What order do you take your vitals in?

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grossk

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Just curious what order other EMTs/Paramedics take their vitals in.
Generally, I like to go BP, pulse, chest sounds, Resp rate, then glucometer.
Obviously given the circumstances, the order in which these are taken can change.
 
Depends on the circumstances and what ever order I want to go in. I can't say that there's an "order" that I went in.
 
What does a chest sound like?

Sorry, not trying to be a **** but if we want to be recognized as a medical profession we need to use proper terminology such as lung sounds and heart tones.

I check what is most pertinent first. Breather? SpO2 is the first thing going on to get a baseline saturation prior to starting treatment. Dizziness, lethargy, a headache, syncope or other complaints that points towards a potential cardiovascular problem BP is gonna come sooner than later.

I guess I could say I check a pulse first thing every time because I always feel a radial while I introduce myself but I don't count it. Just feel for fast, slow normal, strong, weak, thready, normal.

Medicine is dynamic. There's no set order to do things in. Cardiac arrest with a respiratory etiology I'm going to focus more along the lines of ABC but if it's any other etiology it'll be CAB. That's a very simplified explanation but I think it makes sense.
 
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Pretty much the above. I try and get a ballpark radial pulse immediately. If something is immediately abnormal than they'll be going on the monitor rather soonish and the my medic partner will start to do his thing.
 
Interesting. The reason I ask is because my supervisor said I need to get into a "rhythm" or order of doing things. But like what was previously stated, medicine is dynamic. That you for the posts.
 
grosskuntz said:
Interesting. The reason I ask is because my supervisor said I need to get into a "rhythm" or order of doing things. But like what was previously stated, medicine is dynamic. That you for the posts.
Click to expand...

Which makes sense. If you have a set order of doing something, you will be much less likely to miss something when you're new. This is especially true for your first several truly sick patients when your brain decides to check out (it happens, don't fret). The key issues, though, is first, remain flexible. Second, a lot of vital signs don't need to be exact. Being able to look at a chest and tell if someone is breathing too fast/slow or too deep/shallow is more important than remembering that a "normal" rate is 12-20/minute. If its close, sure, count, but a number is just a number and needs to be put into context with the rest of the assessment.
 
I start with some very basic stuff. Does the patient notice that I'm there? Does the patient seem to make sense while I make small talk and introduce myself? I usually shake their hand (they think it's in greeting, but I'm getting skin signs...) or I'll find another way to get the skin signs. All the while I'm looking at breathing (general rate/rhythm/apparent depth/work of breathing) and somewhere along the lines I'll check a pulse for fast/slow/regular/irregular. How long does this take? From the time I walk in to the time I'm done, about 10 seconds, and often general impression takes about 2 seconds. No, I don't have exact vitals, but I probably know at that point whether I can take my time or if I must scoop and run.

No, I don't consciously do this, it's something I just do. When it comes to formally taking vital signs I don't think I have a set pattern that I do. I kind of focus in on what's needed and what I happen to (quite literally) have on hand at the time. Sometimes I'll delegate certain tasks out... to another provider or to a machine. I don't necessarily care the order the info is obtained, just the info.

Getting into a rhythm is not a bad thing to do, but don't get so set in your ways that you can't adapt to a new situation or to a patient that needs things done in a different order than you're used to. Eventually you'll just go with whatever... Until then, set yourself up for success and have your "stuff" packed the same way so you know where it is and it's presence in a certain "pattern" reminds you to get stuff done.
 
Robb said:
What does a chest sound like?

Sorry, not trying to be a **** but if we want to be recognized as a medical profession we need to use proper terminology such as lung sounds and heart tones.
Click to expand...


Chest sounds = lung sounds and breath sounds anteriorly. It is a generally accepted term, at least at my college of medicine. Should you use it in a medical journal? Probably not, but it's perfect for day-to-day use in oral presentations or on an online forum.


But to the point of the OP.

For everyone:

10 second survey. Is this patient sick or not sick? Do we have evidence of Airway, Breathing, Circulation, Disability? This is going to be the hardest part of "vitals" and just comes with time. No one can really train you on how to do a 10 second survey.

After that, for a stable patient:
1) Talk to the patient and make introductions to assess cognitive function I don't need a full GCS number, but I want an estimate. I do this while reaching in the jump bag for equipment I need.
2) Place Pulse-ox on a finger contralateral to the side I will take a BP on. Let it sit for a second to capture. Great time to do a cap refill too.
3) Place BP cuff (or as Robb might insist we call it, the sphygmomanometer ;) ) on the patient.
4) Palpate radial pulse to ensure it matches the waveform/light pulse on the pulseox. If it does, then I have my pulse reading. If not, I'll have to get bilateral pulses later.
5) Take BP
6) Take respiratory rate. I usually do this while writing down other things to not make it obvious, or during the manual pulse if the pulse-ox fails.
7) As needed, take the pulse rate manually

From here, depending on what the CC is, I'll look at breath sounds, pupils, glucose etc. in an order that makes sense for the CC.

