Questions on taking blood pressure and gear needed for going on calls…

[RunnerD1987]

Hi, just did my first shift with my local volunteer ambulance station a week ago. I had difficulty obtaining the blood pressure of the patient. Felt a bit embarrassed, but we used the automatic cuff and were only able to ascertain one set of blood pressure results. I am certified as an EMR, Emergency Medical Responder, were not required though are allowed to take blood pressure if needed. I am continuing with an EMT course in February so want to become confident taking patient’s blood pressures if I do on the next calls. Believe my issue is I release the pressure too quickly and cannot hear the Korotkoff sounds. Any advice or tips to offer in regards to taking blood pressure I appreciate it.

Second question is in regards to basic essential gear for going on calls. Through research found, that decent pair of boots is important so am planning to save up for those. In the meantime, a relative of mind is allowing me to borrow boots he owned while being a police officer. I am also looking at purchasing a pair of pants that I can use specifically for going on calls. I wore my jeans for the first shift have no problem with that, but as I said just want pants that will only be used on calls. Going through the website found that BDU’s are the way to go and three brands are highly recommended: Propper; True-Spec; 511 Pants. If any other brands to recommend or out of those brands do, you recommend.
With the pants, probably will looking into investing into a good pair of socks and some under shirts.

With the pants am looking into investing into one more item that might be a necessity to purchase, any suggestions. Have a small Maglite and turnout gear the station gives us. I was considering buying a few books:
Anatomy & Physiology for Emergency Care (2nd Edition) [Hardcover] Bryan E. Bledsoe (Author), Frederic H. Martini (Author), Edwin F. Bartholomew (Author), William C Ober (Author), Claire W. Garrison (Author);

EMS Field Guide: Basic & Intermediate Version (Informed) - Spiral-bound (Sept. 19, 2006) by Jon Tardiff, Paula Derr, and Paul Lesage;

Quick Spanish for Emergency Responders: Essential Words and Phrases for Firefighters, Paramedics, and EMT's [Paperback]

Appreciate the response back and have a good one.

 

[Shishkabob]

Blood pressure wise: You stated that you believe you went too fast, which means the answer to that problem is slow down. You have time to get an accurate BP, but at the same time don't be afraid to admit you can't get one and let someone else have a shot. PS-- Some patients will have no audible blood pressure.



Pant wise: I have 5.11s, I like them as far as EMS pants go. Find a pair that fits your needs and you should be good to go.




Book wise: A&P books are always useful, but you will also be better served by going to an A&P class.

Field guides, in my opinion, are better if you get the ALS version. Lots of drugs listed in the back, an EKG ruler, "normal" lab values, etc etc. I don't really use any of the quick reference stuff in the guides, except for the things I listed.

As far as the Spanish book goes, atleast in the ALS version of the field guide they have a section for Spanish translation.

 

[C.T.E.M.R.]

Im guessing by your username and Cert That your from Connecticut, the best advice i can give you is most of the roads suck, so its hard to get a bo going down the road, Ambient noise is an issue even if you are not moving Plus getting bps takes a little bit of practice, i still have a habit of releasing the air to quick, Good luck though, as far as your other questions Linuss pretty much got it all and i definitley agree with him.

 

[Sassafras]

Don't worry. I got my EMR a year and a half ago and EMT in June. I still handed a BP off to another EMT today. Sometimes a different set of ears is needed. He tried the electric and still didn't get it so we went up to a larger size and finally heard a faint BP. It's more important to ask for help and get an accurate set of vitals than it is to spare your ego. Never be embarrassed to ask for help. If you don't believe a reading try again as well. It comes in time and with practice and still there will be patients you crap out on. Enjoy the journey.

 

[Shishkabob]

Plus, don't be afraid of doing a palpated BP. You aren't giving any vasoactive drugs, so palpated BPs are just fine.

 

[jjesusfreak01]

I have tried, and failed, two field BPs, but I don't feel bad about it because each time a senior medic also tried and failed to get one. Maybe my new scope will help out!

PS: My new strategy is to try the auscultated BP twice, and then go for the palp.

 

[RunnerD1987]

tries ddididdid ppapaspasspass tththethe ccucufcuffcuff oofoff to sn

Appreciate the response. After two tries asked the person riding with me to make an attempt. Just something have to continue to work on. Thanks on the book suggestions.

 

[Hockey]

Here's a tip that seems to work lately...


Crank that BP cuff up nice and tight. Count to like 5...then let it go slowly


Seems to always hear it better

 

[mgr22]

Taking BPs is something you can practice at home, assuming you can borrow a cuff and have at least one willing "patient."

