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Re: [E-Chir] Re: EMS and fist aid working together

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  • James D Sena
    The further dumbing down of CPR. We had that in my ARC CPR class when I renewed this year. The given reason was In an emergency most people can t remember
    Message 1 of 24 , Dec 6, 2006
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         The further dumbing down of CPR.  We had that in my ARC CPR class when I renewed this year.  The given reason was "In an emergency most people can't remember how to check for a pulse, or even find their own".

        I disagree with it, and I won't stop checking for a pulse myself.  Then again my original training was not "lay person".  For the first 10 years I had a CPR card it was either "CPR for the Professional Rescuer" or "CPR for Health Care Providers".  It is a much more educational program than "Standard CPR with AED".

        And don't even get me started on the dumbing down of AEDs either.

      Lord Brendan ap Llewelyn



        Ninka wrote:
      The new Heart and Stroke guidelines (which govern St. John's, Red Cross and all other first aid training providers) no longer teach pulse checks to the lay provider. In fact, there is no longer a check for signs of circulation of any type. If you have to breathe for a patient, then you immediately start CPR. These new standards came into effect in either September or October of this year.
       
      Xristina


      ----- Original Message ----
      From: "Benetti,Sandy [Ontario]" <sandy.benetti@...>
      To: E-Chir@yahoogroups.com
      Sent: Wednesday, December 6, 2006 8:53:16 AM
      Subject: RE: [E-Chir] Re: EMS and fist aid working together

      Who is "we" St. John's, Red Cross, someone else? Any one with CPR training gets taught how to take a pulse.  I don't know if it's mandatory, but at Pennsic they asked for copies of my CPR certs as well as my first aid ones.
       
      S.
      -----Original Message-----
      From: E-Chir@yahoogroups. com [mailto:E-Chir@ yahoogroups. com] On Behalf Of MaryCatharine
      Sent: December 6, 2006 8:20 AM
      To: E-Chir@yahoogroups. com
      Subject: RE: [E-Chir] Re: EMS and fist aid working together

      With the new modalities, we no longer teach the
      "lay person" to take a "pulse", anywhere, period...
      We are to only teaching/recerting EMS to "take pulses "...
       
      Have fun with this one,
       
       
      MaryCatharine
      ...."Of course he has a knife. He always has knives.
      We all have knives.  It's 1183 and we're all barbarians."

      Katharine Hepburn (1907 - 2003) As: Eleanor of  Aquitaine.
      The Lion in Winter. 1968
      -------Original Message----- --
       
      Date: 12/05/06 14:11:42
      Subject: RE: [E-Chir] Re: EMS and fist aid working together
       

      All good points, however as a first responder you still don't need the BP cuff. You can take a carotid pulse and a distal pulse. If you do them at the same time, they should both have the same rate and rhythm. If they don't there's a problem. If you can find one and not the other, there's a problem.  These are the 2 major pulse points most first aiders use.  Finding a podieital pulse is tricky and finding a femoral pulse is usually only done as a drastic measure.  Both carotid and distal pulse tell you a rough approximation of the systolic pulse.
       
      So, taking vitals yes. Change in pulse or a difference between carotid and distal pulse for rate rhythm or strength tell you if your patient is stable, improving, deteriorating and are (along with pupil response and respiration rate, skin colour and condition and level of consciousness) are all things you can relay to EMS. They don't require a BP cuff or stethoscope. I'm with the ski patrol, I know this.
       
      Seonag
      -----Original Message-----
      From: E-Chir@yahoogroups. com [mailto:E-Chir@ yahoogroups. com] On Behalf Of KIM MCAULEY
      Sent: December 4, 2006 10:21 AM
      To: E-Chir@yahoogroups. com
      Subject: Re: [E-Chir] Re: EMS and fist aid working together



      You are very correct in all those assessments Streonwald. However, as a person who has to call 911 more than most, I can tell you that St. John does suggest that taking a full set of vitals is a good thing. Including BP. However, and this is in big red letters, you do this only when you have done everything else on the list of things to do and while still waiting for EMS to arrive, cause you called them right at the beginning. Taking vitals sure beats twiddling your thumbs?
       
      In the case of BP, there are certain things that a *changing* blood pressure can tell EMS and the hospital. If you can, get the baseline vitals so they have more information to work with.
       
      Curious? Google Cushing's Triad for more information. ::grins:: Who wants to do a report for the class on it?
       