After that, for an unstable patient:

Correct Airway, Breathing, and Circulation in that order. Only check vitals if it's really important to something I'm doing (such as a contraindication for an intervention) and even then, only check relevant vitals.

On unstable patients, there have been transports where I never took one set of vitals since in the time it took to get from the scene to the hospital, I never got past A, B and/or C.

Some would argue that stable patients should always get a full set of vitals. I disagree. If I'm 2 blocks from the hospital where my driver can have me to the bay in 30 seconds, I'm not going to sit on scene for 5 minutes just to get a complete set of vitals and history and all of that. For example, in an MVC 4 blocks over from the hosptal where the patient self-extricated but wants to go to the hospital, my order might very well be:

1) 10 second survey--he's stable
2) C-spine clearance protocol - I can clear, hop on into the truck for me please!
3) History--what happened. Weren't paying attention and ran into the pole? Or did you get dizzy and pass out first?
4) Courtesy Call to hospital to let them know we are inbound, no entry note, just a call only because
5) We pull into the ambulance bay.

Sitting on scene and taking a full set of vitals and a full history when you can see the hospital is the BLS equivalent of sitting on scene and trying to get an IV for 20 minutes. Just because you haven't done much doesn't mean you haven't done the best possible for the patient.

A patient having an MI doesn't need an IV--they need a cath lab. The IV is part of the requirements for a cath, but your goal is cath, not IV. If you can't get it, you can't get it, move on and let the hospital get the IV where they have ultrasound and other cool toys.

Vitals are just that--a tool for assessing and treating the patient. But they are not the end goal.
 
As I do my initial questioning I am feeling their pulse just for rapid/slow, and how strong it is. While I am doing that I watch their breathing just to see if it's rapid/slow, and how well they are breathing.

Then I put on SpO2 on one finger, and get a BP on the other other so I can get both at once. If necessary I go from that to chest sounds or cbg, depending on which is priority (respiratory complaint or issues I saw vs. abnormal mentation and a hx of diabetes).

All assessments should follow the same basic principles, but adapted to fit the scenario.
 
Applying the pulse ox only takes 2 seconds of your time, and gives you readings for two important vital signs (and you can also gauge whether they respond to commands when you ask them to hold out a finger of a stated hand).

So I always take care of the pulse ox first, then take care of whatever seems most pressing and glance at the pulse ox reading while taking a BP (opposite extremities) or checking BGL.

Unless they're in respiratory distress, lung sounds come last.
 
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Don't really have a set way of doing vitals. The C/C and how the patient is presenting determine the order.
 
DesertEMT66 said:
Don't really have a set way of doing vitals. The C/C and how the patient is presenting determine the order.
Click to expand...


I completely agree with this, however I should also add that While I don't get respirations until later, you can usually tell respirations before you count. Also, I like to get pulse right away if I can. The quality of the pulse can be almost as important as the rate. To give an example: one I had a few months ago: 20 y/o F passed out. Was aaox3 when I arrived. I'm asking history questions as I take her pulse, which was non-existent. That leads me to take a blood pressure which is crazy low. I ask BP history questions, she says she's had it taken at the doctor's office and it's usually "normal". This leads me to ask what she's had to eat or drink today, has she taken any drugs or alcohol is she on any current medications. I take a blood sugar reading which is normal and pulse ox is normal. No signs of shock from sepsis, allergy or cardiac, No meds, no drugs, went drinking the night before...and...she hasn't had any water for about 18 hours since she was drunk. Most likely dehydration.

Point is, the quality and "rate" of breathing can usually be spotted as you approach and I really like to take pulse first, as quality of pulse can give a ton of info in addition to rate.
 
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Generally speaking I will assess level of consciousness while simultaneously palpating radial pulses to assess if there is a perfusing blood pressure and assess skin after my general impression as I approach scene/pt. After that it depends greatly upon my pt's clinal presentation so far as to which vital sign I want to get next. Might be a blood pressure, or SpO2, BGL, BP, ECG, or breath sounds. It really depends.
 
JPINFV said:
If you have a set order of doing something, you will be much less likely to miss something when you're new.
Click to expand...

Yep, this.

Personally, I would strongly encourage a new person to do the same things in the same order every time. As you gain experience you'll naturally become more flexible and fluid.

My patient assessment starts with speaking to the patient, looking at their respiratory effort / rate / rhythm and skin color, and palpating a pulse if necessary. That takes seconds and before long it happens without even thinking about it.

After that I place the monitors, and I generally do NIBP cuff (and start it cycling) -> Spo2 probe on the hand opposite the BP cuff -> EKG leads. I'll then listen to the chest.
 
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