Hello! I started working with a town close to me as an attendant (someone who is certified in CPR but is in an EMT-B class). All the calls we get are 911 calls. I was taught about a month ago how to take blood pressure and pulse by my crew chief. I can do both fine when I am on scene, but as soon I get in the ambulance I cannot hear/feel anything. Does anyone have any suggestions on how to get past the noise and all the bumping around so that I can take the BP and pulse en route?
Taking BP and pulse in the ambulance
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JPINFV
Gadfly
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If possible, practice with your seatbelt on. This will get you used to operating how you should be, even if it's not how most people operate. At least for me, I care a bit less about bumps when I know that I'm strapped in.
Rest your feet on the undercarriage of the gurney if possible instead of the floor of the ambulance.
I always rest the patient's arm on the top of my thigh. This cuts out a lot of noise artifact because the leg is a much better insulator than the gurney.
The last thing I can think of off the top of my head is to clench your jaw if you're having trouble hearing. The mandable and muscles protrude slightly into the auditory canal which will make a better seal around your stethoscope. Don't believe me? Stick your fingers into your ears and clinch your jaw.
Rest your feet on the undercarriage of the gurney if possible instead of the floor of the ambulance.
I always rest the patient's arm on the top of my thigh. This cuts out a lot of noise artifact because the leg is a much better insulator than the gurney.
The last thing I can think of off the top of my head is to clench your jaw if you're having trouble hearing. The mandable and muscles protrude slightly into the auditory canal which will make a better seal around your stethoscope. Don't believe me? Stick your fingers into your ears and clinch your jaw.
reidnez
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All the above is excellent advice.
Also, are you using the cheap stethoscope the service generally provides? If so, I'd strongly invest in purchasing a decent one for yourself. You don't have to spend $150 on Littmann to have a decent piece of gear. I read a couple of lab tests which electronically compared different models, before I bought mine. The conclusion I drew was this: there is BIG difference in transmission of sound between a $5 steth and a $25 steth, while there is a pretty small difference between a $25 steth and a $150 steth. Thus, the middle-of-the road models are by far the best value for us--we're not cardiologists, we just need BP and lung sounds.
I always had trouble getting BP's with the Chinese-made, generic stuff that schools and ambulance services provide, possibly because I have moderate hearing loss. I spent $25 on my own (Omron Sprague-Rapport) and it was definitely worth it. Just my 2 cents.
Also, are you using the cheap stethoscope the service generally provides? If so, I'd strongly invest in purchasing a decent one for yourself. You don't have to spend $150 on Littmann to have a decent piece of gear. I read a couple of lab tests which electronically compared different models, before I bought mine. The conclusion I drew was this: there is BIG difference in transmission of sound between a $5 steth and a $25 steth, while there is a pretty small difference between a $25 steth and a $150 steth. Thus, the middle-of-the road models are by far the best value for us--we're not cardiologists, we just need BP and lung sounds.
I always had trouble getting BP's with the Chinese-made, generic stuff that schools and ambulance services provide, possibly because I have moderate hearing loss. I spent $25 on my own (Omron Sprague-Rapport) and it was definitely worth it. Just my 2 cents.
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njff/emt
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For pulse, obviously go for radial, sometimes when your bouncing around you need to squeeze a little harder but not too much., If you have no luck there move up the arm and use the brachial as last resort, you could also use the other arm if you have no luck there either., As for BP, one trick I use is placing the scope under the cuff right on top of the brachial artery and pump the cuff up, if you hit the right spot you should be able to hear it with little to no problems.
You can read through the many threads that discuss "what is the best steth?" I think we recently went from the $9 models to the $5 models to save money, but personally, I think the biggest reason to have your own scope is because who knows where those other ones in the back of the rig have been.
That being said, unless you lose or break it, your stethoscope will last years, so I didn't see any reason not to invest a little money in a good one. And the dual-lumen tubing on the higher-end models does make a difference, as far as I can tell. I'd stay away from a sprague, because the tubes bump together while you're in motion, and that can give a lot of artifacts.
