Taking Vitals in the Rig--Training

[sixmaybemore]

From a practical point of view, if the heart is beating so fast that you can't count it, you're going to immediately recognize that the CC is probably due at least in part to the extremely fast heart rate, at which point you're going to get them on an EKG and let the machine give you an estimate. Feeling for a pulse is great for a first impression. And the first impression of a pulse too fast for me to count is "holy crap, that's fast. This looks like a cardiac issue. Let's get them on the EKG immediately."

You can try to estimate and multiply, but in the end, as BLS, it's acceptable to say to the paramedic, hey, the heart rate was so tachy that I was unable to get an accurate measure. Auscultating may help. With children that have naturally high HRs, I often just feel/listen for a shorter amount of time and then just do more multiplication.

Thank you. That was helpful to me.

 

[SmokeyBear]

This works for me:
1) take the initial BP on scene giving you a "starter"-if its an ER see #3
2) agree w/ Hastings Count pulse for 15 and multiply by 4.
3) I invested in an auto-cuff....saves ALOT of headache. Quick, easy and accurate But make sure you clean them well

4) if you're partnered with a medic then use the stats from the LP12. This saves alot of headache as well. If the medic wants stats NOW while applying the the leads see #3

 

[BossyCow]

3) I invested in an auto-cuff....saves ALOT of headache. Quick, easy and accurate But make sure you clean them well

There's a whole thread devoted to how inaccurate these are.

 

[mycrofft]

Wear crepe soled shoes and thick socks to limit conducting noise off floor.

I had a coworker who would raise his feet off the floor of the noisy modular on rattly roads. Close our mouth; it's an instinct we use to hear faint sounds better, but it will let more ambient noise into your head. Also, even if you have a cruddy scope, buy earpieces which you find will effectively seal your ear canal. In fact, buy a few so you can carry some right next to your spare oxygen yoke regulator O-rings. No matter what scope you wind up with, fish them out of your bat-belt and whip 'em on. (I like floppy black rubbery ones but they tend to degrade quickly). And tell your nattering patient and coworkers to "dou-zo, yaka-mashii" (or "quieta su boca, por favor" as you prefer).

Hmm. Wonder if anyone makes a rubber buffer to put between a cot's (litter's) wheels and the floor, and the litter catch holding the whole thing still?

sidebar: Also works in reverse. My acquantance who worked SWAT etc did the same to cushion footfalls for sneaking around. Just the socks helps, oddly enough.

 

[SmokeyBear]

There's a whole thread devoted to how inaccurate these are.

I use them in nursing school, many hospitals/nursing homes use them, several of my rotations use them and I have found the ones I have used to be just as accurate as taking them by hand--especially on obese patients Some are not as accurate as others but, I definitely will not say they ALL are inaccurate. I will not venture to say that ALL manual cuffs are completely accurate or even BETTER--would you? I would also not venture as far to say that the people taking manual blood pressures are completely accurate either--especially on bumpy roads, screaming patients et al. Point is, there are devices out there that can make an EMT's life easier and provide better service for the patient. There are 100s of autocuffs out there and I would never be as bold to say that they are ALL innaccurate. I have had no problems with my autocuff matching within 1 or 2 numbers, or even exactly with whats on the LP12. I will continue to use them and the manual ones from time to time (to keep my skills sharp) as well.

Some agencies/stations may even have a list of approved devices, submitter could check with his supervisor and find out

 

[Ridryder911]

Want to know what they call those that use automatic BP machines for the baseline? ..






Defendants.


As well, one can only use the 15 second method if the rate is regular! One should be taking an apical if it is too fast. Again, something that should had been taught and discussed as according to the Basic EMT curriculum.

R/r 911

 

[SmokeyBear]

As well, one can only use the 15 second method if the rate is regular! One should be taking an apical if it is too fast. Again, something that should had been taught and discussed as according to the Basic EMT curriculum.

R/r 911

True Indeed.

 

[SmokeyBear]

Want to know what they call those that use automatic BP machines for the baseline? ..
Defendants.

Thats nice And what are they called when hospitals and nursing homes use them all the time? "Experts?" A good lawyer will dissect any and everything...including baselines read from a manual cuff during lights and sirens. Wouldn't you if you were paid by the hour?



Still using them.

