ArcticKat
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+1, My first BP on a patient is done with my ears. The LP12 then cycles subsequent BPs. If I get one from the LP12 that does not fit the clinical picture it's back to verification with my ears.
If we have time to do a manual BP before we go to the hospital I will auscultate the BP to be sure. However, if we have a priority I will try to get the blood pressure by watching the needle. If you let out the air slow enough, you will see the needle bounce instead of smoothly going down. That is probably a little less accurate, but is useful since it's a little difficult to hear the thumping when the ambulance is moving on these bumpy roads. I'm sure you all know that technique though.
Hmmm, two words that are massively important where vital signs are concerned. "Corelate Clinically".
I've seen automated NIBPs be off. I've also seen the LPs obtain a pressure the provider didn't like, the provider get a number that was "better" and BLS the patient when the higher or lower number was indeed correct. Don't immediately distrust technology, if it seems off investigate deeper rather than writing it off as "wrong". You might find the patient fits the machine.
and yet, almost every hospital I have ever been to uses NIBPs as their standard BP taking devices, instead of a manual scope and cuff. I wonder why that is.
If we have time to do a manual BP before we go to the hospital I will auscultate the BP to be sure. However, if we have a priority I will try to get the blood pressure by watching the needle. If you let out the air slow enough, you will see the needle bounce instead of smoothly going down. That is probably a little less accurate, but is useful since it's a little difficult to hear the thumping when the ambulance is moving on these bumpy roads. I'm sure you all know that technique though.
Absolutely.
I'm just saying I've seen too many medics rely on NIBPs alone.
Bad habit to get into, needle bounce doesn't always correlate to BP. Plus you'll find your scenes run a lot smoother if you slow down a bit and focus on smoothness rather than speed. Getting in a hurry actually ends up wasting time more often than not, and leads to mistakes.
Rarely does a couple of minutes matter.
Yea, I'm definitely not making a habit of that. I've only used that on like one or two trauma calls. Most calls weren't that serious.
Y'all aren't taking a monitor to bedside on every patient?
Yikes...
No. This county seems to prefer to play in the back of the medic unit rather than on scene. Not that we just load the patient and get going, mind you; often, we get the patient in the back, then start doing stuff.
We do bring the LP12 in whenever information from dispatch provides any hint that it might be a good idea to do so.
Similarly, we don't bring the ALS bag in on every call, either.
I'd love to have a monitor, but a BLS unit with minimal funding doesn't see a need for one.Y'all aren't taking a monitor to bedside on every patient?
Yikes...
I'd love to have a monitor, but a BLS unit with minimal funding doesn't see a need for one.
Different situation, although you do have an AED right?
Been burned way too many times to play this game. Let me give you some of the P2 calls(lower priority calls that we're not required to bring equipment in on) I've had in just the last two weeks.
1. P2 to the NH on altered LOC. His LOC was altered because of afib w/RVR at 240 with resultant severe pulmonary edema. Required bedside cardioversion.
2. P2 to a different NH for altered lab values. The altered lab was a K+ of 1.6. Pt found to be in a 3rd degree AV block at a rate of 40. Hemodynamicly stable.
3. P2 to a residence for abdominal pain. Abdominal pain was due to DKA.
Cardiac monitor, airway equipment and suction go to the bedside of every 911 patient because of stuff like this, unless their ambulatory at the curb. I know you don't have control over this as your not running you own unit. But to me the mark of a professional is coming ready to play and not having to run back to the truck when presented with something they didn't expect. What's carrying the stuff in gonna hurt? It's kinda like laying a line on a possible structure fire.
are you kidding me? you bring all that stuff for a sprained ankle? or a hangnail? or a 3 year old who is sick?Been burned way too many times to play this game. Let me give you some of the P2 calls(lower priority calls that we're not required to bring equipment in on) I've had in just the last two weeks.
1. P2 to the NH on altered LOC. His LOC was altered because of afib w/RVR at 240 with resultant severe pulmonary edema. Required bedside cardioversion.
2. P2 to a different NH for altered lab values. The altered lab was a K+ of 1.6. Pt found to be in a 3rd degree AV block at a rate of 40. Hemodynamicly stable.
3. P2 to a residence for abdominal pain. Abdominal pain was due to DKA.
Cardiac monitor, airway equipment and suction go to the bedside of every 911 patient because of stuff like this, unless their ambulatory at the curb.
actually, it's kinda like laying a line on a activated fire alarm.I know you don't have control over this as your not running you own unit. But to me the mark of a professional is coming ready to play and not having to run back to the truck when presented with something they didn't expect. What's carrying the stuff in gonna hurt? It's kinda like laying a line on a possible structure fire.
your questions really isn't the same as what you are askingSo how many of you would be a patient at an ED where the crash cart had to come from upstairs?
Is it that much of a problem to carry the bags in?
Yep, three items. The stretcher, the monitor and our airway bag which has a compact battery powered suction in it.are you kidding me? you bring all that stuff for a sprained ankle? or a hangnail? or a 3 year old who is sick?
Don't confuse "bradycardia/cardiac rhythm disturbance" with "decompensating". Two different things. We had a nice conversation on the 40min ride to her ED. What she needed was potassium, which I couldn't provide.(and if the patient's heart rate is 40, are they really hemodynamicly stable?)
The difference is AFAs are not a confirmed complaint. It's an automatic activation. If someone calls 911 and ask for an ambulance, something is wrong in their eyes.actually, it's kinda like laying a line on a activated fire alarm.
Several departments I've worked with and around do just that. Why? Because it's flaking a bit of hose on the ground and keeps you from being behind. And no, it's not just little rural departments either.if you think it might be needed, than bring it. you got smoke showing from the house, might be a good idea to lay the line. if you are told multiple calls, might be a good idea to lay the line. you get a reported structure fire, and when you show up there is nothing showing, are you going to be laying a line and pulling hose lines off the truck? probably not.
And if the patient had hit an R on T as you walked on the door? Show up ready to work. Expect to have to control an airway, work an arrest, ect everytime you walk in the door and you won't end up behind the 8-ball.Have I been burned? sure. i remember being on the (ALS) FD engine, and got dispatched for back pain. when we got there, the patient is also having check pains. what did the lead medic do? told me to get the ALS bag and monitor, and found he had PVCs on his 4 lead.
going back to your fire analogy, have I gone to an AFA, and when we arrived, found smoke showing? yeah. still doesn't mean I'm going to lay in to every AFA.