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# How do you do vitals on the fly...

I am just starting out in EMS as a NYS Certified First Responder (a.k.a Emergency Medical Responder.) I know how to do pulse and BPs etc... what I would like to know from the veterans of the field is how do you do the math after counting palpation??? I suck at quick math and was curious is you all have any suggestions to help me when doing things such as fire ground rehab

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count for a full minute - when you are first learning AND with sicker patients - to get a bigger picture - since you are not JUST counting - but also evaluating rhythm changes and matters such as strong and consistent or weak and inconsistent (thready)

Super sick - in the field - you may even take it for a few minutes continuously if the count is all over the place - fast/slow/random/repeat, etc. You get the point.

And repeat often - since patients can start to decompensate without much notice - and their pulse and BP changes - so you need to not only take the current vitals, but also remember the prior ones, such as

BP 140/72 and Pulse 100, and strong at 1:10 am
BP 100/50 and Pulse 140, and irregular at 1:20 am
BP 80/50 and Pulse 80, and very weak and irregular at 1:30 am

(i.e. while these may seem to be random numbers - if your BP changed from 140/72 to 80/50 that is something important to mention as treatment must change, not just write down on the notes)

Pulse - After more experience on your part, or with more stable patients (non-trauma) you can count for 20 seconds, then multiply time 3.... or count for 30 seconds and multiply times 2...

But if you are going to work in this field... you better get practicing your math skills on the fly - since a mis-count could lead to a mis-treatment, and a failure to realize how serious a patient's medical condition is progressing.

Good Luck.
Very good advice, I forgot to mention this question was based for rehab (hence on the fly) but I made a chart to kind help me with memorizing the numbers and such.. as of now rehab is the only thing I can do, and I see it being very valuable to me for when i get my EMT this December when I am of age....

thanks for the help
you are old enough to add, subtract, and multiply ;-)

and teach others how to do it - on the fly

practice practice practice

soon you will have to know how to calculate water need and water usage - so you better get practicing now now now

... if you mean rehab at a drill or fire call - I always count pulse at least for one minute... commonly there is a rehab period of time (let us say 15 minutes at a working fire)... so I take vitals at the beginning and end of rehab... if the initial vitals are within normal limits, then it is not as closely managed as it is when the vital signs are extremely high (or out of wack) - such as rapid respirations, super rapid or irratic pulse, and super high or low BP

FF/EMS do pass out on scene from heat exhaustion - and the vitals may indicate a person headed towards heat exhaustion - and commonly someone with heat exhaustion will not be able to think clearly and will not be able to ask for help - so you will have to recognize and intervene - and stop them from returning to manual labor
Besides what you already have, a B/P is simple, pump past you feel a pulse and listen on the way down, first number you hear a pulse back is systolic, when you stop hearing "thumps" is diastolic. On the "fly" or by palpation, pump until you don't feel a pulse and a little beyond, keep your fingers on the wrist and let the air out of the cuff, when you feel a pulse back, that is systolic and that is over "P" or palpation, you won't get a diastolic.

For a pulse, count the beats, a minute is whatever you get, if you go 30 seconds, multiply by two, if you go 15, multiply by 4, if for 10, multiply by six.....out of those you should be able to do some simple math.

I suck at quick math and was curious is you all have any suggestions to help me when doing things such as fire ground rehab

Since you say you are limited to fireground rehab, then there really is no reason for many of the quick "on the fly" tricks, at rehab you should have time to do good assessments. Another important aspect is vitals alone are not an indicator to go by, take a look at the overall person and time. If just into rehab, pulse and pressure typially will be high, upon ready to leave, they should be back to normal.
Usually that is what I do, the FF is greeted by a water tender, who takes the time they arived to rehab, and take their accountability tag. they then are directed to a myself or another medic to get assessed, cooled down and etc, their vitals are recorded and once they are medically ready they go back into the fire they are released...

this is where my question comes into play: We have had one call and one drill where we initiated EMS rehab, we stage one ambulance to be stripped for rehab, and one standing by with a crew to transport(also our duty crew). we are lucky if we have 4 EMS personnel present. both of these times we have had a ambulance call go out during rehab and we are left to either 1 or 2 medics... in my particular case I was left for up to a half hour alone assessing up to 15 people. so thats why I was asking if you all had an "on the fly" method
Usually that is what I do, the FF is greeted by a water tender, who takes the time they arived to rehab, and take their accountability tag. they then are directed to a myself or another medic to get assessed, cooled down and etc, their vitals are recorded and once they are medically ready they go back into the fire they are released...

this is where my question comes into play: We have had one call and one drill where we initiated EMS rehab, we stage one ambulance to be stripped for rehab, and one standing by with a crew to transport(also our duty crew). we are lucky if we have 4 EMS personnel present. both of these times we have had a ambulance call go out during rehab and we are left to either 1 or 2 medics... in my particular case I was left for up to a half hour alone assessing up to 15 people. so thats why I was asking if you all had an "on the fly" method
this is an incident command matter - if you are not EMS licensed you should not be left alone to evaluate anyone EVER
Oh no no, that never happens, perhaps I worded that wrong... I am EMS Licensed, I was just curious of other peoples practices...
Also---get a good stethescope if you plan on doing this for a while - its a well worth while investment. Never trust the machines B/P's they gve you on some of the monitors they have today--they can be way off. I have had my Littman Cardiology for years (been a medic for 29 years) --it was a little over 200 dollars when i bouyght it many years ago but it was a well worth while investment. Again--only would only recommend on that type of investment if you plan on doing it for a while.
Sounds good, I have a cheap littman now, but it seems feasible to get a higher grade one.
good good good
excellent point Michael - when it comes to stethescopes - good ones are essential and paying more for a good one that allows you maximum hearing ability in a high-noise environment is well worth all the money - also label it with your name - since it is liable to get lost quickly if you do not keep a close watch on it

ask around to seasoned EMTs and find out what they recommend then go try a few out to find one that works best for you

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