AS THEY'RE IMPORTANT.
THEY'RE VITAL TO THE CLIENT'S CARE.
YOU'RE NOT ONLY GET VITAL SIGNS TO KNOW ABOUT YOUR CLIENT,
BUT MEDICATIONS ARE DETERMINED BECAUSE OF VITAL SIGNS.
MEDICATIONS ARE ADDED OR DELETED BECAUSE OF VITAL SIGNS.
AND SO THEY'RE CRITICAL AS TO DETERMINING TREATMENTS,
MEDICATIONS AND CARE FOR YOUR CLIENT.
VITAL, THEREFORE THEY'RE AN A-SKILL.
WE NEED YOU TO BE GOOD AT THIS ONE.
AND BECAUSE OF THAT WHEN YOU TEST,
SOMETIMES THE STATIONS TAKE A LITTLE LONGER
BECAUSE WE NEED YOU TO BE RIGHT.
IT'S ONE THING TO PRACTICE, BUT WHEN YOU COME TO TEST,
IF YOU'RE NOT ON, WE GOT TO HELP YOU BE ON. SO WE'LL HELP YOU LITTLE BIT.
WE MAY SEND YOU TO PRACTICE A LITTLE MORE AND THEN RE-TEST LATER.
BUT WE NEED YOU TO BE ON WITH VITAL SIGNS.
WE DO IT AT WEEK FOUR. YOU'RE GOING TO START CLINICAL AT WEEK 7.
SO THAT GIVES YOU A COUPLE OF WEEKS TO KEEP,
KIND OF, WORKING AT IT IF YOU'VE NEVER DONE IT BEFORE.
BECAUSE YOU WANT TO FEEL CONFIDENT. YOU WANT TO GET RIGHT VITALS FOR YOUR CLIENTS.
ALRIGHT. EXCUSE ME.
THIS IS, KIND OF, A HARD DEMO TO DO.
NOT BECAUSE I CAN'T GET VITAL SIGNS, BUT BECAUSE YOU CAN'T HEAR ANYTHING I'M GETTING.
AND SO IT'S, KIND OF, WEIRD. I'M STILL GOING TO TALK THROUGH IT,
AND COACH YOU THROUGH AUDIBLY
WHAT YOU WOULD BE HEARING.
AND WE'LL, KIND OF, PRACTICE A LITTLE ON EACH OTHER
AND FIND THINGS AND DO SOME DIFFERENT TECHNIQUES.
BUT THE KEY TO THIS ONE IS,
YOU'RE JUST GOING TO HAVE TO PRACTICE, PRACTICE, PRACTICE
ON EACH OTHER, ON YOUR FAMILY.
I'VE BEEN HEARING YOU'VE BEEN DOING THAT ANYWAYS.
THEY'RE GOING TO LOVE BEING, KIND OF, YOUR HUMAN MANNEQUINS FOR THE NEXT THREE YEARS.
BUT THE MORE PULSES YOU FEEL,
THE MORE HEARTS YOU LISTEN TO, THE MORE LUNGS YOU LISTEN TO,
THE MORE YOU BEGIN TO DISTINGUISH BETWEEN NORMAL AND ABNORMAL.
AND THAT'S ALL WE REALLY WANT YOU TO FOCUS ON THIS SEMESTER,
IS THAT IF YOU GET A GOOD EAR FOR NORMAL, YOU'LL PICK UP ABNORMAL
AND THAT'S WHEN YOU CAN START ACTING.
AND YOU CAN JUST SAY, "THIS IS ABNORMAL.
THESE ARE CONGESTED LUNG SOUNDS. THIS ISN'T RIGHT."
NEXT SEMESTER, WE'RE GOING TO FOCUS MORE ON ABNORMALS AND BEGIN TO LABEL THOSE.
RIGHT NOW, JUST START GETTING NORMAL DOWN.
AND THAT'S A GOOD STARTING PLACE.
SO WHAT YOU'RE GOING TO DO IS GO TO ONE STATION.
YOU'LL BE IN PAIRS, I DOESN'T MATTER IF YOU PAIR UP.
WE'LL PAIR YOU. IT DOESN'T -- WHATEVER.
BUT WHEN YOU GO, YOU'RE GOING -- ONE PERSON -- ADAM.
YOU'RE ADAM, RIGHT? OH, THAT'S GOOD.
IF ADAM AND I WENT TOGETHER, I WOULD DO ALL OF HIS VITAL SIGNS.
THEN HE'S GOING TO TURN AROUND AND DO ALL OF MINE.
SO YOU'LL GET THE WHOLE SET. WHAT ARE VITAL SIGNS?
VITAL SIGNS ARE TEMPERATURE, PULSE, RESPIRATIONS AND BLOOD PRESSURE.
AND THE FIFTH VITAL SIGN? PAIN.
OKAY. SO WE'LL DO A PAIN ASSESSMENT AS WELL.
SO YOU WANT TO BE GETTING FIVE BITS OF INFORMATION FROM YOUR CLIENT.
THERE'S A LOT OF VARIATION AS TO WHICH KIND OF TEMPERATURE YOU MIGHT GET AND SO FORTH.
AND WE'LL TALK ABOUT THOSE.
BECAUSE YOU'RE WORKING ON REAL PEOPLE, EACH OTHER,
YOU NEED TO REALLY WASH YOUR HANDS.
I REALLY DID, RIGHT BEFORE WE STARTED.
BECAUSE, YOU KNOW, THIS IS REAL THIS TIME. IT'S NOT JUST A MANNEQUIN.
SO WE'RE NOT JUST GOING TO SAY, "I DID DO."
OKAY, I THINK THAT'S ALL TO PREFACE THIS.
AND THEN WE'LL JUST WORK THROUGH ALL THE STUFF.
SO IF YOU'RE FOLLOWING ALONG, WE'LL JUST START FROM THE TOP
AND WE'LL START WITH TEMPERATURE.
FIRST THING I WANT TO DO IS DO MY HIGH FIVE.
I'VE CHECKED MY DOCTOR'S ORDERS.
SOMETIMES THEY ORDER VITAL SIGNS, SOMETIMES THEY DON'T.
TYPICALLY, THEY'LL SAY VITAL SIGNS , Q-SHIFT. Q BEING EVERY.
I'M GOING TO START TEACHING YOU A FEW MORE ABBREVIATIONS.
OR THEY'LL SAY EVERY FOUR HOURS,
OR...EVERY SHIFT WHILE AWAKE.
SO YOU'RE NOT WAKING THEM UP JUST TO GET VITAL SIGNS
WHEN IT'S NOT THAT BIG OF A DEAL FOR THEIR DIAGNOSIS AND SO FORTH.
THEY MAY NOT ORDER VITAL SIGNS.
WE TYPICALLY, IN THE HOSPITAL GET THEM EVERY SHIFT.
WHEN YOU COME ON, YOU TAKE A SET OF VITAL SIGNS
SO THAT YOU ARE AWARE OF YOUR CLIENT.
BUT YOU CAN GET VITAL SIGNS ANY TIME YOU WANT.
IT'S A NON-INVASIVE PROCEDURE AND IT'S A NURSING JUDGMENT.
YOU CAN GET ONE PIECE OF A VITAL SIGN OR YOU CAN DO THE WHOLE SET.
SO, WE'RE GOING TO DO THE WHOLE SET.
BUT APPRECIATE YOU CAN JUST GO GET A TEMP,
JUST GO GET A RESPIRATION, JUST GO GET A -- WHATEVER YOU NEED.
ALRIGHT, CHECKED MY DOCTOR'S ORDERS.
I HAVE GATHERED MY EQUIPMENT.
A LOT OF STUFF FOR SHOW AND TELL.
WHAT YOU'RE GOING TO NEED TO GATHER --
ACTUALLY YOU DON'T NEED TO GATHER ANYTHING.
THEY'LL HAVE IT ALL AT THE STATION FOR YOU.
BUT IF YOU WERE GOING TO GET VITAL SIGNS, YOU'D WANT A THERMOMETER WHICH I HAVE.
WE'RE GOING TO DO -- IT'S A NON-MERCURY, BUT A GLASS THERMOMETER.
OR YOU WOULD GRAB AN ELECTRONIC.
ELECTRONIC IS SO INCREDIBLY EASY
THAT WE'RE JUST GOING TO VERBALIZE THROUGH THAT, AND I'LL SHOW YOU HOW TO DO IT.
AND YOU'RE GOING TO TALK THROUGH THAT ONE FOR A RECTAL TEMP
SINCE WE'RE NOT GOING TO DO THAT.
ARE YOU RELIEVED?
WHEW, ADAM, I FORGOT TO LET YOU KNOW THAT PART. OKAY.
WE'RE GOING TO GET ORAL TEMPERATURES.
I'VE GATHERED MY EQUIPMENT.
WHAT THAT MEANS IS I'VE GATHERED A THERMOMETER THAT'S WASHED.
I JUST TOOK THIS TO THE SINK AND I WASHED IT WITH SOAP AND WATER.
I'M GOING TO CLEAN IT ONE MORE TIME WHEN I GET INTO THE PROCEDURE
WITH ALCOHOL AND I'M GOING TO PUT A COVER ON IT.
SO THAT IT'S OH, SO VERY CLEAN FOR US.
OKAY. AND I PUT I ON A PAPER TOWEL
BECAUSE A PAPER TOWEL IS CLEAN. THESE ARE FAIRLY CLEAN,
BUT I REALLY WOULDN'T LAY ANYTHING ON THESE THAT I WAS GOING TO PUT IN MY MOUTH.
SO ALWAYS PROTECT YOUR AREA WITH A BARRIER.
AS WELL AS GATHERING STUFF FOR MY TEMPERATURE,
I HAVE GATHERED A STETHOSCOPE.
AND I HOPE YOU HAVE ALL BOUGHT A STETHOSCOPE.
THAT'S THE ONE PIECE OF EQUIPMENT YOU DO NEED TO GET.
I'LL TALK ABOUT THAT WHEN WE DO THE APICAL PULSE.
BUT I HAVE A STETHOSCOPE.
WE WILL BE PROVIDING THE STETHOSCOPE AT THE STATION
BECAUSE I HAVE A DUAL-HEAD STETHOSCOPE...
THAT LOOKS LIKE THIS.
SO THAT I CAN LISTEN TO THE SAME THING YOU'RE LISTENING TO.
WHEN YOU'RE PRACTICING, THESE ARE WONDERFUL
SO THAT YOU CAN, KIND OF, HEAR WITH EACH OTHER AND COUNT TOGETHER
AND MAKE SURE EVERYBODY'S HEARING THE SAME THINGS.
SO EVERYONE SHOULD AT LEAST PRACTICE WITH SOMEBODY AT SOME POINT
TO SEE IF YOU'RE HEARING AND COUNTING THE SAME THINGS.
I'LL TALK ABOUT THAT LATER.
AND THEN IF YOU REALLY WANT TO JUST HAVE A LITTLE GROUP ACTIVITY,
WE HAVE THE OLD FOUR-HEAD ONE.
