Running scenarios in class . quick assessment of ABC rates

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HelpmeHelpyou

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Need some help from the experienced EMT-P or anyone that knows any sorta of "trick", advise, a overall quicker way of determining the rates of Respiratory rates, and Pulse rates.

We are running scenarios in class, I feel slow when taking vitals. My instructor said it generally comes with experience, but I also don't want to be a cookie cutter EMT either. Meaning, I don't want to make a guesstimate, I am not sure. I just want to be faster at obtaining those two vitals.

I am also nervous, as I am taking Night Skill Drills. A extra one day class that's optional to better yourself in real life scenarios. I just feel very ineffective, I can take vitals. Just doesn't to seem quick enough. I don't think anyone else in my class seems to really care, but I just feel it takes up time and want to be quicker.

I appreciate any help. I feel that this is my weak area, however throughout my medical and trauma assessments. I know those like the back of my hand and can say them in my sleep. In fact, the night before we were tested on the skills for both, I woke up saying them in order. As I was told, they are very important to know throughout the life of a EMT.
 
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CAOX3

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Practice, use your friends, your family, whoever, it will come but it takes time. Your not in a controlled enviorment so it can take some time to develop those skills.

Also understand your assessmnets, everyone doesnt fit into a nice little box like they teach you now.

Never guess, if you cant get vitals admit it and let someone else try, I have times where I cant hear something, no biggie. Admit defeat and give someone else a shot.:)
 
Shishkabob

Shishkabob

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It DOES come with experience.


In the initial assessment, all that really matters is, is it "fast or slow"? You don't need specifics at first, unless it seems abnormal.


Later on, when you DO need a full set of vital, don't worry if it takes a little bit. Take your time, and get it right. Worry about speed later. When you get used to it, you can do accurate vitals in just a couple of minutes max.
 
tcripp

tcripp

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I agree with Linuss - that first glance should tell you...is it fast or is it slow; is it regular or irregular; is it shallow, labored or "normal". That's what you need to focus on - the "sick/not sick" in that first few moments.

One thing I've done, along with the continued practice, is to get a feel for how fast the pulse is per second. If it's right at 1 beat per second, then you know you have a 60 second pulse. Slower than that, you've got bradycardia. I can now touch the pulse and can give a fair idea of brady/normal/tachy.

Then, you get the vital signs and take the time needed to ensure they are accurate.
 
Melclin

Melclin

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It may just be your perception that it takes a long time. Time yourself and see if its reasonable.

Also, practice counting pulse/taking BP while talking to the patient. You can quickly cover what happened/what/when/howlong etc, allergies, meds, GCS and relevant med hx while you get your first round of vitals (of course going back over it more thoroughly when you have time). Practicing taking a BP with the TV on in the background it another good way to get used to doing everything quickly and effectively with lots of extraneous noise.

I took to taking my own pulse, guessing the rate and then counting it while sitting on the toilet, waiting for a bus, etc. After a while you can guess pretty accurately. I reckon I can estimate with an accuracy of about +/-5 within 3-4 seconds of palpation. But it hardly ruins anybodies itinerary if you take an extra 10-15 seconds to count it out. So you may as well eliminate the guess work.

Resp rates are a tricky one in that initial period because there is so much talking going on. Whether its fast/slow and the work they're putting into it comes first. A formal resp rate can come later in most people. Also counting the time in between resps can give you a rough idea (4 seconds = RR of 15, 5 seconds, = RR of 12 etc). Much easier when its slow too.

Another way to quantitatively assess resp status is to get them to count to ten and note the number the can get to before having to take another breath. You can't tell anything from one assessment because everybody is obviously going to do that differently, but I've heard its a useful trending tool.
 
firetender

firetender

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My last year as a paramedic I realized one day I forgot my watch. I followed through on all my patient's care, took vitals as usual and then, once I had them hooked up to a monitor found that my pulses were off AT MOST two beats a minute in a range from 60 to 120. And respirations even more "clear".

I stopped worrying if I had a watch or not and started listening to my own, internal time clock. It never failed me; the number showed up.

Reverse engineering will show you just do it again, and again, and again until YOU trust you!

(I can hear the Judge today; "And you mean to tell me you've been rendering emergency medical care without a watch for six months? Case CLOSED; Defendant Guilty!")

But the truth that no one wants to hear is that if you really pay attention and really educate yourself, after a while you trust yourself to just "know" where exactly your patient is at in his/her crisis and what you absolutely must do to get him/her to the hospital; your brain has nothing to do with it.
 