I think you should wait to buy anything at least until you've done a few more shifts, so you have a better idea of your preferences. When I started in EMS, I spent some money buying what others had, then stopped using most of that stuff. For now, observe, learn and explore.

 

[medicRob]

Taking BPs is something you can practice at home, assuming you can borrow a cuff and have at least one willing "patient."

I think you should wait to buy anything at least until you've done a few more shifts, so you have a better idea of your preferences. When I started in EMS, I spent some money buying what others had, then stopped using most of that stuff. For now, observe, learn and explore.

+1

If you drive a diesel truck, you can always hop in that bad boy and try to take a pressure with the engine on. That's how I always practiced.

 

[b2dragun]

Go buy a cheap bp cuff and set of ears...ebay sells then for like $20. Not gonna be great for the field but it will be good enough to practice on mom, dad, girlfriend...that way it will become second nature.

As for pants, i have company issued with all the pockefs and snaps, i also have a pair of 5.11 pants with pockets and snaps. In the end i prefer to wear double knee ****ies with the small side cell phone pocket. I find i hold onto too much when i have space for it...when everything i need is in my jump bag. All i carry now is shears, tape, and an extra pair of gloves. You can't beat a pair of reliable sturdy $20 ****ies.

 

[Madmedic780]

Enroute I find it's easier to hear a BP by raising my feet off the floor. Also palpate the brachial artery first and put your stethoscope right on that spot.

 

[feldy]

while i am a young emt my self, i too have had a few occasions where i could not get a bp. If we are going a 3 lead, ill use the monitor but that does not always give an accuate reading especially if we are driving or if the pt has trouble sitting still. It never hurts to get an extra set of ears. My medic asked to me check his reading b/c he wasnt sure.

Also, once you starting doing more runs, you will find that some people have a stronger, more audible pulse than others and once you are able to distinguish that, then you will be able to hear the weaker ones betters.

Also, i use my own cuff instead of the ones on the truck unless i need the pedi or the extra large or the monitor. I can trust it more than i can the other one.

 

[rcklizard]

Hi, just did my first shift with my local volunteer ambulance station a week ago. I had difficulty obtaining the blood pressure of the patient. Felt a bit embarrassed, but we used the automatic cuff and were only able to ascertain one set of blood pressure results. I am certified as an EMR, Emergency Medical Responder, were not required though are allowed to take blood pressure if needed. I am continuing with an EMT course in February so want to become confident taking patient’s blood pressures if I do on the next calls. Believe my issue is I release the pressure too quickly and cannot hear the Korotkoff sounds. Any advice or tips to offer in regards to taking blood pressure I appreciate it.

Second question is in regards to basic essential gear for going on calls. Through research found, that decent pair of boots is important so am planning to save up for those. In the meantime, a relative of mind is allowing me to borrow boots he owned while being a police officer. I am also looking at purchasing a pair of pants that I can use specifically for going on calls. I wore my jeans for the first shift have no problem with that, but as I said just want pants that will only be used on calls. Going through the website found that BDU’s are the way to go and three brands are highly recommended: Propper; True-Spec; 511 Pants. If any other brands to recommend or out of those brands do, you recommend.
With the pants, probably will looking into investing into a good pair of socks and some under shirts.

With the pants am looking into investing into one more item that might be a necessity to purchase, any suggestions. Have a small Maglite and turnout gear the station gives us. I was considering buying a few books:
Anatomy & Physiology for Emergency Care (2nd Edition) [Hardcover] Bryan E. Bledsoe (Author), Frederic H. Martini (Author), Edwin F. Bartholomew (Author), William C Ober (Author), Claire W. Garrison (Author);

EMS Field Guide: Basic & Intermediate Version (Informed) - Spiral-bound (Sept. 19, 2006) by Jon Tardiff, Paula Derr, and Paul Lesage;

Quick Spanish for Emergency Responders: Essential Words and Phrases for Firefighters, Paramedics, and EMT's [Paperback]

Appreciate the response back and have a good one.

Walmart carries a black cargo pant made by Wrangler for only $18.95 a pair, work well for the EMT on a budget!

 

[Melclin]

BPs: Watch a youtube video (there are plenty) and practice. Like most skills its easy to learn and hard to master. It just takes times and practice, don't fret too much.

Pants are pants, mate. Get a pair that are pant like in nature. I don't know that a good pair of pants is any more important for the job than for any other job.

Save up for pants? Invest in socks? What the hell kind of collectors addition clothes are you buying? Seriously, don't go blowing tons of money on this stuff. You were, I imagine, equipped with sufficient life skills to drive to your local shop and buy a set of practical but cheap pants, socks and under shirts. It seems like you're really worried about it. Don't be, its not that important.