THE THING WITH THE FOUR-HEAD ONE IS IT BIFURCATES ALL THE SOUND.
AND SO IT GETS A LITTLE BIT LESS EACH TIME YOU BREAK OFF A SOUND PIECE.
SO YOU NEED SOMEONE THAT'S GOT A REALLY GOOD, STRONG PULSE
WHEN YOU ALL WANT TO PRACTICE HEARING AND COUNTING FOR AGREEMENT.
SO WE'LL TALK ABOUT THAT A LITTLE LATER TOO. SO I'VE GATHERED MY STETHOSCOPE.
I HAVE ALSO CLEANED IT WITH ALCOHOL.
AND I HAVE A BLOOD PRESSURE CUFF THAT I'VE GATHERED.
ALL OF THIS WILL BE AT THE STATION.
SO THE MAIN THING IS BRING YOU AND HAVE YOUR HANDS WASHED.
JUST A WORD ABOUT YOUR STETHOSCOPE.
IF YOU HAVEN'T PURCHASED IT YET, JUST GET A CHEAP ONE.
YOU JUST STARTED. YOU DON'T KNOW WHERE YOU'RE GOING TO SPECIALIZE OR WHAT KIND YOU NEED.
SO, I MEAN, IF YOU BOUGHT A REALLY NICE LITTMANN
AND SPENT YOUR 100 BUCKS OR WHATEVER. GOOD FOR YOU.
I'D PUT MY NAME TAG. I'D WRITE IN NON-PERMANENT INK
ALL ON THAT, MY NAME ALL ACROSS THERE SO YOU GET IT BACK AND IT WORKS.
BUT I CHEAT.
ALRIGHT, I HAVE GATHERED MY EQUIPMENT.
I HAVE REALLY WASHED MY HANDS, I'VE IDENTIFIED MY CLIENT HERE,
WHICH IS STUDENT AND WHICH IS ADAM
AND I HAVE PROVIDED NO PRIVACY.
OKAY.
ADAM, I NEED TO GET YOUR VITAL SIGNS TODAY.
AND THAT WILL BE YOUR TEMPERATURE, PULSE, RESPIRATIONS AND BLOOD PRESSURE.
BEFORE WE GET GOING, I JUST WANT TO MAKE SURE YOU'RE COMFORTABLE.
HAVE YOU EXERCISED OR DONE ANYTHING -- EXERTED YOURSELF IN THE LAST 15 TO 30 MINUTES.
HAVE YOU HAD ANYTHING TO EAT OR DRINK HOT OR COLD IN THE LAST 15-30 MINUTES.
- HAVE YOU SMOKED? - NO.
OKAY. ANY OF THOSE THINGS CAN AFFECT THE TEMPERATURE.
SO CHECK ON THAT AND THEN YOU NEED TO WAIT 15 OR 30 MINUTES DEPENDING ON WHAT IT IS.
MOST OF THE TIME 30 IS BEST IF YOU CAN BECAUSE IT WILL AFFECT THOSE READINGS.
ALRIGHT, THE FIRST THING I WANT TO DO IS TAKE YOUR TEMPERATURE.
AND WHILE THE THERMOMETER IS IN YOUR MOUTH, I'M GOING TO GO AHEAD
AND GET YOUR PULSE AND RESPIRATION, SO.
GET ALL MY LOOT HERE.
FIRST THING I WANT TO DO IS GET MY THERMOMETER,
AND ON YOUR THERMOMETER YOU HAVE HERE --
YOU CAN'T SEE IT, I'LL PASS IT AROUND IN A MINUTE.
BUT THERE'S -- WHERE THE MERCURY WOULD RISE TO,
TO TELL YOU WHERE THE TEMPERATURE IS.
THIS IS ACTUALLY A NON-MERCURY THERMOMETER, SO I DON'T EVEN KNOW WHAT TO CALL THIS STUFF.
THEY JUST CALL IT NON-MERCURY.
THEY'VE PRETTY MUCH ELIMINATED ALL MERCURY PRODUCTS OUT OF THE HOSPITAL
BECAUSE IT IS TOXIC.
IF YOU WERE TO BREAK A MERCURY THERMOMETER IN THE HOSPITAL,
YOU'D HAVE TO HAVE YOUR HOUSEKEEPING COME TO CLEAN IT UP.
THEY HAVE A SPECIAL PROCEDURE FOR VACUUMING IT UP.
YOU CAN'T TOUCH IT. TRY TO CONTAIN IT PAPER TOWELS AND GET IT ON YOURSELF.
IF FOR SOME REASONS TWO THERMOMETERS GOT BROKE IN THE SAME ROOM,
YOU'D HAVE TO EVACUATE THE ROOM, IT'S A HAZARDOUS SPILL.
TWO.
OKAY, SO THAT'S WHY THEY GOT RID OF THEM.
AND THEY HAVE NON-MERCURY.
WHY WOULD WE EVEN USE THESE?
WELL, GO BACK AND YOU'RE THINKING TO OUR ISOLATION ROOMS.
WE CAN'T BE TAKING THESE IN SOMETIMES.
SO WE HAVE TO LEAVE SOMETHING FOR OURSELVES.
SO WE'LL PUT A GLASS THERMOMETER IN THERE THAT CAN JUST STAY.
SO YOU NEED TO MAKE SURE AND KNOW WHAT YOUR PRODUCT IS WHEN YOU'RE USING IT.
AND YOU WOULD GET THESE FROM CENTRAL SUPPLY TO TAKE INTO THE ROOMS.
ALRIGHT. I'VE GATHERED MY THERMOMETER AND I'VE LOOKED HERE TO SEE WHERE THE MERCURY IS.
AND YOU JUST, KIND OF, WIGGLE IT. THERE'S A WHITE BACKGROUND.
AND YOU SHOULD SEE BLUE THAT COMES UP LIKE A THERMOMETER
THAT YOU WANT TO FIND ON HERE.
AND IF IT'S ABOVE 94, 96,
YOU WANT TO SHAKE IT DOWN SO THAT TEMPERATURE IS ABLE TO RISE UP.
YOU DON'T WANT TO LEAVE IT AT 98. IT WON'T ADJUST ITSELF BACK DOWN.
SO YOU HAVE TO SHAKE IT DOWN.
AND TO DO THAT, YOU WANT TO GRAB IT HERE AT THE END.
DON'T EVER HANDLE A THERMOMETER BY THE MERCURY END WITH YOUR DIRTY HANDS
BECAUSE THAT'S WHAT'S GOING TO GO IN THE MOUTH.
YOU WANT TO TAKE IT BY THE END AND SNAP IT DOWN.
AND THAT WILL SHAKE THAT MERCURY.
YOU CAN'T JUST, KIND OF, GO LIKE THIS.
IT WON'T MOVE. I MEAN, YOU HAVE TO WRIST SNAP.
WHACK. WHACK.
THAT'LL SEND IT ON DOWN AND THAT'S HOW WE TYPICALLY BREAK THEM.
BECAUSE WE SNAP THEM RIGHT OUT OF OUR HANDS OR WE HIT TABLE TOPS OR CHAIRS.
SO BE CAREFUL WHERE YOU'RE SNAPPING WHEN YOU SNAP. NOT EVEN ABOVE A TABLE.
WAY BACK HERE, AWAY FROM STUFF AND SNAP IT.
ALRIGHT, IT'S ALREADY DOWN.
SO THERE YOU GO.
THEN WHAT I WANT YOU TO DO IS TAKE AN ALCOHOL SWAB,
AND I WANT YOU TO TAKE THE SWAB AND CLEAN FROM BULB IN.
NOTICE HOW I'M JUST WIPING IT FROM BULB OUT.
AND I'M DONE.
DON'T SCRUB BACK AND FORTH BECAUSE YOU'LL TAKE
FROM THE DIRTIEST END BACK TO WHAT YOU WANT TO BE CLEANEST.
AND THAT CAN BE THROWN AWAY.
ALRIGHT.
THEN WHAT YOU'RE GOING TO DO IS TAKE A SHEATH...
AND COVER IT. AND THEY'RE FAIRLY SIMPLE.
YOU JUST PUT IT INTO THE NUMBER ONE SLOT WHERE IT SAYS INSERT.
THEN IF YOU'LL HOLD ON TO THOSE INSERT TABS,
AND WHERE IT SAYS PEEL BACK, PEEL AND SNAP ON THE DOTTED LINE.
PEEL AND SNAP ON THE DOTTED LINE.
AND MAKE SURE YOUR SHEATH IS REALLY ON THERE.
EVERY NOW AND THEN IT STICKS AND IT RIPS ON THE BOTTOM.
SO THAT'S NOT REAL GOOD.
ALRIGHT. SO IT LOOKS GOOD.
ADAM, WHAT I'D LIKE FOR YOU TO DO IS OPEN YOUR MOUTH.
I WANT TO PUT THIS UNDER YOUR TONGUE, BUT I WANT TO PUT IT IN THE BACK PART OF YOUR TONGUE.
IT'S CALLED THE POSTERIOR SUBLINGUAL POCKET.
YOU KNOW, SOMETIMES THEY JUST, KIND OF, DUMP IT RIGHT HERE IN THE FRONT OF YOUR TEETH
AND YOU, KIND OF, BALANCE THAT THING.
WHAT YOU WANT TO DO IS GET IT INTO THAT POSTERIOR POCKET.
AND IT'S THE POCKET WHERE YOUR TONGUE, KIND OF, ATTACHES TO YOUR MOUTH BACK THERE.
THAT'S WHERE YOU GET THE BEST CORE TEMPERATURE.
AND IT'S EASIER TO HOLD ON TO, ACTUALLY.
SO IF YOU'LL OPEN YOUR MOUTH. PUT THAT IN.
YOU CAN HOLD THAT IF YOU WANT. IT'S NOT HEAVY.
ALRIGHT, I NEED THAT TO STAY IN FOR AT LEAST TWO MINUTES.
SO IT'LL BE WAY THAT BY THE TIME I'VE TAKEN HIS PULSE.
NOW, WE'RE GOING TO BE EFFICIENT PEOPLE AND NOT JUST STAND HERE
FOR TWO MINUTES WHILE THAT'S BREWING,
WE'RE GOING TO GO AHEAD AND GET A PULSE ON HIM WHILE IT'S COOKING.
SO I WANT YOU TO GET TWO DIFFERENT PULSES.
I WANT YOU TO GET A RADIAL PULSE, WHICH IS THE PULSE ON THE WRIST,
AND I ALSO WANT YOU TO GET AN APICAL PULSE.
THE RADIAL PULSE, WE, KIND OF, IDENTIFIED THE RADIAL BONE
WHEN YOU WERE DOING YOUR RADIAL DEVIATION AND YOUR ULNAR DEVIATION.
AND BY THE WAY, YOU GUYS WERE WONDERFUL YESTERDAY.
