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First pulse is always palpated. Second is off pulsox if the first few beats match what I get while palpating to make sure it is accurate.
I don't have a problem with that. I lose my mind when I'm told by an EMT with a pulse oximeter that the HR "keeps going all slow" because the pulse ox loses contact due to low perfusion or whatever else. Palpate the radial artery and realize it's regular and a normal rate! It's either that or them calling us for a HR of 180 when they never took a manual pulse and realized it was a consistent 80...