Again, something that should had been taught and discussed as according to the Basic EMT curriculum.

Since I can count on you to dissect every post with such vigilance combined with your assumption that none of us knows the basics, I will indeed try make sure to mention every possible variable in the future *takes a bow

 

[micsaver]

I did a BP tonight using the Bell of the scope. I was amazed by the sound I could hear as the blood whooshed while the cuff deflated. The beginning of the systolic sound was WAY MORE obvious than when I would listen with the diaphragm. I was so excited that I tried it again. Same result. Awesome.

Thanks for all your tips for getting a BP in a noisy environment and while on the moving ambulance. The other thing that I found was a bit off with my technique was the pressure of my auscultation. I really needed to press a bit more against the arm/artery to get good sounds.

 

[Ridryder911]

Thats nice And what are they called when hospitals and nursing homes use them all the time? "Experts?" A good lawyer will dissect any and everything...including baselines read from a manual cuff during lights and sirens. Wouldn't you if you were paid by the hour?



Still using them.



Since I can count on you to dissect every post with such vigilance combined with your assumption that none of us knows the basics, I will indeed try make sure to mention every possible variable in the future *takes a bow

Almost all hospitals has policies describing that automated blood pressure cuffs should NOT be used on patients that have extreme movement or equipment that interferes with the working of the equipment.

As well, if you read most manufactures books it is recommended that one always obtain a baseline blood pressure before relying upon an automated blood pressure machine. Even the manufacture(s) disclaims themselves on dangerous readings that a manual should be obtained.

There are too many well documented instances that the machine gave false information and it was depended upon and poor outcome came from the result of it.

One can acclaim all they want, it is usually standard medical care to always attempt manual on critical patients.

 

[traumateam1]

Ugh....

Almost all hospitals has policies describing that automated blood pressure cuffs should NOT be used on patients that have extreme movement or equipment that interferes with the working of the equipment.

As well, if you read most manufactures books it is recommended that one always obtain a baseline blood pressure before relying upon an automated blood pressure machine. Even the manufacture(s) disclaims themselves on dangerous readings that a manual should be obtained.

There are too many well documented instances that the machine gave false information and it was depended upon and poor outcome came from the result of it.

One can acclaim all they want, it is usually standard medical care to always attempt manual on critical patients.

I have never, ever, ever used an automated BP cuff before for my p/t assessments. I have not and will not use them. Technology is great.. but I do as much manual vitals, and p/t assessment as possible. Obviously somethings like BGL, 3-12 lead, SpO2, etc aren't manual... they are automatic, but things like using the SpO2 for a pulse reading, and automatic BP cuffs and whatnot, is a big no no. (In my opinion!)

 

[Hastings]

Ironically, the only times I've attempted to use an auto-BP cuff (when we couldn't get a manual BP for some reason), the damn thing wouldn't work for some reason. Something would come unplugged, it wouldn't inflate, or it simply broke.

So I don't know how accurate they are. I just know they're not worth the effort.

 

[rhan101277]

Yeah everyone wants a easy way out I guess with those electronic one's.

 

[traumateam1]

Just a rant...

Ironically, the only times I've attempted to use an auto-BP cuff (when we couldn't get a manual BP for some reason), the damn thing wouldn't work for some reason. Something would come unplugged, it wouldn't inflate, or it simply broke.

So I don't know how accurate they are. I just know they're not worth the effort.

That's why I don't like them. Not reliable, not accurate (most of the times) and to finicky. Imagine trying 3 times with the auto, then having to switch to the manual. Now you've wasted a lot more time than you would have if you just used the manual from the beginning. Not to mention how unprofessional it looks. And so what.. you use the auto for 6 months then all of a sudden you go to use the auto and it breaks down.. then you fumble trying to get a manual BP because you haven't used one in so long. Just bad news all together.
Another thing.. (lol).. with all the auto BP cuffs I've had experience with.. if there is an error, it usually will continue going down until it reaches a systolic of around 50-60 then it will say error, so then you have to redo it all over again. If you are using the manual one, and the pt moves or coughs or whatever.. at least you are human and are able to realize that, and continue going.. or you just pump it up again 20 mmHg.
I just don't like them.. as you can tell.

 

[Hastings]

I know this wasn't the original purpose of the thread, but just a quick story while we're on the subject.

