When taking a pulse

The advice we got for skills testing was "if you count to 15 and you are off by only 1-2 beats, when you multiply that by 4 you can end up being off in your final number by at least 4-6 beats. you can't be off by more than 6 beats to pass the skill". Basically the less time you count for, the more you increase your margin of error. Personally based on that reason alone, I count for at least 30. Any less is not accurate or skills test worthy and I feel my patient deserves care at skills testing levels as long as I'm capable of providing it.
 
I'm among the ones that push for the full 60 minutes. I've been taught that 'Even if you get a normal rhythm, ect, within the first 10/15 seconds, that could very possibly change after you are done with the pulse.'
 
LIT said:
The advice we got for skills testing was "if you count to 15 and you are off by only 1-2 beats, when you multiply that by 4 you can end up being off in your final number by at least 4-6 beats. you can't be off by more than 6 beats to pass the skill". Basically the less time you count for, the more you increase your margin of error. Personally based on that reason alone, I count for at least 30. Any less is not accurate or skills test worthy and I feel my patient deserves care at skills testing levels as long as I'm capable of providing it.
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You raise a very good point. This is especially important when you are counting respirations as well!
 
Minimum 30 seconds, if far out of normal range, take a full 60 seconds.
 
60 seconds is really not necessary and i'snt really an efficient use of time. In 60 seconds I could have taken a 15 second pulse, got an Sp02 probe on, taken NiBP/ manual BP and done a 6 lead ECG all of which can be used to obtain a HR. Granted this would be modified for people with irregular heart rates etc but IMHO 60 seconds taking a pulse inst really necceasry. Yes a manual pulse can tell you a wealth of info, but 15-30 seconds should be more than enough.

I guess this will also be different for EMT-Bs etc in the US who dont work using Lifepaks and the like.
 
LIT said:
The advice we got for skills testing was "if you count to 15 and you are off by only 1-2 beats, when you multiply that by 4 you can end up being off in your final number by at least 4-6 beats. you can't be off by more than 6 beats to pass the skill". Basically the less time you count for, the more you increase your margin of error. Personally based on that reason alone, I count for at least 30. Any less is not accurate or skills test worthy and I feel my patient deserves care at skills testing levels as long as I'm capable of providing it.
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Patient's deserve the best level of care possible, but that does not have to be perfectly synonymous with "skills testing levels." Patient's also deserve to be assessed efficiently, and I don't it is efficient to count for 60 seconds in most cases.

Taking a pulse is counting a distinct movement, I don't think many people are going to off by any beats. Even if I am of by 1-2 beats, and the margin of error increases during multiplication, and I end up being six beats off, where does this leave me? Are those six beats going to effect any aspect of my care? Probably not, a pulse is not a fixed number and I've had plenty of stable (IFT) patients whose pulse changed more than six beats during transfer. That does not worry me, it's the body reacting to changes in environment. Now if they really have an irregular pulse I might count for 30-60 sec to confirm that it is irregular. Even if it is irregular, there is nothing I can do to correct it, beyond call for ALS. And if further assessment finds no other abnormalities, I am not calling ALS.

smilingblueeyes said:
I'm among the ones that push for the full 60 minutes. I've been taught that 'Even if you get a normal rhythm, ect, within the first 10/15 seconds, that could very possibly change after you are done with the pulse.'
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Couldn't the rhythm change after taking the pulse for 60 seconds?
 
smilingblueeyes said:
I'm among the ones that push for the full 60 seconds. I've been taught that 'Even if you get a normal rhythm, ect, within the first 10/15 seconds, that could very possibly change after you are done with the pulse.'
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Fixed it for readability...
I would think that if a rhythm can change after the first few seconds, it could very well change after the first 60 seconds... or for that matter, after 5 minutes of counting.

What I want to truly know is if the basic rate/rhythm is fast, slow, regular, irregular, or irregularly irregular and I can pretty much get that in 15 seconds. If I really absolutely REQUIRE a more exact count of a pulse rate, I'll do it over 30 seconds or a minute, depending upon the actual need. Frankly, I'd rather do a 15 second count for PR and use the next 15 second window to find a convenient start time for me to do a 30 second RR count.
 
Like Akula has stated, all that I care about is if it's normal or not. If not, then is it tachy or brady? Is it regular or irregular? More exact numbers can wait till everything else is set.



After that, I check to make sure it matches the monitor and I'm good to go.
 
Agreed. A pulse that can change in 60 seconds could also change in 61. It's just not practical to sit there with your finger on their wrists for the entire transport on the off chance it'll change up in a few seconds.
 
Ever heard of Sinus Dysrhythmia? Pulses tend to vary pretty consistently. Next time someone's on the monitor and you stick an IV check out their rate before and after, 9/10 I'd bet it'll increase. Lots of variables can cause a change in pulse rate.
 
NVRob said:
Ever heard of Sinus Dysrhythmia? Pulses tend to vary pretty consistently. Next time someone's on the monitor and you stick an IV check out their rate before and after, 9/10 I'd bet it'll increase. Lots of variables can cause a change in pulse rate.
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That's why they're called Baseline Vitals. There's always variations in all V/S during a call, but they're going to return to normal after you do the IV poke. That's why we take serial vitals, if they don't return to normal, look for the cause.
 
when i was a new EMT I was so nervous and I used to squeeze the wrist so hard trying to feel a pulse that i would actually act like a tourniquet and couldn't feel a damn thing!
 
ArcticKat said:
That's why they're called Baseline Vitals. There's always variations in all V/S during a call, but they're going to return to normal after you do the IV poke. That's why we take serial vitals, if they don't return to normal, look for the cause.
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I agree with you. I was more pointing out the fact that extrinsic factors can cause a change in pulse. You could count for 120 seconds and 99% of the time I'd bet the rate from the first 60 would not match up with the rate from the second 60.
 
NVRob said:
I agree with you. I was more pointing out the fact that extrinsic factors can cause a change in pulse. You could count for 120 seconds and 99% of the time I'd bet the rate from the first 60 would not match up with the rate from the second 60.
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Ahhh, I get it now. I'm a nice boy, just a little slow.

^^If anyone uses that quote in their signature line I'll slap ya.
 
IMO check for 15sec then multiply x4 during you inital assesment then hook them to your monitor if you have one
 
The only problem with a Lifepack 12 of any other vital sign monitor is you can NOT get a "quality" of the pulse...and its not ALWAYS accurate
 
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