I HAVEN'T DONE THE RANGE OF MOTIONS STATION FOR A WHILE,
I USED TO BE WALKERS AND CANE.
YOU WERE GREAT. YOU REALLY DID A GOOD JOB.
LOT OF STUFF TO LEARN AND YOU NAILED IT.
YOU WERE FAST, NO HIM-HAWING AROUND.
YOU JUST DID IT. I WAS REALLY PROUD OF YOU. SO...GREAT JOB.
ALRIGHT, RADIAL PULSE. THUMB SIDE.
WHAT YOU WANT TO DO IS FIND YOUR THUMB, GO UP THAT BONE
AND THEN THERE'S A CARTILAGE RIGHT OFF TO THE SIDE OF THAT BONE.
OKAY. SO YOU FEEL A LITTLE NOTCH IN BETWEEN BONE AND BONE.
AND AND DROP YOUR FINGERS INTO THAT POCKET.
AND YOU SHOULD FEEL A PULSE IN THERE.
A COUPLE OF THINGS YOU WANT TO DO WITH THAT PULSE.
NOTICE THAT I HAVE MY HANDS UP HERE AT THE TOP,
AND YOU'RE ALL, KIND OF, FEELING FORWARD.
NO ONE FEEL WITH YOUR THUMBS. IF YOU PUT YOUR THUMB UP HERE,
YOU'RE FEELING YOUR OWN PULSE OFTEN.
SO YOU WANT TO ALWAYS MAKE SURE YOU'RE FEELING WITH YOUR FINGERS.
AND YOU SHOULD FEEL THE BOUNDING IN THERE.
BOOM, BOOM, BOOM.
AND THAT'S ALL WE'RE COUNTING. EACH BOUND IS THE PULSE.
SOMETIMES IT'S A LITTLE DIFFICULT TO FEEL A PULSE IN THIS DIRECTION.
SO IF I WERE TO TAKE A HAND HERE,
AND I'M GOING TO COME IN AND FIND THE PULSE.
IF YOU TAKE THE HAND AND FLIP IT DOWN, THE PULSE WILL FALL INTO YOUR FINGERS.
YOU ALSO CAN TAKE AND PUSH THE PULSE A LITTLE BIT INTO THAT BONE,
SO YOU'VE GOT SOME BACKGROUND FOR IT TO BOUND AGAINST.
AND IT'LL STRENGTHEN THAT BEAT UP.
CAN YOU FEEL THE DIFFERENCE FROM...
TOP TO BOTTOM.
IT'S STRONGER.
SO FIND A GOOD STRONG PULSE WHEN YOU'RE CHECKING A PULSE.
AND GRAB THAT AREA.
ALRIGHT, ALL OF YOUR COUNTING SHOULD BE WITHIN ONE MINUTE.
IT'S A MINUTE PULSE IS WHAT WE'RE AIMING FOR,
BUT WE TYPICALLY DON'T COUNT FOR A MINUTE.
WE COUNT FOR 30 SECONDS AND THEN MULTIPLY TIMES TWO.
SO, THAT'S WHAT WE WOULD DO.
WE GET UP THERE AT THE 12. WHEN IT HITS THE 12, IT'S ACTUALLY 0.
AND THEN 1,2,3,4,5.
6,7,8,9,10.
11,12,13,14.
15, 16, 17. SO YOU CAN'T TELL HERE. I COULD BE LYING.
AND SO FORTH. AND I KEEP COUNTING UNTIL IT GETS TO EXACTLY THE 6
BECAUSE YOU WANT THAT STRAIGHT 30.
IF YOU ACTUALLY COUNTED 12 TO 6, IT WOULD BE 31 SECONDS.
SO WE WANT A CLEAN 30. STOP.
AND YOU'RE GOING TO MULTIPLY THAT NUMBER BY 2.
I PROBABLY WOULD HAVE GOT ABOUT 36. I WAS AT 18 IN 15 SECONDS.
SO LET'S SAY 36.
NOW, I'M GOING TO KEEP THAT NUMBER IN MY MIND.
YOU'RE GOING TO HELP ME, RIGHT? 36
WHAT I REALLY WANT YOU TO DO IS I WANT YOU TO COUNT FROM 12 TO 6
AND GET YOUR FIRST 30 SECOND COUNT,
BUT WE'RE ALSO GOING TO BE VERY EFFICIENT.
AND THE SECOND 30 SECONDS OF THE MINUTE, WE'RE GOING TO COUNT RESPIRATIONS.
ALRIGHT?
NOW TO COUNT RESPIRATIONS, I COULD HOLD HIS HAND LIKE THIS AND JUST LOOK AT IT,
BUT HE'S GOT TWO SHIRTS ON AND I MAY NOT BE ABLE TO SEE VERY WELL.
I'M LOOKING FOR RISE AND FALL OF CHEST.
AND I'M LOOKING FOR EITHER THE DIAPHRAGM TO RISE.
AND YOU MIGHT NOT BE ABLE TO SEE OR FEEL EITHER ONE.
SO WHAT I'D LIKE TO DO IS JUST TAKE THEIR HAND
AND JUST LAY IT ON THEIR STOMACH, LIKE THIS.
AND I CAN COUNT PULSE AND I CAN FEEL RESPIRATIONS WITH MY HAND.
AND HE DOESN'T KNOW I'M DOING IT. BECAUSE IF I SAID,
ADAM, I'M GOING TO COUNT YOUR RESPIRATION. ADAM GOES, "OKAY."
WHICH IS GOOD, I CAN SEE HIM.
BUT YOU WANT TO GET HIM AT REST AND YOU DON'T WANT HIM TO --
YOU WANT HIM TO BE DOING IT WITHOUT YOU JUST GETTING SOME KIND OF FALSE READ ON HIM.
ALRIGHT.
SO HERE WE GO.
LET ME TALK A LITTLE BIT MORE. DURING THAT FIRST 30 SECONDS --
LET'S TAKE THIS OUT.
IT GETS SPIT ON THE END SO YOU WANT TO BE ABLE TO TRAP IT HERE A LITTLE BIT.
OKAY. JUST GRAB IT BY HERE AND FOLD IT INSIDE ITSELF.
SO YOU NEVER TALK -- YOU NEVER HAVE SALIVA ON YOUR HANDS.
I'M GOING TO WIGGLE IT TO SEE WHERE THE BLUE LINE IS.
AND IT LOOKS LIKE IT'S 97.2.
EACH LITTLE LINE COUNTS AS A 0.2...
ON THIS SCALE, SO.
IT GOES 97, 98, 99, 100, 101
ON UP TO -- THIS ONE GOES UP TO 108.
YOU'D BE DEAD IF IT WAS THAT HIGH, BUT 108.
YOU'RE LOOKING TO FIND THE 97, THE 98, THE WHOLE NUMBER.
AND THEN IT GOES UP IN TENTHS AND INCREMENTS OF 0.2.
SO DON'T SAY IT'S 99.3 OR 99.7.
YOU DON'T KNOW THAT. JUST PICK THE CLOSEST.
IT DOESN'T MATTER IF YOU GO UP TO 0.8 OR 0.6.
IT DOESN'T MATTER. AND PICK YOUR NUMBER.
I'M GOING TO PASS THIS AROUND. I'LL WIPE IT OFF HERE.
AND I WANT YOU TO LOOK AT IT AND SEE IF YOU GET THE SAME NUMBER
AND I WANT YOU TO LOOK VERY CAREFULLY AT THE 98.
ON THIS THERMOMETER, IT MARKS 98.6
BECAUSE 98.6 IS CONSIDERED THE AVERAGE ADULT NORMAL TEMPERATURE.
SO IT MARKS IT AT 98.6
AND PEOPLE MISREAD AROUND THE 98 WHOLE NUMBER.
FIND YOUR 97, YOUR 98, YOUR 99,
AND MAKE SURE YOU UNDERSTAND THOSE INCREMENTS OF 0.2.
YOU'LL NOTICE THERE'S AN ASTERISK STEP ON EVERY SINGLE ONE OF THESE SKILLS.
AND THE ASTERISK STEP IS THE VITAL SIGN ITSELF.
SO IF YOUR READ THE 98.6 AS 98,
AND IT'S REALLY 98.6, YOU MISSED THAT ONE.
YOU HAVE TO BE WITHIN 0.2 HIGH OR LOW OF YOUR INSTRUCTOR.
SO YOU GOT TO GET THOSE RIGHT.
OKAY. CRITICAL. SO HERE WE GO.
ON THAT. SO YOU WERE VITAL SIGNS. 97.2 SO FAR.
PULSE WAS 36 FOR THE HALF MINUTE.
BUT WE'RE NEVER GOING TO SAY, WHEN I SAY, "WHAT DID YOU GET AS FOR YOUR PULSE?"
YOU'RE NOT GOING TO SAY, "I GOT 36."
YOU'VE GOT TO MULTIPLY THAT BY 2 AND SAY, "I GOT 72...
FOR MY PULSE."
YOU'RE ALSO WHEN YOU'RE FEELING, YOU'RE FEELING FOR QUALITY OF PULSE.
IS IT THIN, IS IT RAPID, IS IT BOUNDING, IS IT AVERAGE.
SO YOU'RE -- THE QUALITY AND THE IRREGULARITY OR REGULARITY.
WAS IT BEATING REGULARLY LIKE MUSIC?
PULSES SHOULD JUST CLIP ALONG
AND YOU SHOULD BE ABLE TO SING A SONG TO IT.
IT SHOULD HAVE A BEAT.
IT SHOULD JUST, YOU KNOW, GO ALONG.
NOW YOU KNOW HOW MUSIC CRESCENDOS SOMETIMES FOR EMPHASIS AND SLOWS,
BUT THE BEAT IS STILL THERE.
THAT'S OKAY. WHEN YOU BREATHE, WHEN YOU BREATHE IN...
IT GOES A LITTLE FASTER --
NO, ACTUALLY, IT SLOWS. AND THEN IT GOES A LITTLE SLOWER
WITH OUR INSPIRATION AND OUR EXPIRATION.
BUT THE BEAT STAYS STEADY.
IF YOU'RE COUNTING ALONG AND IT GOES...
BUMP-BUMP, BUMP, BUMP, BUMP, BUMP, BUMP,
BUMP-BUMP, BUMP, BUMP.
THAT'S NOT REGULAR BEATING, THAT'S IRREGULAR BEATING.
IF YOU PALPATE AN IRREGULAR BEAT,
THEN YOU NEED TO COUNT THE PULSE FOR A FULL MINUTE.
BECAUSE YOU DON'T KNOW HOW MANY IRREGULARS WOULD BE IN THAT FULL MINUTE,
AND THAT'S THE ONLY WAY TO GET AN ACCURATE PULSE.
ALRIGHT. SO, YOU'RE FEELING FOR QUALITY
AND REGULARITY WHEN YOU'RE PALPATING.
OKAY. LET'S GO BACK TO PULSE AND RESPIRATIONS.