Due to wait times of 6 months for a general checkup at my previous doctor, we decided to find a new one. Well, the whole family started going to this new place. My mum got one doctor, I got another. She came home after the first appointment and tells me the doctor wants to see her back due to hypertension. I take her blood pressure. It's perfect. She goes back. She comes back and tells me that it was high again, and they want to start her up on blood pressure medicines. Again, I check her. It's fine. I tell her, mom, your blood pressure is fine. This has never even come up before. I've taken your blood pressure many times, and it's never been as high as they're claiming it is. Then I ask her, how are they taking it? That blood pressure machine, she says.

Well mom, your doctor wants to load you up on blood pressure medicines because a machine told them your blood pressure was high. Did they take it manually to confirm? No, they didn't. Mmk mom. You're not taking any medication. You don't have hypertension. Tell them to check manually next time they bring it up. She does. That's strange, your blood pressure is perfect.

 

[traumateam1]

I know this wasn't the original purpose of the thread, but just a quick story while we're on the subject.

Due to wait times of 6 months for a general checkup at my previous doctor, we decided to find a new one. Well, the whole family started going to this new place. My mum got one doctor, I got another. She came home after the first appointment and tells me the doctor wants to see her back due to hypertension. I take her blood pressure. It's perfect. She goes back. She comes back and tells me that it was high again, and they want to start her up on blood pressure medicines. Again, I check her. It's fine. I tell her, mom, your blood pressure is fine. This has never even come up before. I've taken your blood pressure many times, and it's never been as high as they're claiming it is. Then I ask her, how are they taking it? That blood pressure machine, she says.

Well mom, your doctor wants to load you up on blood pressure medicines because a machine told them your blood pressure was high. Did they take it manually to confirm? No, they didn't. Mmk mom. You're not taking any medication. You don't have hypertension. Tell them to check manually next time they bring it up. She does. That's strange, your blood pressure is perfect.

Interesting eh? Thank God for technology.. but some technology should stay at home, literally. Auto BP cuffs are good for pt's with confirmed hypertension, and they need to keep an eye on it at home. But it's not to be used by medical professionals in the field.. because you get false readings like Hastings example.

Anyways.. I think I kinda side tracked this thread.. so time to get back on subject.

Cheers!

 

[reaper]

Interesting eh? Thank God for technology.. but some technology should stay at home, literally. Auto BP cuffs are good for pt's with confirmed hypertension, and they need to keep an eye on it at home. But it's not to be used by medical professionals in the field.. because you get false readings like Hastings example.

Anyways.. I think I kinda side tracked this thread.. so time to get back on subject.

Cheers!

As I have stated before, there is nothing wrong with NIBP technology. It all comes down to operator error!

 

[EMTWintz]

If they are having difficulty hearing the bp, they make a double earpiece steth that way the student and teacher can listen. Helped out the ones on our squad know what to listen for.

 

[SmokeyBear]

Almost all hospitals has policies describing that automated blood pressure cuffs should NOT be used on patients that have extreme movement or equipment that interferes with the working of the equipment....

So hospitals use them, as you claim, when "not moving" so to end this little debate of ours...you dont have to use an auto cuff while the van is moving or even IN the van. On the contrary, you can use them on scene (just like a manual) and it takes seconds.

Almost all hospitals has policies describing that automated blood pressure cuffs should NOT be used on patients that have extreme movement or equipment that interferes with the working of the equipment....There are too many well documented instances that the machine gave false information and it was depended upon and poor outcome came from the result of it..

Since you mentioned "extreme movement" and liability, I suppose you believe that manuals are foolproof? That little "dip" in the road...was it a beat or "just a dip"? Are all the variables/environmental circumstances that come with using manuals to be ignored because of technology prejudice? Or do we just assume they are "always right just because" or because "I remember reading some article that said..?" Either way, I enjoyed the debate but, they are accepted by my agency and almost every medical service in my area. I will continue to use the auto cuff and manual as well from time to time Cheers

 

[SmokeyBear]

Anyways.. I think I kinda side tracked this thread.. so time to get back on subject.

Cheers!
[/FONT]

It did indeed. The guy asked for suggestions, I gave some and it diverted into a discussion on "technology error" vrs. "user error." But, I see nothing wrong with it Its a lively discussion and everyone is being civil...so far