      Kaellyn
       
       
       
      >>>>>>>>>>>>


      I agree.  As a Ski Patroller of 18 years experience (including over
      ten years as an instructor), I have never needed, nor taken a BP
      reading.  If I don't find a pulse anywhere distal to an injury - it's
      a load and go.  If I don't find a peripheral pulse - it's a load and
      go.  If I find an abnormal (ie. unexpected) rate, or strength, or an
      unusual rhythm in any pulse - it's probably load and go.  A BP cuff,
      or a stethoscope won't help me decide.

      Basically, any unusual circulatory function requires care that I can't
      provide (ie. beyond blankets, O2, monitor, transport) and my patient
      needs to go to the hospital, ASAP.




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    • Benetti,Sandy [Ontario]
      Hey maybe we can go medieval on them and resort to leaches and maggots (noting that still are both used in modern medicine and that in some cases maggots
      Message 2 of 24 , Dec 6, 2006
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        Message
        Hey maybe we can go "medieval" on them and resort to leaches and maggots (noting that still are both used in modern medicine and that in some cases maggots work better and cleaning up a nasty wound than  a lot of modern antibiotics).
         
        Seonag :)
        -----Original Message-----
        From: E-Chir@yahoogroups.com [mailto:E-Chir@yahoogroups.com] On Behalf Of James D Sena
        Sent: December 6, 2006 2:08 PM
        To: E-Chir@yahoogroups.com
        Subject: Re: [E-Chir] Re: EMS and fist aid working together

           The further dumbing down of CPR.  We had that in my ARC CPR class when I renewed this year.  The given reason was "In an emergency most people can't remember how to check for a pulse, or even find their own".

          I disagree with it, and I won't stop checking for a pulse myself.  Then again my original training was not "lay person".  For the first 10 years I had a CPR card it was either "CPR for the Professional Rescuer" or "CPR for Health Care Providers".  It is a much more educational program than "Standard CPR with AED".

          And don't even get me started on the dumbing down of AEDs either.

        Lord Brendan ap Llewelyn



          Ninka wrote:
        The new Heart and Stroke guidelines (which govern St. John's, Red Cross and all other first aid training providers) no longer teach pulse checks to the lay provider. In fact, there is no longer a check for signs of circulation of any type. If you have to breathe for a patient, then you immediately start CPR. These new standards came into effect in either September or October of this year.
         
        Xristina


        ----- Original Message ----
        From: "Benetti,Sandy [Ontario]" <sandy.benetti@...>
        To: E-Chir@yahoogroups.com
        Sent: Wednesday, December 6, 2006 8:53:16 AM
        Subject: RE: [E-Chir] Re: EMS and fist aid working together

        Who is "we" St. John's, Red Cross, someone else? Any one with CPR training gets taught how to take a pulse.  I don't know if it's mandatory, but at Pennsic they asked for copies of my CPR certs as well as my first aid ones.
         
        S.
        -----Original Message-----
        From: E-Chir@yahoogroups. com [mailto:E-Chir@ yahoogroups. com] On Behalf Of MaryCatharine
        Sent: December 6, 2006 8:20 AM
        To: E-Chir@yahoogroups. com
        Subject: RE: [E-Chir] Re: EMS and fist aid working together

        With the new modalities, we no longer teach the
        "lay person" to take a "pulse", anywhere, period...
        We are to only teaching/recerting EMS to "take pulses "...
         
        Have fun with this one,
         
         
        MaryCatharine
        ...."Of course he has a knife. He always has knives.
        We all have knives.  It's 1183 and we're all barbarians."

        Katharine Hepburn (1907 - 2003) As: Eleanor of  Aquitaine.
        The Lion in Winter. 1968
        -------Original Message----- --
         
        Date: 12/05/06 14:11:42
        Subject: RE: [E-Chir] Re: EMS and fist aid working together
         

        All good points, however as a first responder you still don't need the BP cuff. You can take a carotid pulse and a distal pulse. If you do them at the same time, they should both have the same rate and rhythm. If they don't there's a problem. If you can find one and not the other, there's a problem.  These are the 2 major pulse points most first aiders use.  Finding a podieital pulse is tricky and finding a femoral pulse is usually only done as a drastic measure.  Both carotid and distal pulse tell you a rough approximation of the systolic pulse.
         