HERE WE ARE. HE WOULD HAVE A THERMOMETER IN HIS MOUTH. IT TAKES 2 MINUTES.
I'M CHECKING HIS PULSE. 30 SECONDS.
RIGHT AFTER THAT 30 SECOND COUNT OF 36,
I WOULD START THEN COUNTING RESPIRATIONS IMMEDIATELY.
YOU'RE GOING TO COUNT RESPIRATIONS FOR 30 SECONDS AS WELL.
A RESPIRATION IS A COMPLETE INSPIRATION...
AND EXPIRATION.
ONE RESPIRATION, OKAY.
SO YOU HAVE TO HAVE THE COMPLETE.
SO IF HE WAS EXPIRING, I'D HAVE TO WAIT TILL THAT'S OVER AND COUNT THE FULL IN AND OUT.
OKAY. SO EXAGGERATE YOUR BREATHING JUST A LITTLE BECAUSE NONE OF US CAN SEE IT HERE.
WE'LL START AT THE TWO,
COUNT TO 30 SECONDS, 2 BEING 0. START NOW.
ONE.
TWO.
THREE.
FOUR.
FIVE.
EIGHT.
NOW I COULD FEEL HIM BREATHING WITH MY ARM
MORE THAN I COULD WITH MY HAND, I REALIZED AS I WAS WATCHING.
SO I DIDN'T REALLY NEED TO LOOK AT HIM.
YOU HAVE YOUR WATCHES, BUT FOR OUR PURPOSES. OKAY.
SO, HOW MANY DID WE GET?
- 8. - 8 WHICH IS TIMES 2, 16.
SO HIS VITAL SIGNS SO FAR ARE TEMPERATURE ORAL, 97.2.
PULSE, 72, REGULAR.
RESPIRATIONS, 16.
WHEN WE'RE DOING RESPIRATIONS,
AGAIN YOU'RE NOTING QUALITY AS WELL AS REGULARITY.
ARE THEY SHALLOW? ARE THEY DEEP? ARE THEY REGULAR?
PEOPLE BREATHE ALL SORTS OF WAYS.
THEY CAN BREATHE REALLY FAST.
OH, THAT'S FAST. YOU STAY WITH THEM AND COUNT ALL THOSE.
THEY CAN BE DYING AND BE DOING SOME CHAIN-STOKE BREATHING.
FOR THE LONGEST PERIOD OF TIME AND THEN...
OKAY? LONG GAPS.
THEY CAN BE ACNINC. WHAT'S THAT?
NOT BREATHING AT ALL. THAT'S NOT A GOOD SIGN.
AND SO YOU'RE LOOKING FOR THOSE KINDS OF THINGS WHILE YOU'RE TAKING.
IT'S JUST NOT A COUNT. ANYBODY CAN COUNT.
NURSES ARE ASSESSING QUALITY OF THOSE VITAL SIGNS.
ALRIGHT, MY MEMORY IS GOOD. IT'S JUST SHORT.
AND SO YOU MAY BE WANT TO BE WRITING DOWN AS YOU GO WHAT THESE ARE.
YOU CAN WRITE ON YOUR PAPER TOWELS.
SOMETIMES I'LL TAKE MY LITTLE ALCOHOL SWAB AND SCRIBBLE THEM DOWN
IF I DON'T HAVE A PIECE OF PAPER OR WHATEVER
SO THAT YOU CAN REMEMBER
THESE VITAL SIGNS.
97.2. 72.
16.
ALRIGHT.
THOSE THREE. REALLY, YOU SHOULD BE DONE
WITH THOSE FIRST THREE VITAL SINGS IN THREE MINUTES.
VITAL SIGNS SHOULD, REALLY, ONLY TAKE FIVE MINUTES.
SO WE SHOULD BE DONE IN TEN MINUTES AT EACH STATION, THEORETICALLY.
ALRIGHT.
LET'S GO BACK TO TEMPERATURE HERE A LITTLE BIT.
TEMPERATURE, ORAL IS ONE METHOD OF TAKING A TEMPERATURE.
WHAT'S A NORMAL TEMPERATURE RANGE FOR AN ADULT?
AVERAGE NORMAL?
- 97 TO 100.
- ACTUALLY TO 100.5. OKAY?
- THE BOOK SAYS 100.4 IS NORMAL.
- AND SOME WILL SAY 100.3 AND SOME WILL SAY --
BUT ANYWHERE, KIND OF, IN THERE. YOU HAVE TO --
IT DOESN'T REALLY MATTER. BUT INTERESTINGLY, UP TO A 100, RIGHT?
WE WANT TO MAYBE STOP AT 99.
BUT MOST PHYSICIANS DON'T WANT TO HEAR SOMEONE BEING FEBRILE
TILL THEY'VE GONE OVER A 100.3 TO A 100.5.
DEPENDING ON YOUR PHYSICIAN, THEY'RE NOT FEBRILE.
I MEAN, YOU CAN BE WARM JUST, KIND OF, RUNNING AROUND AND BEING ACTIVE
AND RUN A 99.4 DURING THE DAY WHILE YOU'RE BUSY.
AND THAT DOESN'T MEAN YOU HAVE A FEVER, GO HOME AND GO TO BED.
IT MEANS YOU'RE BUSY AND YOU'RE ACTIVE.
SO THOSE ARE YOUR PERIMETERS.
WHAT IF A CLIENT HAS A TEMPERATURE OF 96.2?
WHAT WOULD THAT BE?
WHAT WOULD BE THE MEDICAL TERMINOLOGY?
HYPO LOW THERMIA TEMP.
VERSUS IF THEY HAVE A FEVER OF 100.3, THEY'RE?
- HYPER. - HYPER.
HYPERTHERMIC.
AND THAT'S VITAL SIGNS.
NOW OUR TEMPERATURE.
THERE'S A COUPLE OTHER WAYS TO TAKE A TEMPERATURE.
ORAL, WE TALKED ABOUT.
ANYONE THAT'S ALERT, ORIENTED AND COOPERATIVE,
ORAL IS A VIABLE METHOD.
BUT THEY'RE NOT ALL THAT WAY. THEY MAY HAVE DIFFICULTY BREATHING.
WHAT IF SOMEONE'S A MOUTH BREATHER?
THEY'RE HAVING TROUBLE AND YOU PUT A THERMOMETER IN?
THIS ISN'T GOOD. THEY CAN'T BREATHE AND HOLD THAT.
THEY THEN NEED TO KEEP THEIR MOUTH CLOSED WHILE THEY'RE DOING IT AND NOT BITE.
SO AXILLARY MAY BE ANOTHER OPTION FOR YOU.
UNDER THE ARM.
IF YOU DO AXILLARY WITH A GLASS THERMOMETER,
THEN YOU NEED TO KEEP IT IN -- IT VARIES FROM BOOK TO BOOK AS WELL.
BUT ANYWHERE FROM FIVE TO TEN MINUTES DEPENDING ON WHO YOU'RE READING.
SO AT LEAST FIVE UNDER THE ARM.
WHEN YOU DO AXILLARY, THE THERMOMETER GOES
TO THE MIDDLE OF THE AXILLA AND THEN CLOSE DOWN SNUG ON IT.
IT DOESN'T HAVE TO BE STICKING OUT. YOU CAN PUT IT IN THIS WAY AS WELL.
BUT I LIKE TO STICK IT OUT JUST SO I DON'T FORGET ABOUT IT.
YOU KNOW, YOU GET BUSY AND SO FORTH.
SO WE DO THAT ON PEOPLE THAT ARE NOT COOPERATIVE OF THE ADULT POPULATION,
ARE DISORIENTED, MOUTH BREATHERS, THAT KIND OF THING.
ALMOST ALL BABIES. WE DON'T DO MANY RECTAL TEMPS ANY MORE,
SO MOSTLY AXILLARY ON INFANTS, CHILDREN.
IT'S A GOOD METHOD OF TEMPERATURE.
ANOTHER METHOD IS TYMPANIC.
YOU SEE THAT A LOT IN THE HOSPITALS,
AND PARTICULARLY IN THE PEDIATRIC ENVIRONMENT BECAUSE IT'S QUICK.
BUT I'D LIKE TO ALSO SAY IT'S NOT VERY ACCURATE CONSISTENTLY
BECAUSE IT HAS TO DO WITH OPERATOR ACCURACY.
YOU CAN'T HARDLY MISS THE ARMPIT IN THE MIDDLE,
BUT BECAUSE OF THE DIRECTION THAT PEOPLE PUT IT IN
AND BECAUSE OF THE FIRMNESS WITH WHICH THEY PUSH IT INTO THE EAR, YOU CAN GET,
I MEAN, WITHIN MANY DEGREES OF VARIANCE FROM OPERATOR TO OPERATOR.
BECAUSE THE IDEA IS THE ANGLE THAT IT GOES INTO THE EAR.
AND READ THROUGH ON YOUR BOOK, BUT IT'S GOT TO BE POINTING FORWARD, LIKE, TOWARDS THE NOSE
TO BE THEN POINTING TOWARDS THE TYMPANIC MEMBRANE.
AND IT NEEDS TO BE FIRMLY PUT INTO THE EAR NOT JUST LIGHTLY.
SO IT'S VERY FAST AND IF IT'S DONE CORRECTLY, IT CAN BE ACCURATE.
BUT IF IT'S NOT, YOU GET A LOT OF VARIANCE.
AND YOU CAN TEST YOURSELF ON TECHNIQUE FROM ONE EAR TO THE OTHER
AND SEE IF YOU'RE GETTING THE SAME THING.
SO NOT ALWAYS AN ACCURATE METHOD,
BECAUSE OF OPERATOR INCONSISTENCIES.
FINALLY THEN, THE LAST KIND WOULD BE A RECTAL THERMOMETER.
GOES INTO THE RECTUM ON PEOPLE THAT YOU NEED TO GET A GOOD CORE TEMP ON.
THEY CAN'T HOLD IT IN THEIR MOUTH, YOU WANT A DIFFERENT READING,
YOU MAYBE WANT TO COMPARE RECTAL VERSUS AXILLARY.
TO SEE WHERE -- WHICH IS BETTER.
THAT THERMOMETER NEEDS TO BE A DIFFERENT THERMOMETER THAN THE OTHERS.
YOU DON'T USE THE SAME ONE AND THAT'S IMPORTANT.
RED FOR RECTAL. BLUE OR GREEN IS USUALLY ORAL.
SO NOTE THAT WHEN YOU'RE USING ALL OF THESE THERMOMETERS.
RED, RECTAL. BLUE FOR OTHER.
IT GOES INTO THE RECTUM AN INCH TO AN INCH AND A HALF.
IT NEEDS TO GO INTO THE SIDE WALL -- I'LL TALK THROUGH THAT IN A MINUTE.
SO THAT YOU'RE NOT IN STOOL.
AND THEN IT ALSO NEEDS TO STAY IN ABOUT FIVE MINUTES.
USUALLY THREE TO FIVE DEPENDING ON THE TEXT THAT YOU READ.
