On Every Patient, Get A [Insert Here] Measurement?

[cruiseforever]

There is a 911 service near me that requires the first BP to be ascultated or palpated. After that they can use NIBP. I really think I'm going to try to make that my practice.

I do this all the time with Zoll NIBP. Kind of on the same topic. Do you count a pulse out or do you just use the number on the monitor/pulse ox?

 

[EpiEMS]

Question that occurred to me today while getting a set of vital signs....anyone mandating VS must be even numbers?

I remember in EMT school they always told us that because BP Cuff gages are marked in even that if we documented an odd number (157 over 97 for example) they'd say we made up a number (or something along those lines, I forget exactly what they said as that was 4 years ago now lol).

I've heard this, but it seems a bit silly to me. 159/80 vs. 158/80 is meaningless. If it's between the lines, just report the odd number. On that point, does it really (clinically) matter whether we're looking at, say, 90 systolic vs. 94 systolic? Maybe for some protocols, sure, for NTG, but in general, there's a pretty wide margin of error for auscultation of BP.

Do you count a pulse out or do you just use the number on the monitor/pulse ox?

When I just have the pulse-ox on, I check the pulse-ox waveform and number versus my manual count. If they're out of sync, manual is what I report.

 

[DrParasite]

I do this all the time with Zoll NIBP. Kind of on the same topic. Do you count a pulse out or do you just use the number on the monitor/pulse ox?

I have worked in the EMS departments that were affiliated with level 1 trauma centers. I found only two manual BP cuffs in the ER, both of which were located in the trauma bays. You can imagine how often they were used outside of the trauma bays. And I would imagine that the ratio of manual pulse counts to monitor/pulse ox was somewhere in the area of 1:10,000. If it's good enough for RNs & MDs, why is it not good enough for EMS?

BTW, I am not saying you shouldn't know how to take a manual pulse and manual BP, but if the rest of the healthcare system has moved to objective mechanical devices to count pulse and calculate BPs, why are we so hesitant to give up relying on our siren abused ears and callused fingers??

 

[NomadicMedic]

I only manually count a pulse if it's too slow or too fast on the initial feel. Same with respiration.

Does it really matter if the pulse is 70 or 76? Does it matter is the respiration rate is 16 or 18?

 

[cruiseforever]

I only manually count a pulse if it's too slow or too fast on the initial feel. Same with respiration.

Does it really matter if the pulse is 70 or 76? Does it matter is the respiration rate is 16 or 18?

I was thinking more along the lines of a pt. being in Afib. with large swings in the rate.

 

[nater]

BP
HR
SpO2
Respiratory Rate
Patient Temperature
Cabin Temperature (CAMTS req.)
Blood Glucose in all patients with GCS <15.
Intubated patients add ETCO2, PIP Pplat when applicable.

 

[Handsome Robb]

Our only required vital signs are BP, HR and RR. GCS is included as a vital as well and is required but I don't really consider it a "vital sign". Transports are required to have two sets. Refusal can have one.

Extra stuff like BGL and SpO2 are only included if indicated and we're actually pushed to not use them if they're not indicated due to us doing itemized billing. "Don't bill someone for something they don't need, but if you use it you have to bill for it. So don't use it unless it's indicated."


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