        So, taking vitals yes. Change in pulse or a difference between carotid and distal pulse for rate rhythm or strength tell you if your patient is stable, improving, deteriorating and are (along with pupil response and respiration rate, skin colour and condition and level of consciousness) are all things you can relay to EMS. They don't require a BP cuff or stethoscope. I'm with the ski patrol, I know this.
         
        Seonag
        -----Original Message-----
        From: E-Chir@yahoogroups. com [mailto:E-Chir@ yahoogroups. com] On Behalf Of KIM MCAULEY
        Sent: December 4, 2006 10:21 AM
        To: E-Chir@yahoogroups. com
        Subject: Re: [E-Chir] Re: EMS and fist aid working together



        You are very correct in all those assessments Streonwald. However, as a person who has to call 911 more than most, I can tell you that St. John does suggest that taking a full set of vitals is a good thing. Including BP. However, and this is in big red letters, you do this only when you have done everything else on the list of things to do and while still waiting for EMS to arrive, cause you called them right at the beginning. Taking vitals sure beats twiddling your thumbs?
         
        In the case of BP, there are certain things that a *changing* blood pressure can tell EMS and the hospital. If you can, get the baseline vitals so they have more information to work with.
         
        Curious? Google Cushing's Triad for more information. ::grins:: Who wants to do a report for the class on it?
         
        Kaellyn
         
         
         
        >>>>>>>>>>>>


        I agree.  As a Ski Patroller of 18 years experience (including over
        ten years as an instructor), I have never needed, nor taken a BP
        reading.  If I don't find a pulse anywhere distal to an injury - it's
        a load and go.  If I don't find a peripheral pulse - it's a load and
        go.  If I find an abnormal (ie. unexpected) rate, or strength, or an
        unusual rhythm in any pulse - it's probably load and go.  A BP cuff,
        or a stethoscope won't help me decide.

        Basically, any unusual circulatory function requires care that I can't
        provide (ie. beyond blankets, O2, monitor, transport) and my patient
        needs to go to the hospital, ASAP.




        Yahoo! Groups Links

        <*> To visit your group on the web, go to:
            http://groups. yahoo.com/ group/E-Chir/

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        Click Here To Receive My New Creations In Your Inbox!
        Letter Made: January 6, 2005
        Font Used: Harrington
        For Personal Use Only! No Copyright Infringement Intended



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      • J Corso
        While leeches and maggots are used - it must be remembered that maggots eat dead flesh only - if infected - antibiotics are still used - I myself have applied
        Message 3 of 24 , Dec 6, 2006
        • 0 Attachment
          While leeches and maggots are used - it must be remembered that maggots eat
          dead flesh only - if infected - antibiotics are still used - I myself have
          applied leeches and maggots to flesh in my work! Not really nice to do - but
          it was cool in a clinical way - the leech story isnt really gross and i can
          share if wanted but the maggot story is a little graphic - still willing to
          share but email firect and i will save the group the grossness!! LOL
          Giovanni Ferraius (aka John)