Try to get at least one set of vitals before you start moving, that will give you a good baseline.
TraprMike
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well, I tryed all these methods.. feet on streatcher, feet off floor. can't hear crap.. and something simple as resperations.. bouncing around on streatcher. jiggling of chest parts... (nice way of saying fat and boobs) makes it hard to detect the resp's... ahhh... going crazy..
ExpatMedic0
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Ask your supervisor or EMT partner how to take a B/P by palpation. Normally this is only done when its way to noisy or we have trouble getting a B/P. Taking a B/P can be difficult in the back of an ambulance with lights and sirens or on a noisy scene of a MVC. In addition to that keep practicing on what the above people mentioned. Its better to get a B/P with your ears, but there is no shame in grabbing a quick one by palp sometimes.
Also what state allows attendants to operate or staff an ambulance? Are you a 3rd rider or part of a 2 person crew?
Also what state allows attendants to operate or staff an ambulance? Are you a 3rd rider or part of a 2 person crew?
TraprMike
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???
ExpatMedic0
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I want to know if he is part of a 2 guy crew (just himself and his EMT partner) or if he is a 3rd person riding with a 2 man EMS crew.
If its just him and his EMT partner I want to know what state allows that
If its just him and his EMT partner I want to know what state allows that
TraprMike
Forum Lieutenant
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ah,, ok,,, getting late... in MN it's a 2 EMT gig. at least.. we try to have 3, but sometimes it's not necessary. what state allow a First Responder and EMT-B as a legal ambulance??
nevermind, I think I'll start a new thread about this..
nevermind, I think I'll start a new thread about this..
Tincanfireman
Airfield Operations
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Another method is to place your hand under the patient's elbow and (gently!) hyperextend the elbow upwards. This will sometimes help in capturing pulse sounds. Also, keep your tubing straight and neat; nothing like sphygmomanometer noise to mask a pulse.
EMTinNEPA
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Usually what I will do is rest the patient's arm on my thigh, gently hyper extending the elbow. Then I will apply the sphygmomanometer and palpate the brachial pulse. Wherever I feel it, that's where I put the head of the stethoscope. I then use my hand to seal the entire diaphragm of the stethoscope against the patient's skin and take their pressure. 99.99% of the time I have no problem auscultating a blood pressure with this method. Sometimes you just have to take one by palp.
Bloom-IUEMT
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Lol so basically you just do it like you are supposed to do. B) I kept trying to do it using the carotid and it wasn't making the patients very happy.
JPINFV
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Bloom-IUEMT
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Wait...what? :wacko: You have to use the carotid when you take BP using the neck right? Lol joking.
I have the same problem though. I usually watch for the bounce of the sphygmomanometer needle that begins with systolic and stops at the diastolic.
JPINFV
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Is the image showing up for anyone else? When I checked the thread again, it didn't load the hotlink for me...
Meursault
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Not to promote THE STICKY THAT I WROTE TO COVER COMMON QUESTIONS or anything, but
teenageremt
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if having trouble finding a radial pulse sometimes you might want to make sure you have on the right glove size. I use to always were large gloves and then i moved down to medium. They were a little tighter on my hand and make it easier to feel the pulse.
Bloom-IUEMT
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I actually found that sticky you posted after the fact.....that is REALLY helpful by the way. The powers that be should organize a sort of categorized table of helpful and informative posts that newcomers (and old comers, ha ha ziiing
) can reference before posting on the forums. everything is very disjointed and disorganized now and the search function works as well as 1996 yahoo.com did. Maybe we could put all those threads in a table format a top of the main page or something? Idk just a thought...Ive learned more perusing your organized sticky in one night than I did aimlessly sifting through the forums for several weeks.
EMTinNEPA
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There are times when "by the book" works best ^_^