What you should be worried about are clinical issues. A reference is your first priority. It absolutely comes above what brand of socks you will buy. I would say a good rule of thumb for just about anything would be that a person should spend more on their education for a given field than they did on their socks. Can you imagine turning up to your pt and saying, "Terribly sorry, but I have no idea whats wrong with you because I spent all my money on these gold plated socks and had nothing left to educate myself with but Scrubs reruns". I'm not having a crack at you, I'm just using a bit of humour to make a point about priorities.

If money is a big issue then the internet has so much out there for free. I wouldn't bother with an expensive and yet strangely useless EMT book just yet. A much better range and quality of resources are easily available on the web. Unleash your google-fu or search for one of the many threads here about educational resources. Get some A&P into you. People knock it, but wikipedia is an excellent source of knowledge for beginners on most topics. Easy to read and surf too.

 

[systemet]

Believe my issue is I release the pressure too quickly and cannot hear the Korotkoff sounds. Any advice or tips to offer in regards to taking blood pressure I appreciate it.

* Do a few hundred, and you'll get better. This sounds flippant, but honestly, find a BP cuff and a stethoscope, find a volunteer and take their pressure a few different times. Don't worry if it change a bit between trials, it probably will. Repeat. Most people think a skill is different when they've done it 20 times. When they've done it 500, it usually seems easier.

* As much as you can, position the patient in a position that's easiest for you to take their pressure, instead of bending around like a pretzel, move their arm, etc.

* Ensure that the arm is fully extended, that the cuff is sufficiently snug, and not sliding all over the place. Avoid taking the pressures over clothing, and if possible remove it versus just rolling up sleeves.

* Landmark by palpating for the brachial, watch what the tubes are in contact with, esp. part of the vehicle/stretcher, make sure you're not gripping the diaphgragm too hard.

* Some people swear by Spragues, but if you can get a cheap Littman classic (if such a thing exists), then they seem to work pretty well for most of the things you need to do in EMS.

Through research found, that decent pair of boots is important so am planning to save up for those.

It's nice to have good boots, but they're expensive. I wore the cheapest black leather polishable steel-toe, steel-shank that Walmart sold for the first couple of years. I hate zipper inserts, but other people may feel differently. Generally what you put in your head is more important than what you carry around.

I am also looking at purchasing a pair of pants that I can use specifically for going on calls.

This is probably a good idea from an infection control standpoint. You probably don't want to wear a bunch of clothes that someone's vomited and coughed all over, around your family and friends. It's probably good if they look reasonably professional. But honestly, a major concern for me would be are they cheap? You want to be able to throw them away and buy another pair without too much personal hardship.

With the pants, probably will looking into investing into a good pair of socks and some under shirts.

The moisture-wicking kind are only important if you're wearing a vest, or (I suppose), you're in a really hot climate (I have more experience with really cold). It's nice if you have a T-shirt that's black or navy (assuming you're wearing black or navy shirts), versus fluorescent orange, which looks a little unprofessional.

Have a small Maglite and turnout gear the station gives us.

You should have something to check pupils with. Depending on the area you work in, and how your trucks are stocked, it's nice to have something you can use in a ditch or a building with no power.

There's some nice LED flashlights that don't weight too much but give out some real power. I wouldn't go running around with a full-size 4 D cell Maglite. The small ones are ok for pupils, but poor for scene illumination.

I was considering buying a few books:
Anatomy & Physiology for Emergency Care (2nd Edition) [Hardcover] Bryan E. Bledsoe (Author), Frederic H. Martini (Author), Edwin F. Bartholomew (Author), William C Ober (Author), Claire W. Garrison (Author);

Bledsoe seems like an intelligent guy, but his books tend towards terrible. I haven't read this one, but I'm guessing its written for the lowest common denominator. I'd recommend going for a sort of A&P for allied healthcare book like Tortora & Grabowski, any edition in the last 10 years is ok, unless you particularly care about aquaporins. Later on for medic, you'll probably want something a little heavier hitting.

EMS Field Guide: Basic & Intermediate Version (Informed) - Spiral-bound (Sept. 19, 2006) by Jon Tardiff, Paula Derr, and Paul Lesage;

These are also mostly useless too, but go for the ALS or "Critical care" one, like one of the other posters suggested.

Quick Spanish for Emergency Responders: Essential Words and Phrases for Firefighters, Paramedics, and EMT's

I don't know it. But if this is an issue in your area, it might be worth taking a Spanish course. Also great if you're travelling at all in most of the Americas.