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slb862

slb862

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It does come with experience. I focus on too fast, too slow, or none (which would be a bad thing). Keep in mind that everyone does things alittle different, what works for you will come with time and experimenting. Talk with those you work with or observe others in class. Keep positive and learn, learn, learn. Take what you can use from the experience, leave what doesn't work for you. Good Luck and Have fun in class. :)
 
Aidey

Aidey

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firetender said:
My last year as a paramedic I realized one day I forgot my watch. I followed through on all my patient's care, took vitals as usual and then, once I had them hooked up to a monitor found that my pulses were off AT MOST two beats a minute in a range from 60 to 120. And respirations even more "clear".

I stopped worrying if I had a watch or not and started listening to my own, internal time clock. It never failed me; the number showed up.
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I quit wearing a watch a while ago. I found that I broke them more often than I used them, which wasn't good for my budget.

One of my funnier patient interactions was with a rather batty lady who called 911 for an elevated BP. I don't remember what it was, but it wasn't actually that high (like mid 140s/90s), and she hadn't taken any of her 5 antihypertensive medications yet that morning. In the course of a 10 minute transport she had me take her BP 5-6 times. I had thrown her on the monitor just to be safe, and right after I disconnect her she has me take her BP again. Then she asks me to take her pulse. I feel it, determine there have been no significant changes in rate and give her the number that was on the EKG I had disconnected 30 seconds previously.

She asks me where my watch is, I tell her I don't have one. Oh man did she throw a bloody fit. It was actually kind of funny, we wheel her into the ER and she is going on about medical malpractice and then she wouldn't let the ER doc examine her until the ER doc agreed to report me to the "highest authority". When we were back at that hospital later the ER doc told me the story (while laughing). They discharged her with instructions to take her BP meds and a psych consult.


Back on topic, one of my goals is not to get too hung up on the numbers. All I really care about is fast, normal, slow, regular and irregular initially.
 
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goodgrief

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One thing I learned after EMT school, that all instructors and all field medics, and EMTS will ALL say the same thing with vitals:

It comes with experience

and there is a reason they all say the same thing, because it does.

:)

It is like your clinicals, you will be scared poopless on your first ride, by the 10th your like heh I got this.
 
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Veneficus

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gicts

gicts

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RunnerD1987

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I hear you. Taking baseline vitals feels so foreign from taking the brachial post with the BP Cuff, to the radial pulse, especially the distal, and have not even touched the femoral yet. Though with the radial post have been practicing on some willing patients (I.E. family and friends) has helped. Great thread some good tips.
 
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HelpmeHelpyou

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^ speaking of the femoral artery. Why do doctors love it when you take a pulse rate from this location? So I have been told.
 
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Veneficus

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HelpmeHelpyou said:
^ speaking of the femoral artery. Why do doctors love it when you take a pulse rate from this location? So I have been told.
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Aside from it being a central pulse, I don't see what is more special about it than a carotid.
 
abckidsmom

abckidsmom

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Veneficus said:
Aside from it being a central pulse, I don't see what is more special about it than a carotid.
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You can palpate it less awkwardly while standing at the bedside. For some reason, carotids require an awkward angle of the hand if the patient is supine on the bedside. If they are anything less than awake, it's my central pulse of preference, just because it's easier to find/hold for a while.
 
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Veneficus

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abckidsmom said:
You can palpate it less awkwardly while standing at the bedside. For some reason, carotids require an awkward angle of the hand if the patient is supine on the bedside. If they are anything less than awake, it's my central pulse of preference, just because it's easier to find/hold for a while.
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i'm left handed, i don't find any issue taking the carotid because conviently enough, being on the patient's left works best for me.

The laryngoscope is also my vengence on right handed people for their damn safety scissors that always made my school projects look like crap. :)
 
abckidsmom

abckidsmom

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Veneficus said:
i'm left handed, i don't find any issue taking the carotid because conviently enough, being on the patient's left works best for me.

The laryngoscope is also my vengence on right handed people for their damn safety scissors that always made my school projects look like crap. :)
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eye-to-eye on this one. Five kids, and only one lefty, but she's the one I like the most because we are both having our brains explode teaching her to cut out a circle, the poor dear.

I guess our unit had the nurse stand on the patient's right most times...now that I think of it, that is what side the monitors were on, even in the rooms that were mirror image to the others.

Painful. The world is out to get us. I think the trackball mouse is a great revenge. I've never had a right-handed person sit down at my computer who didn't complain or at least comment on it. Bwahaha.
 
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EMSrush

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Melclin said:
I took to taking my own pulse, guessing the rate and then counting it while sitting on the toilet, waiting for a bus, etc.
Click to expand...

Thank you so much for sharing. I've got a great visual now... :rolleyes:
 
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