ONE OF THE THINGS WE'VE TRIED TO DO IN HERE IS TO UNIFY OUR MATERIALS
SO YOU DON'T SEE A LOT OF DIFFERENT INFORMATION.
BUT IF YOU PICK UP ANOTHER TEXT
AND YOU WATCH ANOTHER VIDEO SERIES THAT'S NOT MOBY,
I'VE, KIND OF, BOUGHT INTO THE MOSBY SYSTEM FOR CONSISTENCY.
YOU'LL SEE A LITTLE VARIANCE.
AND IT'S OKAY.
THERE'S JUST A LOT OF WAYS TO DO ONE THING.
ALRIGHT.
OKAY. LET'S TALK A LITTLE BIT ABOUT TEMPERATURES AGAIN.
TEMPERATURES VARY FROM THE KIND OF TEMPERATURE YOU TAKE.
IF I TOOK HIS TEMPERATURE WHICH I DID, 97.2 ORALLY.
WHAT AM I TO EXPECT HIS AXILLARY TEMPERATURE TO READ?
- LOWER. - LOWER.
TYPICALLY ONE DEGREE.
SO IT'S PROBABLY GOING TO BE 96.2.
WHAT IF WE TOOK A RECTAL TEMPERATURE? WHAT WOULD YOU EXPECT IT TO READ?
HIGHER. USUALLY, ONE DEGREE.
SO PROBABLY 98.2.
AND SO THERE'S A DIFFERENCE ON A AN ADULT BETWEEN THE THREE.
ON AN INFANT, BECAUSE THEIR BODY CORE IS THE SAME,
THEY ACTUALLY FOUND THAT THERE'S NO DIFFERENCE BETWEEN THEIR AXILLARY AND THEIR RECTAL
AND THAT'S WHY WE JUST WENT WITH AXILLARY. NOT TO MENTION ON RECTAL,
THERE WAS THE RISK OF PERFORATING THE ANUS.
AND WE DIDN'T WANT TO PERFORATE BOWEL, STICKING THINGS UP THE REAR.
AND THE OTHER THING IS IT STIMULATES STOOL AND STOOLING.
SO SOMEONE THAT'S GOT DIARRHEA,
SOMEONE THAT'S ALREADY IRRITATED DOWN THERE, THAT'S NOT A GOOD OPTION.
SOMEONE THAT'S HAVING HEART TROUBLE. YOU CAN STIMULATE THE VAGAL NERVE.
AND WE DON'T WANT TO SIMULATE THINGS.
WHAT'S THE VAGAL NERVE?
- CRANIAL NERVE.
- HELPING YOU BREATHE AND STIMULATING YOUR BREATHING.
- UH-HUH, AND PULSE.
SO IT CAUSES YOUR PULSE TO DROP.
SOMEONE THAT'S HAD A HEART ATTACK, THIS ISN'T A GOOD OPTION FOR THEM.
TO BRADY THEM OUT.
AND SO BRADYCARDIA BEING SLOW PULSE.
ALRIGHT, WHICH MOVES ME INTO PULSE. LET'S TALK ABOUT NORMAL PULSE.
NORMAL PULSE IS WHAT RANGE?
60 TO 100 FOR THE AVERAGE ADULT.
IF IT'S OVER 100, IT'S...
- TACHYCARDIA. - TACHYCARDIA.
SO WE HAVE A LITTLE DIFFERENT PREFIX THERE.
TACHY BEING FAST. CARDIA BEING PULSE.
WHEREAS IF IT'S BELOW 6, IT'S CALLED?
- BRADYCARDIA. - BELOW 6O. BRADYCARDIA.
I'VE TALKED ABOUT REGULARS AND IRREGULARS AND SO FORTH.
OKAY. RESPIRATIONS. WHAT IS NORMAL ADULT?
12 TO 20.
NORMAL PULSE -- NORMAL RESPIRATIONS IS CALLED EUPNEA.
E-U-P-N-E-A.
N-E-A IS THE BREATHING.
PNEUMONIA, THE P-N-E-A.
IF IT'S OVER 20, IT'S CALLED...
WE PICK UP THE TACHY WORK AGAIN, THE TACHYPNEA.
SO FAST BREATHING,
IF IT'S BELOW 12, BRADYPNEA.
SLOW BREATHING.
OKAY, SO BE FAMILIAR WITH YOUR NORMALS.
IF A CLIENT WAS BREATHING 22 OR 24 FOR EXAMPLE,
AND I KNEW THAT WAS A LITTLE FAST,
I WOULD PROBABLY COME BACK IN 15 MINUTES AND RECHECK IT.
WAS IT JUST A MOMENT THAT I CAUGHT OR ARE THEY HAVING TROUBLE.
I'D ALSO BE LOOKING AT THEIR CHART TO SEE IF THIS IS HOW THEY BREATHE ALL THE TIME
OR DID I CATCH AN EPISODE.
OKAY.
ALRIGHT. I'LL HIT MY NOTES HERE IN A MINUTE,
BUT I THINK I'VE GOT ALMOST EVERYTHING WE NEED DOWN HERE.
OKAY.
WE NEED TO GET AN APICAL PULSE AS WELL.
BY THEN YOU SHOULD HAVE GOTTEN YOUR RADIAL PULSE
AND YOUR RESPIRATIONS, YOUR TEMPERATURE
DONE IN 2 MINUTES.
IF YOU'RE REALLY FAST, YOU CAN GET AN APICAL DONE AS WELL
IF YOU'RE MATCHING YOUR INSTRUCTOR RIGHT AWAY.
AND WHAT WE'LL DO IS YOU'LL BE ON ONE WRIST, I'LL BE ON THE OTHER.
AND WE'LL SYNCHRONIZE OUR COUNTING.
EVERYONE BY NEXT WEEK NEEDS TO HAVE A WATCH WITH THE SECOND HAND ON IT.
WE MAY USE THE WALL CLOCK AT SOME STATIONS,
BUT A WATCH THAT WE CAN AGREE ON AND LOOK AT.
AND YOU HAVE TO WEAR YOUR WATCH EVERYDAY YOU GO TO CLINICAL.
DON'T EVEN WALK IN THE DOOR WITHOUT YOUR WATCH
AND YOUR STETHOSCOPE AND YOUR PINS.
AND EVERY GOOD NURSE WHEN THEY GET ON THE FLOOR
SNATCHES UP A WHOLE POCKETFUL OF ALCOHOL SWABS.
JUST DO IT NOW. YOU NEED THEM. YOU'VE GOT TO WIPE EVERYTHING OFF, SO GRAB A WHOLE BUNCH.
I AM LOADED FOR BEAR IN MY POCKETS, OKAY.
ALRIGHT. WE'RE GOING TO TAKE AN APICAL PULSE NOW.
LET'S TALK A LITTLE BIT ABOUT YOUR STETHOSCOPE.
IF YOU'VE NEVER USED A STETHOSCOPE.
THEY SHOULD HAVE COME IN PIECES PROBABLY IN YOUR KITS.
AND VERY OFTEN THE EAR PIECES NEED TO BE STUFFED INTO THE STETHOSCOPE ITSELF.
SOMETIMES YOU NEED TO ATTACH THE DIAPHRAGM AND THE BELL.
YOU EAR PIECES WILL COME OFF AND YOU CAN TAKE THESE HARD PIECES OFF
AND PUT THOSE LITTLE SOFT EAR PIECES ON.
I WOULD RECOMMEND THEM OVER THESE HARD PIECES.
WHEN YOU DO IT ALL DAY LONG, THEY REALLY HURT YOUR EARS.
AND THAT'S THE THING.
ALRIGHT, FIRST THINGS FIRST. FOR LISTENING,
WHAT YOU WANT TO DO IS YOU WANT TAKE AND TWIST THESE A LITTLE BIT.
AND THEY MOVE ON YOUR STETHOSCOPE AND YOU WANT TO TWIST THEM.
SO THAT WHEN YOU PUT THEM IN YOUR EARS,
THEY'RE FACING TOWARDS YOUR NOSE.
YOU, KIND OF, THINK YOUR EARS GO BACK, BUT THEY REALLY DON'T.
AND IF YOU GET -- YOU NEED TO HEAR WELL
YOU WANT TO PUT THEM IN YOUR EARS AND YOU WANT TO TWIST THEM TILL YOU SEAL OFF ALL THE NOISE.
AND YOU CAN HEAR THAT WHEN YOU'RE PLAYING WITH THEM.
SO TWIST TILL YOU GET A GOOD SEAL USUALLY POINTING FORWARD.
CAN'T HEAR YOU.
ALRIGHT, YOUR STETHOSCOPE WILL BE ON.
THEN WHEN YOU GO TO YOUR STETHOSCOPE,
YOU HAVE TWO PIECES. I PUT A LITTLE DIAGRAM UP HERE.
YOU HAVE THE DIAPHRAGM WHICH IS THE FLAT PIECE IN THE FRONT.
AND YOU HAVE THE BELL WHICH IS THE SMALLER PIECE,
FOR ME RIGHT NOW, IN THE BACK.
YOUR STETHOSCOPE ACTUALLY SHOULD TWIST
AND THAT'S WHAT TURNS THE SOUND ON TO ONE SIDE OR THE OTHER.
SO MAKE SURE THAT YOU'RE LISTENING TO THE RIGHT SIDE.
THE DIAPHRAGM, DI-HI-I. THE LONG 'I' SOUND.
DIAPHRAGM LISTENS TO HIGH PITCHED SOUNDS.
WE USE IT MOST OF THE TIME BECAUSE IT PICKS UP THE SOUNDS THAT WE NEED
IN THE HEART, THE LUNGS THE BOWEL.
AND SO WE USE THE DIAPHRAGM.
IF WE WANT TO LISTEN TO DISTINCTIVE BOWEL --
HEART SOUNDS OR VALVE SOUNDS, THEY'RE USUALLY A LOWER PITCH.
AND WE'RE GOING TO SWITCH IT OUT TO THE BELL,
AND BELLOW, L-O, LISTENS TO THE LOW SOUNDS.
AND THAT'S IMPORTANT TO KNOW THE DIFFERENCE AND WHY WE DO IT.
WE'RE FOR THE MOST PART GOING TO BE USING THE DIAPHRAGM.
IN YOUR BOOK, IT SAYS THAT WHAT YOU SHOULD DO
TO MAKE SURE THAT YOU'RE LISTENING TO THE RIGHT THING,
IS TO PUT IT IN YOUR EAR AND BLOW ON IT.
PLEASE DON'T DO THAT.
I DON'T KNOW WHAT THEY WERE THINKING ON THAT ONE.
BECAUSE THE WHOLE IDEA IS THIS IS CLEAN.
WHY WOULD YOU GO SPITTING ON THIS THING
TO PUT IT ON TO SOMEONE'S CHEST? THAT DOESN'T MAKE ANY SENSE.
SO, I WOULD JUST RECOMMEND YOU PUT THIS IN YOUR EAR
AND TAP EVER SO GENTLY.
