Taking vitals - dumb question?

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EMSSam

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I've just started placement on the ambulance as part of my course. One of my criteria for the course is to take baseline vital signs without being asked.

I'm just not sure when to take some vitals. BP, RR, PR are all easy as they're done all the time.

But when would I know if I should take temp., blood-glucose, pupils, lung auscultation etc?
 
Personally I check blood glucose when there is a hx of diabetes, complaint that might affect Blood sugar. and someone presenting with s/s of hypo/hyperglycemia. Everything else I make it a point to check at sometime during the trip as a habit so that way when I need the information I don't have to try and recall what I do. Do the same thing the same way everytime. The service you are riding with might have specific protocols for when to check certain things if you don't have access to them or have trouble understanding them ask the person training you that day. The will give you "guidelines" as to what they are looking for and how they do it. Good luck !
 
lets put it this way:

Temp: why would you take a temp? what conditions would you suspect an elevated temp? what patient populations would you suspect a lower-than-normal temp, or possibly more prone to hypothermia? how would you use temp to guide your clinical decision making? what does temp do with the clotting process of your blood? what does temp do with your metabolic rate? cardiac output? RR?

BGL: why would you take a BGL? what types of presenting symptoms would lead you to thing the patient is having a sugar issue? what are the symptoms of hypoglycemia? what are the symptoms of hyperglycemia (HHNK/DKA)? what other endocrine disorders are associated with elevated/decreased BGL?

Pupils: why would you check pupillary status? what conditions lead to "blown" non-reactive pupils? why would one pupil be blown while the other is not in some conditions? what do street drugs do to your pupils? what nerve controls your pupil dilation/constriction?

Breath Sounds: why would you auscultate breath sounds? what conditions are associated with wheezing? rales/rhonchi? plueral/friction rub? decreased sounds? absent sounds? what do these findings tell you? what if these findings are isolateral?
 
Baseline vitals are your BP, HR, RR, and possibly SPo2, everything else is extra.

I have never taken a temp (I also don't have a thermometer), if they feel warm and say they are warm I take off a blanket, and vice-versa.

BGL when suspected is done early on since it dictates your management. In a pt who is walking and talking you know they have some sort of baseline vitals so I'd get a blood sugar first, or while my partner is getting the other vitals.

To a certain extent I don't need an exact number for HR... Grab their wrist if you feel something pulsating that's good. If it is fast when it should not be fast that is bad, and slow when it should not be slow that is also bad.

Lung sounds. Again if I am thinking respiratory that is getting done ASAP.



Try and talk with the people you are working with and establish when these things get done, so that you're not stepping on their toes.
 
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EMSSam said:
I've just started placement on the ambulance as part of my course. One of my criteria for the course is to take baseline vital signs without being asked.

I'm just not sure when to take some vitals. BP, RR, PR are all easy as they're done all the time.

But when would I know if I should take temp., blood-glucose, pupils, lung auscultation etc?
Click to expand...

Let me make it easy.

BP
HR
Resps
Temperature

Are vital signs.

Many US EMS providers are not provided with the equipment to take a temperature. (my opinion is they should, but that has been debated ad naseum with no consensus)

Pupilary response is part of a neuro exam. If you are not doing the exam, it is not your responsibility.

Blood glucose is an adjunct to the physical exam. I would do it only if the lead person felt it was indicated by reasonable clinical suspicion.

auscultation is part of the physical exam. I trust no decisions I make based on exam to anyone elses findings.

Particularly findings heavily reliant on provider skill.
 
I would go with what Veneficus said. When I have an EMT trainee with me and I ask them to get vitals I would like them to reply with Pulse (rate, quality, regularity), BP, RR (rate, depth, and regularity), SP02, and Skins (to include temperature - if we have a thermometer available then a reading).

My physical exam as the ALS provider will cover lung auscultation and the papillary exam - they are free to examine as a learning tool but I will only base my actions on myself or my partner's physical findings.

BGL is a vital sign not obtained on every patient and shouldn't be acquired unless specifically asked for.
 
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Cawolf86 said:
BGL is a vital sign not obtained on every patient and shouldn't be acquired unless specifically asked for.
Click to expand...

Actually it is a lab value, not a vital sign :)
 
Blood sugar on any unknown loss of consciousness case is a very good idea. Do NOT get your own equipment if not provided by the employer.
 
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