          >From: "Benetti,Sandy [Ontario]" <sandy.benetti@...>
          >Reply-To: E-Chir@yahoogroups.com
          >To: <E-Chir@yahoogroups.com>
          >Subject: RE: [E-Chir] Re: EMS and fist aid working together
          >Date: Wed, 6 Dec 2006 14:18:31 -0500
          >
          >Hey maybe we can go "medieval" on them and resort to leaches and maggots
          >(noting that still are both used in modern medicine and that in some
          >cases maggots work better and cleaning up a nasty wound than a lot of
          >modern antibiotics).
          >
          >Seonag :)
          >
          > -----Original Message-----
          > From: E-Chir@yahoogroups.com [mailto:E-Chir@yahoogroups.com] On
          >Behalf Of James D Sena
          > Sent: December 6, 2006 2:08 PM
          > To: E-Chir@yahoogroups.com
          > Subject: Re: [E-Chir] Re: EMS and fist aid working together
          >
          >
          > The further dumbing down of CPR. We had that in my ARC CPR
          >class when I renewed this year. The given reason was "In an emergency
          >most people can't remember how to check for a pulse, or even find their
          >own".
          >
          > I disagree with it, and I won't stop checking for a pulse
          >myself. Then again my original training was not "lay person". For the
          >first 10 years I had a CPR card it was either "CPR for the Professional
          >Rescuer" or "CPR for Health Care Providers". It is a much more
          >educational program than "Standard CPR with AED".
          >
          > And don't even get me started on the dumbing down of AEDs
          >either.
          >
          > Lord Brendan ap Llewelyn
          >
          >
          >
          > Ninka wrote:
          >
          > The new Heart and Stroke guidelines (which govern St.
          >John's, Red Cross and all other first aid training providers) no longer
          >teach pulse checks to the lay provider. In fact, there is no longer a
          >check for signs of circulation of any type. If you have to breathe for a
          >patient, then you immediately start CPR. These new standards came into
          >effect in either September or October of this year.
          >
          > Xristina
          >
          >
          > ----- Original Message ----
          > From: "Benetti,Sandy [Ontario]" <sandy.benetti@...>
          ><mailto:sandy.benetti@...>
          > To: E-Chir@yahoogroups.com
          > Sent: Wednesday, December 6, 2006 8:53:16 AM
          > Subject: RE: [E-Chir] Re: EMS and fist aid working
          >together
          >
          >
          >
          >
          >
          > Who is "we" St. John's, Red Cross, someone else? Any one
          >with CPR training gets taught how to take a pulse. I don't know if it's
          >mandatory, but at Pennsic they asked for copies of my CPR certs as well
          >as my first aid ones.
          >
          > S.
          >
          > -----Original Message-----
          > From: E-Chir@yahoogroups. com [mailto:E-Chir@
          >yahoogroups. com] On Behalf Of MaryCatharine
          > Sent: December 6, 2006 8:20 AM
          > To: E-Chir@yahoogroups. com
          > Subject: RE: [E-Chir] Re: EMS and fist aid
          >working together
          >
          >
          >
          >
          >With the new modalities, we no longer teach the
          >"lay person" to take a "pulse", anywhere, period...
          >We are to only teaching/recerting EMS to "take pulses "...
          >
          >Have fun with this one,
          >
          >
          >MaryCatharine
          >...."Of course he has a knife. He always has knives.
          >We all have knives. It's 1183 and we're all barbarians."
          >
          >Katharine Hepburn (1907 - 2003) As: Eleanor of Aquitaine.
          >The Lion in Winter. 1968
          >-------Original Message----- --
          >
          >From: Benetti,Sandy [Ontario] <mailto:sandy.benetti@...>
          >Date: 12/05/06 14:11:42
          >To: E-Chir@yahoogroups. com <mailto:E-Chir@yahoogroups.com>
          >Subject: RE: [E-Chir] Re: EMS and fist aid working together
          >
          >
          >All good points, however as a first responder you still don't need the
          >BP cuff. You can take a carotid pulse and a distal pulse. If you do them
          >at the same time, they should both have the same rate and rhythm. If
          >they don't there's a problem. If you can find one and not the other,
          >there's a problem. These are the 2 major pulse points most first aiders
          >use. Finding a podieital pulse is tricky and finding a femoral pulse is
          >usually only done as a drastic measure. Both carotid and distal pulse
          >tell you a rough approximation of the systolic pulse.
          >
          >So, taking vitals yes. Change in pulse or a difference between carotid
          >and distal pulse for rate rhythm or strength tell you if your patient is
          >stable, improving, deteriorating and are (along with pupil response and
          >respiration rate, skin colour and condition and level of consciousness)
          >are all things you can relay to EMS. They don't require a BP cuff or
          >stethoscope. I'm with the ski patrol, I know this.
          >
          >Seonag
          >-----Original Message-----
          >From: E-Chir@yahoogroups. com [mailto:E-Chir@ yahoogroups. com] On
          >Behalf Of KIM MCAULEY
          >Sent: December 4, 2006 10:21 AM
          >To: E-Chir@yahoogroups. com
          >Subject: Re: [E-Chir] Re: EMS and fist aid working together
          >
          >
          >
          >
          >
          >You are very correct in all those assessments Streonwald. However, as a
          >person who has to call 911 more than most, I can tell you that St. John
          >does suggest that taking a full set of vitals is a good thing. Including
          >BP. However, and this is in big red letters, you do this only when you
          >have done everything else on the list of things to do and while still
          >waiting for EMS to arrive, cause you called them right at the beginning.
          >Taking vitals sure beats twiddling your thumbs?
          >
          >In the case of BP, there are certain things that a *changing* blood
          >pressure can tell EMS and the hospital. If you can, get the baseline
          >vitals so they have more information to work with.
          >
          >Curious? Google Cushing's Triad for more information. ::grins:: Who
          >wants to do a report for the class on it?
          >
          >Kaellyn
          >
          >
          >
          > >>>>>>>>>>>>
          >
          >
          >I agree. As a Ski Patroller of 18 years experience (including over
          >ten years as an instructor), I have never needed, nor taken a BP
          >reading. If I don't find a pulse anywhere distal to an injury - it's
          >a load and go. If I don't find a peripheral pulse - it's a load and
          >go. If I find an abnormal (ie. unexpected) rate, or strength, or an
          >unusual rhythm in any pulse - it's probably load and go. A BP cuff,
          >or a stethoscope won't help me decide.
          >
          >Basically, any unusual circulatory function requires care that I can't
          >provide (ie. beyond blankets, O2, monitor, transport) and my patient
          >needs to go to the hospital, ASAP.
          >
          >
          >
          >
          >Yahoo! Groups Links
          >
          >
          > (Yahoo! ID required)
          >
          >
          >
          >
          >
          >
          >
          >
          > <http://www.sleepingangel.com/>
          >Click Here <http://groups.yahoo.com/group/princess_silvia_incredimail/>
          >To Receive My New Creations In Your Inbox!
          >Letter Made: January 6, 2005
          >Font Used: Harrington
          >For Personal Use Only! No Copyright Infringement Intended
          >
          >
          >
          > _____
          >
          >
          > No virus found in this incoming message.
          > Checked by AVG Free Edition.
          > Version: 7.5.430 / Virus Database: 268.15.6/568 -
          >Release Date: 12/4/2006 3:20 PM
          >
          >
          >
          ><< ATT786951.gif >>

