BASIC VITALS

O.K., I was just wondering how everyone else does this, or if you have any good tips to pass along....say, you are at the scene of a motor Vechicle accident and have a entrapment, you need to get basic vitals but all you can see or reach is a forearm, elbow to hand, how would you take blood pressure, pulse and everything else you need.?

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Permalink Reply by Ben Waller on October 27, 2008 at 9:00pm

Pablo,

You can get a fairly accurate BP by using a PEDIATRIC BP cuff on the mid-forearm, and auscultating the radial artery or palpating the radial artery pulse.

The 90/palp or 80/palp discussion applies to what is most common in a large population of patients. It does NOT tell you what your patient's BP is. If the arm is hanging down out of a windshield with the car standing on its nose in a ravine, the arm may be perfusing better than the patient's core due to gravity.

The best way to tell if the patient is breathing is to get noise sources shut down and LISTEN. Sometimes, you can hear the patient breath if you get the background noise shut down for a minute. You can also try to reach the patients' chest with a stethoscope if you can worm your arm into the wreckage. Be careful to no lacerate yourself if you attempt this.

If none of this works, get the extrication team to open an inspection hole large enough to assess the patient's ABCs as quickly as possible without causing additional injury.

A pulse oximeter is a good tool - it's better than nothing in this case. As long as the patient doesn't have carbon monoxide toxicity, the pulse ox will tell you how well the red blood cells are oxygenated. It won't tell you how many of those red blood cells are circulating - in other words, it won't measure the patient's relative circulating blood volume.

Unless the patient has an airway problem or tension pneumothorax that can't be corrected with EMT-B skills, access to ALS is not really all that important for most trauma patients. They need surgical intervention to save their lives, not IVs of crystalloids or heart monitors. The reason for helicopter transport is to save time. If you can't save time by calling for the helo, just load and go.

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Permalink Reply by danny on November 10, 2008 at 4:47pm

remember keep it kiss-- keep it simple simple, if they are talking a and b are taken care of no visible bleeding and you have a pulse then c is taken care of. its only when a isn't working that you go oh chit. but anyway there is no real good way to it when entrapment is involved and you only have partial access to the pt. so do the best you can do and act when necessary- danny d.