OH! NOW I'M ON.
CHECK THE DIFFERENCE IN THE SOUNDS.
WHEN YOU'RE ON, BOOM. IT BLASTS YOUR EAR OUT.
SO EVER SO GENTLY JUST TAP ON THE EDGE
AND MAKE SURE THAT YOU'VE CONNECTED TO THE RIGHT SIDE OF YOUR STETHOSCOPE.
YOUR STETHOSCOPE HAS TO BE CLEANED AFTER EVERY USE WITH A CLIENT.
I'VE ALREADY CLEANED MINE, BUT...
I'LL DO IT AGAIN. SEE HOW MANY THINGS I'VE GONE THROUGH ALREADY.
JUST CLEAN OUT THAT BELL, WHAT'S IN CONTACT WITH CLIENTS.
AND THAT'S AN OSHA REQUIREMENT, OKAY.
ALRIGHT. MY STETHOSCOPE'S READY, I'M READY. CLIENT.
THERE ARE ACTUALLY FOUR LOCATIONS ON THE HEART TO LISTEN TO THE VALVES.
YOU'LL FOCUS ON THOSE WHEN YOU DO YOUR ASSESSMENT COURSE NEXT SEMESTER.
BRIEFLY.
THE AORTIC VALVE IS ACTUALLY ON THE RIGHT SIDE OF THE CHEST.
MIDCLAVICULAR LINE. THESE BEING YOUR CLAVICLES.
MIDCLAVICULAR LINE, SECOND INTERCOSTAL SPACE.
ICS. INTERICOSTAL SPACE.
YOUR SECOND INTERCOSTAL SPACE
IS THE SPACE RIGHT BELOW YOUR CLAVICLE.
INTERESTING. YOU CAN LISTEN THERE AND HEAR THE AORTIC VALVE.
BUT IT'S NOT AS LOUD AS THE VALVE THAT WE WANT.
WE WANT THE MITRAL VALVE.
SO YOU COULD GO OVER HERE AND LISTEN ON THE LEFT-HAND SIDE TO THE PULMONIC VALVE.
IT'S ACTUALLY MIRRORED TO THIS.
IT'S THE MIDCLAVICULAR LYING, SECOND INTERCOSTAL SPACE,
AND YOU CAN PICK UP THE PULMONIC VALVE.
WE DON'T WANT THAT ONE.
IF YOU TAKE YOUR STERNUM,
AND YOU GO TO THE FIFTH INTERCOSTAL SPACE,
AND IF YOU START HERE RIGHT BELOW THE CLAVICLE,
THAT'S TWO AND FEEL THREE AND FOUR AND FIVE.
AND APPRECIATE THAT YOUR LUNGS, KIND OF --
THE RIBCAGE DIPS DOWN A LITTLE BIT.
YOU'RE GOING TO GO FIFTH INTERCOSTAL SPACE RIGHT LATERAL TO THAT STERNUM.
YOU'RE GOING TO PICK UP THE TRICUSPID VALVE.
BUT WE DON'T WANT THAT ONE.
OKAY, BUT THAT'S THE THREE.
NOTICE, THEN, THERE'S SOME MOVEMENT AROUND HERE
WHERE YOU'RE GOING TO PICK UP SOME REFERRED SOUND.
WHAT WE WANT IS THE -- WHAT THEY CALL THE POINT OF MAXIMUM IMPULSE.
THE PMI. THE LOUDEST PLACE.
MAXIMUM IMPULSE, WHICH IS THE MITRAL VALVE.
THE MITRAL VALVE IS MIDCLAVICULAR LINE.
FIFTH INTERCOSTAL SPACE. NOTICE THAT THE RIBCAGE GOES DOWN.
AND IT ENDS UP BEING RIGHT ABOUT THE NIPPLE.
WHEN WAS THE LAST TIME SOMEONE TOOK YOUR PULSE THERE?
[LAUGHTER]
THEY DON'T. RIGHT?
SO WE'VE GOT TO BE A LITTLE BIT DISCREET HERE.
BUT WE DO WANT TO BE MIDCLAVICULAR
AND BE SENSITIVE TO OUR CLIENT.
SO, THIS IS WHAT YOU DO.
I HAVE A GUY SO IT'S NOT USUALLY AS BIG OF AN ISSUE,
BUT GUYS ARE A LITTLE MORE CHALLENGING TO HEAR THAN FEMALES ARE.
THEY HAVE A THICKER MUSCULAR WALL.
AND SO THE SOUND DOESN'T REFER ITSELF
AS EASILY AS IT DOES THROUGH THE FEMALE BREAST TISSUE WHICH IS FAT.
AND SO THAT BREAST TISSUE CONDUCTS SOUND A LITTLE BETTER
SO ACTUALLY THROUGH BREAST TISSUE, YOU'RE ACTUALLY GOING TO HEAR THE SOUND
A LITTLE BETTER THAN YOU ARE THROUGH THAT THICK MUSCULAR WALL.
ALSO KNOW THAT THEIR RIBCAGE DIPS A LITTLE BIT MORE
THAN THE FEMALE RIBCAGE DOES.
AND SO YOU'RE ACTUALLY GOING TO FIND ON THE MALE,
THE PMI, POINT OF MAXIMUM IMPULSE,
MIDCLAVICULAR LINE, FIFTH INTERCOSTAL SPACE, USUALLY RIGHT BELOW NIPPLE.
OKAY? SO A LITTLE BIT LOWER.
SOMETIMES I CAN'T HEAR IT VERY WELL SO WHAT I'LL DO IS HAVE THEM TURN TO THEIR SIDE
AND I'LL GO RIGHT BETWEEN STERNUM AND NIPPLE, FIFTH MIDCLAVICULAR
AND LET THE HEART, KIND OF, FALL INTO MY STETHOSCOPE.
THEN I CAN HEAR IT MUCH, MUCH BETTER.
SO, LITTLE TRICKS TO THE TRADE.
WE'RE JUST DOING A SITTING UP, BEING RELAXED, KIND OF, A PULSE.
NOW.
WE KNOW WHERE WE'RE AIMING.
I HAVE A CHEAP STETHOSCOPE.
WHEN YOU BUY CHEAP, YOU NEED TO MAKE CONNECTION WITH SKIN.
OKAY? IT'S REALLY IMPORTANT.
THEY'RE SOME SUPER-DUPER STETHOSCOPES THAT BOAST THAT YOU CAN HEAR
THROUGH FIVE LAYERS OF CLOTHING, FIVE TOWELS, FIVE THIS AND THAT AND THE OTHER.
I'VE TRIED THEM AND IT'S TRUE. BUT YOU'RE GOING TO HAVE CHEAP.
SO, THE ULTRASCOPE AND WE'LL HAVE SOME OF THOSE.
AND THEY ACTUALLY HEAR THROUGH CLOTHING.
BUT WHAT HAPPENS WHEN YOU HAVE A LOT OF CLOTHING, IS YOU PICK UP SOME ARTIFACTS.
YOU PICK UP SOME RUBBING FROM THE CLOTHING
AND YOU DON'T ALWAYS HEAR AS CLEARLY AS YOU WOULD IF YOU MAKE SKIN CONTACT.
SO, WE WANT TO CONTACT THE SKIN.
A GUY PROBABLY WOULDN'T CARE IF WE RIPPED HIS SHIRT OFF,
BUT IN TECHNIQUE WE'RE GOING TO DROP OUR STETHOSCOPE AND JUST MOVE IT
AND KEEP YOUR HAND OUTSIDE OF SKIN...
TO HEAR. SO, I'M PRESSING.
AND YOU'RE GOING TO HAVE TO PRESS FIRMLY AND MAKE CONNECTION.
AND THEN COUNT YOUR PULSE. OKAY?
SO YOU'LL BE IN UNIFORMS THAT DAY,
DON'T WEAR A LOT BUNCH OF T-SHIRTS AND JUNK UNDER THOSE.
IT'S REALLY HARD TO GET IN TO SHIRTS
I'M LOOKING AT YOUR TURTLENECKS AND GOING, "OH, BUMMER."
YOU KNOW, COS WE WANT TO GET TO CLOTHING -- THROUGH CLOTHING.
OTHER THING YOU CAN DO IS JUST GO UP UNDERNEATH CLOTHING AS WELL.
AND YOU CAN STUFF UP HERE AND IT WOULDN'T FEEL AS INTRUSIVE.
WHAT I DON'T WANT TO SEE IS TO HAVE YOU STICK YOUR HAND ALL THE WAY DOWN THE SHIRT.
FOR TWO REASONS, IT'S A LITTLE INVASIVE AND IT STRETCHES OUT THEIR CLOTHING.
AND IT'S JUST NOT NECESSARY FOR HEARING.
YOU DON'T HAVE TO FEEL THIS TO HEAR OUT OF IT.
SO, I'M GOING TO DROP IT DOWN.
DO YOU FEEL LIKE I'VE INVADED YOUR SPACE, REALLY? NO.
SO I WOULD COME HERE. I'M GOING TO FIND MY LOCATION.
YOU CAN'T HEAR A THING I'M HEARING.
BUT IT IS A BEAUTIFULLY STRONG PULSE.
AND I WOULD START COUNTING AT THE 6.
THE 6 BEING 0.
1,2 AND SO FORTH.
WHEN YOU COUNT THE APICAL PULSE,
YOU'RE LISTENING NOW FOR TWO SOUNDS TO BE ONE BEAT.
BECAUSE YOU'RE LISTENING TO VALVES OF THE HEART OPEN AND CLOSE.
OPEN AND CLOSE, SO YOU'VE HEARD IT REFERRED TO
AS THE LUB-DUB, LUB-DUB, LUB-DUB.
SO YOU WANT IT -- IT'S A HIGHER LOWER PITCH, HIGHER LOWER.
AND EACH OF THOSE TWO SOUNDS COUNT AS ONE BEAT.
SO YOU WANT TO FALL INTO THE RHYTHM.
YOU CAN FIND IT FOR A FEW SECONDS.
LIKE FOR, YOU KNOW, 5 0R 10 AND YOU GO, "OKAY, I'VE GOT IT."
YOU'RE FOLLOWING INTO THE RHYTHM,
AND THEN YOU AGREE. WE'RE GOING TO START COUNTING AT.
AND WE'LL START COUNTING TOGETHER.
YOU ALWAYS COUNT THE HEART FOR A FULL 60 SECONDS.
NONE OF THE 30 SECOND CHEAT, MULTIPLY TIMES 2.
THE HEART GETS A FULL 60.
THERE'S NOT MUCH ELSE TO SAY ON THAT EXCEPT THAT YOU'RE LISTENING
FOR THE SAME THINGS YOU WERE FEELING FOR BEFORE.
REGULARITY, QUALITY, RATE
TO SEE IF THE BEAT IS IRREGULAR.
IN FACT, ANYTIME I FIND AN IRREGULAR PULSE BEAT,
I ALWAYS TAKE A APICAL.