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        • MaryCatharine
          That was the whole point... The we IS everyone... It is not the new Heart and Stroke guidelines . It is the new guidelines for cardiopulmonary resuscitation
          Message 4 of 24 , Dec 6, 2006
          • 0 Attachment
            That was the whole point...
            The "we" IS everyone...
             
            It is not the "new Heart and Stroke guidelines".
             
            It is the new guidelines for cardiopulmonary resuscitation (CPR) and first aid were released recently by ILCOR, the International Liaison Committee on Resuscitation, in 2006, who are  the body that reviews CPR and first aid every five years.
             
            ( This is why everyone from Red Cross, to St. John's, and beyond update the modalities, every five years...)
             
            The most important thing for Canadians to know right now is that the CPR they've been trained to perform is not “wrong.” The new guidelines reflect current scientific research and are a natural evolution of CPR since its introduction to the general public over 20 years ago.  The new recommended guidelines are focussed on simplifying CPR even further, making it even easier to learn.
             
            I teach how to take the carotid, brachial pulse, radial pulse, and femoral pulses...
            I do not have to, but I do.
             
            I could show the Abdominal aorta,  (Very thin individuals may be able to note a slight pulsation beneath the stomach when lying down in a relaxed position. This pulsation is caused by the abdominal aorta, the continuation of the aorta from the heart. At the level of the umbilicus (belly button), the aorta splits into the left and right common iliac arteries which deliver blood to the legs.)
            Or the Popliteal artery, (This artery lies behind the knee. Bend your knee slightly and feel in the soft area behind the knee.)
             
            I do not normally teach this to lay people because it confuses them, especially if it their first time learning First-Aid & CPR/AED.  I have been instructing for 17 years.
             
            Yours in health and safety,
             
            MariaKatharina
            ...."Of course he has a knife. He always has knives.
            We all have knives.  It's 1183 and we're all barbarians."

            Katharine Hepburn (1907 - 2003) As: Eleanor of  Aquitaine.
            The Lion in Winter. 1968
            -------Original Message-------
             
            Date: 12/6/2006 2:12:14 PM
            Subject: RE: [E-Chir] Re: EMS and fist aid working together
             

            Thanks for the update.  So, what about the first aid side (St. Johns and Red Cross) do they not teach that any more either?
             
