Vitals Signs....

bryncvp

Forum Lieutenant
102
0
0
I have a question for everyone. I got into a 'debate' the other day about what were appropriate vitals signs to take and when. My position is that automatically you usually take..BP, HR, RR, Glucose, pupil, LS, SPO2, EKG, and temp for just about every patient. It was argued that it is complete over kill to do that for almost every patient and only do the vitals that you 'need'. My point to that was that you dont really know what you need..until you need it. Do I think all of these vitals are crucial pieces of information for every patient...no. Do I think doing a complete assessment including these vitals is important..yes. Patients lie..they may not know what is important and what is not.

So my question is....what do you all take as standard vital signs for just about every patient?
 

Zodiac

Forum Crew Member
63
0
0
I was taught that BP, HR, RR, and SPO2 was all that needed to be checked in most patients and that all other vitals were to be checked if the patient's condition/history called for it. For example, I probably wouldn't check blood glucose unless the patient had a history of diabetes mellitus or presented with ALOC or other symptoms that could possibly be attributed to wacky BGL and I've found that most protocols follow the same principle more or less. I have, however, had patients ask me to check something that I wouldn't normally check on them (usually older people who are a little bit paranoid about their health) and I have no problem with doing that for them if it puts their mind at ease.
 
Last edited by a moderator:

MrBrown

Forum Deputy Chief
3,957
23
38
It depends what their primary problem is ...

Everybody gets blood pressure, pulse and GCS ... the one thing we are absolutely bloody terrible at counting here is a respiratory rate and it is not often done unless the patient is short of breath or sick.

Somebody who is unconscious or lowered level of consciousness, post-seizure, stroke like symptoms, diabetic and unwell etc will get a blood glucose measurement.

Get an ECG if you think there might be a cardiac problem.

SPO2 is helpful if your patient is unwell/sick looking or has possible respiratory or oxygenation problem e.g. asthma, pneumonia or carboxyhaemaglobin
 

ArcticKat

Forum Captain
470
0
0
BP, HR, SpO2, RR, Temp on scene. BGL, basic neuro enroute, bumped up to on scene if a high index of suspicion exists. ECG, Trops, advanced neuro, if c/c or exam indicates a need.
 

crazycajun

Forum Captain
416
0
0
BP, HR, SpO2, RR, Temp on scene. BGL, basic neuro enroute, bumped up to on scene if a high index of suspicion exists. ECG, Trops, advanced neuro, if c/c or exam indicates a need.

This^^^^^
 

Akulahawk

EMT-P/ED RN
Community Leader
4,926
1,323
113
At a very basic level, you get simply BP, PR, RR, GCS and maybe Temp on scene. Adding in anything else (HR/EKG, BGL, SpO2, Troponin...) all depend entirely on the chief complaint, and index of suspicion based on exam findings...
 

TransportJockey

Forum Chief
8,623
1,675
113
All of my adult patient get, as a minimum, BP, HR, RR, BS, GCS. If there's index of suspicion (AMS, HX of DM, Unconcious/Unresponsive of unk) or I'm starting an IV, I get a CBG. EKG is index of suspicion as well. I rarely get temp since it's rare my truck has a thermometer that works on it.
 

BEorP

Forum Captain
370
1
0
BP, HR, SpO2, RR, Temp on scene. BGL, basic neuro enroute, bumped up to on scene if a high index of suspicion exists. ECG, Trops, advanced neuro, if c/c or exam indicates a need.

Do you do a blood sugar on every patient?
 
OP
OP
bryncvp

bryncvp

Forum Lieutenant
102
0
0
In RI, it's pretty much expected to get a BLG...it's even a Basic skill...not that it's that tough to do.

My main reasoning for doing all of that for my vitals is this: a PT could be saying one thing for a cheif complaint, but could be hiding something. FR example...75 yo male fell in the bathroom saying he slipped on the wet floor. Sounds believable but he could be hiding other symptoms because of his pride. I guess I have seem too many House episodes ('everybody lies') and don't fully trust what a pts says but do trust my objective measurements. Plus the more information I get, the better picture is painted for the doc.

Other thoughts??
 

usafmedic45

Forum Deputy Chief
3,796
5
0
Plus the more information I get, the better picture is painted for the doc.

Really now? There is a difference between the clinical equivalent of data mining and being able to provide a better clinical picture. One is the practice of a professional, the other of a novice or amateur. I'll let you figure out which one is which.
 

BEorP

Forum Captain
370
1
0
In RI, it's pretty much expected to get a BLG...it's even a Basic skill...not that it's that tough to do.

My main reasoning for doing all of that for my vitals is this: a PT could be saying one thing for a cheif complaint, but could be hiding something. FR example...75 yo male fell in the bathroom saying he slipped on the wet floor. Sounds believable but he could be hiding other symptoms because of his pride. I guess I have seem too many House episodes ('everybody lies') and don't fully trust what a pts says but do trust my objective measurements. Plus the more information I get, the better picture is painted for the doc.

Other thoughts??

It may be easy to do, but it is still an invasive procedure for the patient that will cause them some degree of pain. With a thorough assessment, a blood sugar is not needed on every patient. If it someone fell because they were dizzy, lightheaded, or lost consciousness or if they seem confused then absolutely take a blood sugar. And of course, have a higher index of suspicion if they are a diabetic. But this idea of blood sugars being done as routine as blood pressures is crazy to me and I do not see how it benefits the patients.
 

ArcticKat

Forum Captain
470
0
0
Do you do a blood sugar on every patient?

Yes, with the exception of interfacility transports, at some point during the call. Our health system implemented the policy of acquiring a BGL for every patient seen in the OPD and extended it to us. If we do the BGL in the ambulance, then the hospital doesn't have to.

Persoanlly, I'm not a fan of the policy and tend to "forget" for those I don't feel the need or for those who are just keeping me too busy elswhere.
 
Last edited by a moderator:

Shishkabob

Forum Chief
8,264
32
48
I take what is pertinent to the situation at hand. Medical calls tend to get a lot more than simple isolated trauma.


Someone "feels ill", and they'll get a full work up. If they lacerated their pinky finger on a kitchen knife, I really couldn't care less what their temperature is unless something else pops up.
 

usalsfyre

You have my stapler
4,319
108
63
In RI, it's pretty much expected to get a BLG...it's even a Basic skill...not that it's that tough to do.

My main reasoning for doing all of that for my vitals is this: a PT could be saying one thing for a cheif complaint, but could be hiding something. FR example...75 yo male fell in the bathroom saying he slipped on the wet floor. Sounds believable but he could be hiding other symptoms because of his pride. I guess I have seem too many House episodes ('everybody lies') and don't fully trust what a pts says but do trust my objective measurements. Plus the more information I get, the better picture is painted for the doc.

Other thoughts??

I've found most patients don't lie. Most are honest, and the ones that are lying are pretty easy to spot when things don't add up.

BGL just isn't that important if there's no reason to suspect it may be an issue.
 
Top