AND TO BE PERFECTLY HONEST, I VERY RARELY WASTE MY TIME WITH THE RADIAL,
I JUST GO STRAIGHT TO THE HEART
BECAUSE I CAN NOT ONLY LISTEN TO THE HEART,
I CAN, KIND OF, LISTEN TO LUNG SOUNDS AND I CAN HEAR 'EM BREATHING.
SO I NEVER HAVE TO DO THAT FAKE WATCHING THING, YOU KNOW.
WHERE DOES IT COME -- BECAUSE you CAN HEAR THE BREATHING
AND SO IT'S A LOT EASIER TO DO.
BUT YOU NEED TO KNOW THEM ALL, SO. AND THAT'S THE POINT.
SO YOU FIND YOUR THING, YOU'RE GOING TO COUNT FOR ONE MINUTE.
YOU'RE GOING TO GET DONE AND YOU'RE GOING TO COMPARE YOUR RATES.
AND I'LL -- I'LL -- WHOOPS, I'M SORRY.
I'LL WRITE MINE DOWN AND THEN I'LL SAY, "WHAT DID YOU GET?"
SO THAT YOU KNOW I'M NOT FUDGING MINE OUT JUST TO MATCH YOURS.
AND WE NEED TO BE WITHIN -- WHAT DID I SAY? 4?
I THINK I WAS AS GRACIOUS AS I CAN BE ON THAT. 4 HIGH OR LOW.
NOW THAT'S A LOT. THAT'S A WHOLE THING OF 8.
I MEAN, WE'RE NOT TRYING TO GET YOU ON THAT, WE JUST NEED TO BE CLEAN.
AND USUALLY, WHERE OUR ERROR IS, IS LIKE
SOMEONE STARTS EXACTLY ON THE 6 OR YOU KNOW.
AND SO YOU MIGHT PICK UP AN EXTRA BEAT THERE AT THAT EXACT SECOND.
BUT WE NEED TO JUST BE IN THE REALM
OF ACCURACY THERE.
ALRIGHT? ANY QUESTIONS ON THAT ONE?
OKAY. SO WE'LL JUST REALLY --
I DIDN'T REALLY COUNT IT. LET'S SAY WE GOT 74.
- APICAL. I DON'T WANT TO TOUCH THIS.
- I DON'T WANT YOU TO EITHER. THANK YOU VERY MUCH.
OKAY. SO WE'VE GOT TEMPERATURE, PULSE, RESPIRATIONS.
WE'VE GOT AN APICAL, RADIAL.
LAST BUT NOT LEAST, WE NEED TO GET A BLOOD PRESSURE.
OKAY. BLOOD PRESSURES ARE A LITTLE TRICKY
TO DESCRIBE AS WELL BECAUSE YOU CAN'T HEAR THEM.
WE'LL TRY A COUPLE LITTLE TRICKS TO HELP YOU WITH THAT.
NOTICE THAT I ONLY DID ONE HIGH FIVE.
I ONLY NEED ONE HIGH FIVE.
I HAVE THIS PATIENT. I'VE IDENTIFIED HIM AND I'M GETTING VITAL SIGNS.
YOU DON'T HAVE TO DO A HIGH FIVE FOR EVERY SINGLE THING YOU DO.
THAT WOULD BE OVERKILL.
BUT THE REASON I PUT INDIVIDUAL SHEETS THERE,
WAS SO THAT YOU COULD APPRECIATE
THAT YOU CAN EACH VITAL SIGN AS ITS OWN ENTITY.
YOU DON'T HAVE TO GET A WHOLE SET,
BUT YOU WANT TO KNOW THE CLIENT YOU HAD
IF YOU WERE JUST DOING ONE THING OR TWO OR SO.
ALRIGHT. WE'RE GOING TO GET THE BLOOD PRESSURE,
I'VE ALREADY CHECKED RELATED TO.
HIS EATING, HIS DRINKING, HIS ACTIVITY.
I DON'T EVEN NEED TO SAY THAT AGAIN.
IF YOU FORGOT THE BEGINNING THIS WOULD BE A GOOD TIME TO PICK IT UP
SO YOU GOT YOUR POINTS THERE. I MEAN, FROM A POINT PERSPECTIVE.
BUT THE ONE THING I DIDN'T REALLY SAY TO HIM
THAT I NEED TO SAY HERE,
IS THAT I NEED TO -- FOR HIM TO REMAIN QUIET.
I WANT TO CREATE A QUIET ENVIRONMENT.
I NEED TO MAKE SURE HIS LEGS AREN'T CROSSED.
WHEN THEIR LEGS ARE CROSSED, IT ACTUALLY INCREASES THE BLOOD PRESSURE A LITTLE BIT
SO YOU WANT TO HAVE LEGS THAT ARE STRAIGHT.
AND YOU WANT TO MAKE SURE TO MENTION THAT.
IN THE GATHERING UP OF EQUIPMENT,
I WANT TO MAKE SURE THAT I HAVE A BLOOD PRESSURE CUFF THAT FITS.
LET ME DESCRIBE THE BLOOD PRESSURE CUFF JUST A BIT HERE.
YOU HAVE THE CUFF ITSELF AND INSIDE THE CUFF,
AND IT'S IMPOSSIBLE TO SEE, BUT YOU CAN FEEL IT.
AND YOU CAN MAYBE SEE THE OUTLINE HERE A LITTLE BIT, IS THE BLADDER.
THAT'S THE PART RIGHT IN HERE,
AND, KIND OF, FEEL IN THERE, IT'S JUST A, KIND OF, RUBBERY IN THERE.
THAT'S WHAT WE'RE PUMPING UP WITH AIR
TO OBLITERATE THE BRACHIAL ARTERY.
THAT'S WHAT THEY'RE DOING WHEN THEY PUT THIS AROUND YOU.
THEY'RE SQUEEZING IT UP WITH AIR SO THAT IT SQUISHES OUT YOUR PULSE AND MAKES IT GO AWAY.
AND WE'RE TRYING TO FEEL WHEN THE PULSE COMES BACK, WHEN THE PRESSURE HITS AGAIN.
THAT'S THE SYSTOLIC, THE HIGHEST PRESSURE IN THE VEIN.
WE WANT THAT POOF-POOF FEEL.
THAT'S WHAT WE'RE LISTENING FOR IN THERE FOR BRACHIAL ARTERIES.
SO IT'S IMPORTANT THEN THAT THE BLADDER --
WHERE'S MY LITTLE ARROW HERE?
THE BLADDER -- THEY PUT IN VERY SMALL PRINT.
THAT THE BLADDER IS POSITIONED OVER THE BRACHIAL ARTERY.
SO YOU'LL SEE THIS LITTLE ARROW THAT TELLS YOU WHERE TO PUT IT,
SO THAT YOU GET THE BEST PRESSURE ON THE ARTERY FOR OBLITERATION.
ALRIGHT. TO DO THAT WE NEED TO HAVE A CUFF THAT FITS OUR CLIENT.
IN YOUR BOOK, IT TELLS YOU THAT THE CUFF SHOULD BE --
THE WIDTH OF THE CUFF SHOULD BE 20% WIDER THAN THE DIAMETER OF HIS ARM.
SO IF I LIFT UP HIS SLEEVE, THIS SHOULD ACTUALLY BE JUST A LITTLE BIT WIDER
THAN HIS ARM DIAMETER.
OKAY, WELL, THAT LOOKS KIND OF CLOSE
OR IT SHOULD BE 40% OF THE CIRCUMFERENCE OF HIS ARM.
SO IF YOU WRAP THIS AROUND HIS ARM,
THAT'S THE CIRCUMFERENCE, THE WHOLE THING.
THEN YOU COULD TAKE THE WIDTH AND SEE IF IT WAS ABOUT HALF OF THE SIZE.
GO IT? YEAH, AND LAUGH.
NOBODY DOES THAT. OKAY.
LET ME TELL YOU THE EASIEST WAY.
THEY FINALLY FIXED US UP WITH SOME DECENT CUFFS.
AND IF YOU LOOK ON YOUR NEWER CUFFS, THEY HAVE THIS RANGE RIGHT HERE.
BOTTOMLINE, YOU WANT YOUR CUFF TO COVER TWO THIRDS OF THE UPPER ARM, NOT THE WHOLE ARM.
IF IT COVERS UP THEIR ANTECUBITAL SPACE, IT'S TOO BIG AND YOU CAN'T HEAR GOOD.
AND IF IT'S REAL SKINNY, YOU'LL GET A FALSE --
OH, I CAN'T REMEMBER HIGH OR LOW READING BECAUSE THE CUFF DOESN'T FIT.
SO TWO THIRDS OF THE UPPER ARM. BUT WHEN YOU GO AROUND THE ARM --
CAN YOU HOLD THOSE LITTLE FLOPPY PIECES THERE FOR A SECOND?
IF THIS WHITE INDEX LINE FALLS WITHIN THIS RANGE HERE...
SEE THE INDEX LINE, WHITE,
FALLS ANYWHERE WITHIN HERE, WHEN YOU WRAP IT AROUND THE ARM...
IT FITS SO MUCH EASIER.
20%, 40%, DIAMETERS, CIRCUMFERENCES, THIRDS, WHAT IN THE WORLD IS ALL THAT ABOUT?
OKAY. NOW IT IS A GREAT TESTING THING,
SO YOU NEED TO KNOW IT BECAUSE THEY'VE DEVELOPED THIS CRITERIA.
BUT JUST KNOW REAL WORLD...GOOD. OKAY?
SO WHEN YOU COME TO TEST, HOPEFULLY, WE HAVE NEW BLOOD PRESSURE CUFFS FOR YOU
AND YOU CAN JUST TELL ME ABOUT THE INDEX LINE
AND THEN I'VE GOT A GOOD FIT.
OR YOU'RE GOING TO HAVE TO KNOW 20% WIDER THAN DIAMETER
OR 40% OF THE CIRCUMFERENCE.
AND IT'S ALL IN YOUR BOOK. I DIDN'T MAKE IT UP.
THERE'S THIS ONE BEAUTIFUL PAGE THAT HAS ALL ABOUT BLOOD PRESSURE IN THE LITTLE BOX,
AND THE SOUNDS ABOUT THE FIVE PHASES
I'D LOOK AT THOSE TWO BOXES.
ALRIGHT. ON THE BLOOD PRESSURE CUFF, ONCE YOU GET THIS AROUND THE ARM,
YOU'RE GOING TO WRAP IT SNUGLY AROUND THE ARM.
SECURE IT WITH THE VELCRO ABOVE THE BRACHIAL ARTERY,
AND ONE INCH ABOVE THE ANTECUBITAL SPACE.
YOUR ANTECUBITAL IS THE BEND IN YOUR ARM, OKAY?
SO YOU WANT THE CUFF TO BE AN INCH HIGHER.
SO THAT WHEN YOU PUT THE STETHOSCOPE ON TO THIS BRACHIAL ARTERY,
IT'S NOT PICKING UP THE ARTIFACTSOUND FROM THE CUFF RUBBING AND BUMPING ALL OVER IT.