            Seonag
            -----Original Message-----
            From: E-Chir@yahoogroups. com [mailto:E-Chir@ yahoogroups. com] On Behalf Of Ninka
            Sent: December 6, 2006 1:26 PM
            To: E-Chir@yahoogroups. com
            Subject: Re: [E-Chir] Re: EMS and fist aid working together

            The new Heart and Stroke guidelines (which govern St. John's, Red Cross and all other first aid training providers) no longer teach pulse checks to the lay provider. In fact, there is no longer a check for signs of circulation of any type. If you have to breathe for a patient, then you immediately start CPR. These new standards came into effect in either September or October of this year.
             
            Xristina


            ----- Original Message ----
            From: "Benetti,Sandy [Ontario]" <sandy.benetti@ ec.gc.ca>
            To: E-Chir@yahoogroups. com
            Sent: Wednesday, December 6, 2006 8:53:16 AM
            Subject: RE: [E-Chir] Re: EMS and fist aid working together

            Who is "we" St. John's, Red Cross, someone else? Any one with CPR training gets taught how to take a pulse.  I don't know if it's mandatory, but at Pennsic they asked for copies of my CPR certs as well as my first aid ones.
             
            S.
            -----Original Message-----
            From: E-Chir@yahoogroups. com [mailto:E-Chir@ yahoogroups. com] On Behalf Of MaryCatharine
            Sent: December 6, 2006 8:20 AM
            To: E-Chir@yahoogroups. com
            Subject: RE: [E-Chir] Re: EMS and fist aid working together

            With the new modalities, we no longer teach the
            "lay person" to take a "pulse", anywhere, period...
            We are to only teaching/recerting EMS to "take pulses "...
             
            Have fun with this one,
             
             
            MaryCatharine
            ...."Of course he has a knife. He always has knives.
            We all have knives.  It's 1183 and we're all barbarians."

            Katharine Hepburn (1907 - 2003) As: Eleanor of  Aquitaine.
            The Lion in Winter. 1968
            -------Original Message----- --
             
            Date: 12/05/06 14:11:42
            Subject: RE: [E-Chir] Re: EMS and fist aid working together
             

            All good points, however as a first responder you still don't need the BP cuff. You can take a carotid pulse and a distal pulse. If you do them at the same time, they should both have the same rate and rhythm. If they don't there's a problem. If you can find one and not the other, there's a problem.  These are the 2 major pulse points most first aiders use.  Finding a podieital pulse is tricky and finding a femoral pulse is usually only done as a drastic measure.  Both carotid and distal pulse tell you a rough approximation of the systolic pulse.
             
            So, taking vitals yes. Change in pulse or a difference between carotid and distal pulse for rate rhythm or strength tell you if your patient is stable, improving, deteriorating and are (along with pupil response and respiration rate, skin colour and condition and level of consciousness) are all things you can relay to EMS. They don't require a BP cuff or stethoscope. I'm with the ski patrol, I know this.
             
            Seonag
            -----Original Message-----
            From: E-Chir@yahoogroups. com [mailto:E-Chir@ yahoogroups. com] On Behalf Of KIM MCAULEY
            Sent: December 4, 2006 10:21 AM
            To: E-Chir@yahoogroups. com
            Subject: Re: [E-Chir] Re: EMS and fist aid working together



            You are very correct in all those assessments Streonwald. However, as a person who has to call 911 more than most, I can tell you that St. John does suggest that taking a full set of vitals is a good thing. Including BP. However, and this is in big red letters, you do this only when you have done everything else on the list of things to do and while still waiting for EMS to arrive, cause you called them right at the beginning. Taking vitals sure beats twiddling your thumbs?
             
            In the case of BP, there are certain things that a *changing* blood pressure can tell EMS and the hospital. If you can, get the baseline vitals so they have more information to work with.
             
            Curious? Google Cushing's Triad for more information. ::grins:: Who wants to do a report for the class on it?
             
            Kaellyn
             
             
             
            >>>>>>>>>>>>


            I agree.  As a Ski Patroller of 18 years experience (including over
            ten years as an instructor), I have never needed, nor taken a BP
            reading.  If I don't find a pulse anywhere distal to an injury - it's
            a load and go.  If I don't find a peripheral pulse - it's a load and
            go.  If I find an abnormal (ie. unexpected) rate, or strength, or an
            unusual rhythm in any pulse - it's probably load and go.  A BP cuff,
            or a stethoscope won't help me decide.

            Basically, any unusual circulatory function requires care that I can't
            provide (ie. beyond blankets, O2, monitor, transport) and my patient
            needs to go to the hospital, ASAP.




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