as the perfusing pulse.

Other Paramedic: "We need to get moving now,the pt is in SVT!!!"

Me: "Um, that is A-Fib, and the perfusing pulse is 88..."
 
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