YOU NEED TO HEAR REALLY CLEARLY ON THAT.
OKAY. LET'S BACK UP ONE MORE TIME.
EVERYBODY NEEDS TO FIND THEIR BRACHIAL ARTERY.
TAKE YOUR ARM.
IT SAYS TO RELAX IT IN YOUR BOOK, SO LET'S RELAX THE FIRST TIME.
NOTICE THIS IS THE BRACHIAL SIDE, BUT IT'S ON THE OPPOSITE SIDE.
OKAY. YOU'RE GOING TO FEEL THIS LUMP OF SKIN
AND MAYBE EVER SO SLIGHT OF A BONE UNDERNEATH
AND THEN THIS CARTILAGE WHERE MY VEIN IS.
CAN YOU, KIND OF, FEEL A CARTILAGE? AND YOU'RE GOING TO FALL INTO THAT NOTCH.
AND THERE SHOULD BE A PULSE RIGHT IN THERE THAT YOU'RE FEELING.
AND IT'S ON THE LITTLE FINGER SIDE.
SO IF SOMEBODY SAYS, "OH, I FEEL IT OVER HERE."
I'M GOING, "NO, YOU DON'T. THERE'S NO PULSE OVER THERE."
IT'S GOT TO BE ON THIS SIDE.
ALRIGHT. NOW SOME OF YOU MAYBE STRUGGLING TO FIND IT.
WHAT I FOUND IS IF YOU PUT THE ARM OUT LIKE THIS AND POP YOUR ELBOW,
IT POPS THAT ARTERY RIGHT UP.
AND OH, I FEEL IT EVER SO STRONG.
I CAN'T FIND IT AS EASILY WHEN MY ARM IS BENT
BECAUSE IT FALLS INTO THE ARM AND I HAVE TO PUSH A LITTLE FIRMER.
POP IT UP AND IT WILL POP RIGHT TO THE SURFACE.
POOF, POOF, POOF.
DID YOU FIND YOURS? THEN YOU'LL HAVE NO TROUBLE.
OKAY. SO WHAT WE WANT TO DO IS KNOW WHERE THAT IS AND PALPATE FOR IT.
SO THAT WHEN I GO TO WRAP THIS CUFF AROUND HIS ARM,
THAT'S WHERE I'M LANDING THE ARROW, IS ABOVE THAT PULSE.
ALRIGHT. I ALSO HAVE ON HERE THE SPHYGMOMANOMETER.
THAT'S A MOUTH FULL.
THE DIAL. THE GAUGE.
THIS IS THE DIAL THAT I'M GOING TO BE --
WHEN I INFLATE WITH MY BALL, I'LL TALK ABOUT THAT IN A MINUTE.
WHEN I INFLATE THE CUFF HERE.
THIS IS GOING TO TELL ME HOW MANY MILLIMETERS OF MERCURY OF PRESSURE
I'M PUTTING INTO THE CUFF.
WHEN YOU LOOK AT YOUR DIAL,
YOU NEED TO MAKE SURE THAT YOUR BLOOD PRESSURE CUFF IS CALIBRATED.
SO THAT IT'S GOING TO READ AND GIVE YOU ACCURATE RESULTS.
THE WAY YOU CAN TELL IS THAT THE DIAL SHOULD FALL
INTO THE LITTLE ROUND CIRCLE HERE AT THE BOTTOM OF THE DIAL.
IF IT'S OUTSIDE OF THE LITTLE CIRCLE, IT'S NOT CALIBRATED.
IT NEEDS TO GO BACK TO BIOMED OR WHOEVER WORKS ON EQUIPMENT
IN YOUR HOSPITALS SO THAT THEY CAN RE-CALIBRATE IT.
THEY HAVE THIS LITTLE SCREW PIECE THAT THEY ADJUST TO GET IT BACK ON.
YOU CAN, KIND OF, SEE IT HERE IF YOUR EYES ARE PRETTY GOOD.
THIS ONE'S BARELY, BARELY IN.
IN FACT IT'S RIGHT TO THE EDGE OF THE BOX.
SO NOT AS CALIBRATED AS I'D LIKE TO SEE.
THAT ONE IS PERFECT IN THE MIDDLE.
AND SO THAT'S WHAT YOU'RE LOOKING FOR.
IS YOUR EQUIPMENT IN GOOD WORKING ORDER TO GIVE YOU GOOD RESULTS.
YOU CAN HOLD THESE TO SEE THEM.
YOU CAN CLIP THEM. THEY HAVE A LITTLE CLIP HERE.
AND SO IT'S USUALLY EASIER, IF YOU JUST OPEN UP THE CLIP,
AND PUT IT IN HERE AND CLIP IT ON TO YOUR CUFF FOR VISUALIZING.
ALRIGHT. ADAM, I THINK I'M FINALLY READY.
NOW WHEN YOU TAKE A BLOOD PRESSURE,
I'D LIKE THE -- WELL, LIKE HAS NOTHING TO DO WITH IT.
TO GET THE MOST ACCURATE READING, YOU NEED THE ARM TO BE EVEN WITH THE HEART.
IF I PUT HIS ARM WAY UP HERE,
IF I WAS REAL TALL AND HE WAS SITTING LOW OR IN A LOW BED,
WHAT DO YOU THINK IS GOING TO HAPPEN TO THE BLOOD PRESSURE?
- IT'S GOING TO COME DOWN.
- IT'S GOING TO DROP AND I'M GOING TO GET A FALSE LOW.
BY THE SAME TOKEN, IF I CAME DOWN LOW AND KEPT IT BELOW THE HEART, I WOULD GET?
- HIGH. - FALSE HIGH BECAUSE THERE'S MORE PRESSURE IN.
SO TO GET THE MOST ACCURATE READING,
YOU'RE GOING TO PUT THE ARM EVEN WITH THE HEART.
USUALLY, IN THE SITTING POSITION I, KIND OF, DROP THEIR HAND
ON MY HIP AND I HOLD THEIR ELBOW
SO I CAN POP IT OUT AND GET A GOOD SOUND.
ALRIGHT. LAST IF YOU CAN PUT THE CUFF ON WITHOUT CLOTHING,
BUT I DO SOMETIMES WRAP IT AROUND A THIN LAYER OF CLOTHING.
IT'S NOT GOING TO BE AS ACCURATE IF YOU'RE DOING IT
AROUND BIG OLD SWEATSHIRTS AND THAT KIND OF THING
BECAUSE YOU'RE GETTING MORE PRESSURE THAN WHAT THIS IS REALLY GOING TO PUT ON AN ARM.
ALRIGHT. LET'S JUST SEE WHERE YOUR PULSE IS HERE.
UP.
OKAY.
I'LL LAND THAT RIGHT HERE.
I'M GOING TO SECURE THIS SNUGLY LIKE THAT SO THAT IT DOESN'T SLIDE AROUND,
AND NOT TOO LOOSE BECAUSE AGAIN, THAT WILL CAUSE FALSE HIGHS OR LOWS.
ALRIGHT. IT'S POINTED TO HIS ARTERY.
I'M GOING TO MAKE SURE ALL THIS TUBING JUNK IS OFF TO THE SIDE,
SO THAT WHEN I SET MY STETHOSCOPE HERE, IT'S NOT GOING TO BE BUMPING IT.
BECAUSE THAT CAUSES A BUNCH OF FALSE NOISE AND I CAN'T ALWAYS HEAR IT START.
ALRIGHT. CAN YOU SCOOT OVER JUST A TOUCH SLIGHTLY,
SO THAT I CAN PUT MY LEG HERE AND YOU CAN REST. OKAY.
ADAM, DO YOU KNOW WHAT YOUR BLOOD PRESSURE RUNS?
- NO. - OKAY, ADAM, DOESN'T KNOW.
IF ADAM KNEW WHAT HIS BLOOD PRESSURE WAS --
LET'S SAY IT WAS NORMALLY 120/80.
HE WOULD SAY, "YEAH, IT'S USUALLY NORMAL, 120/80."
THEN WHEN I PUMP THIS UP, I'M ONLY GOING TO GO 30 MILLIMETERS OF MERCURY HIGHER
THAN WHAT HE BELIEVES HIS NORMAL TO BE AROUND.
THERE'S JUST REALLY NO GOOD REASON TO BE PUMPING IT UP TO, LIKE, 200 OR 250
IF THEIR BLOOD PRESSURE NORMALLY RUNS 110/70.
AND THAT'S HOW THEY TAUGHT US WHEN I FIRST STARTED NURSING.
WE JUST PUMPED EVERYONE TO 200 AND LET OT GO DOWN
AND THAT'S -- AND YOU'VE GOT YOUR THEIR BLOOD PRESSURE.
AND IT HURTS LIKE A BEAR WHEN THEY DO THAT REALLY TIGHT.
AND THEN IF YOU GET SOMEONE THAT'S NOT TOO GOOD AND THEY LET IT OUT SO SLOW,
YOU'RE GOING, "GOSH! IT'S GOING TO BLOW UP."
SO, IF THEY DON'T KNOW WHAT THEIR BLOOD PRESSURE IS,
WE CAN FIND OUT WITHOUT HAVING TO PUMP IT UP ALL THE WAY.
YOU CAN EITHER FIND THEIR RADIAL PULSE, OR THEIR BRACHIAL PULSE.
GET A GOOD POSITION HERE.
AND WHAT YOU WANT TO DO IS YOU GRAB THE BULB IN YOUR HAND,
AND THE LITTLE DIAL, YOU WANT TO GET A GOOD CONTROL OF IT.
YOU ROLL IT CLOCK-WISE UNTIL IT STOPS.
DON'T SYNCH IT IN REAL HARD,
BECAUSE ONCE YOU GET IT PUMPED TO AS FAR AS YOU NEED IT,
YOU'RE GOING TO RELEASE THE VALVE AND LET THE AIR OUT EVER SO SLOWLY.
AT ABOUT THE RATE OF 2 MILLIMETERS OF MERCURY PER SECOND.
SO THAT YOU CAN BEGIN TO FEEL WHEN THE BLOOD PRESSURE COMES BACK.
ALRIGHT. LET ME REPHRASE WHAT I JUST SAID.
I DIDN'T REALLY GET IT.
I'M GOING TO CLOSE THE DIAL, OKAY.
I'VE GOT A FEEL OF IT. IT'S SNUG, BUT NOT TOO TIGHT.
IT HAS TO BE SEALED OR THE AIR LEAKS.
AND I'M GOING TO PUMP UP -- I HAVE A GOOD FEEL OF HIS PULSE.
AND I'M GOING TO SQUEEZE THIS AND START PUMPING THE DIAL UP.
AND I'M FEELING FOR WHEN THE PULSE GOES AWAY.
AND IT WENT AWAY ACTUALLY RIGHT HERE ABOUT 100.
SO I'M GOING TO PUMP IT UP TO 120 OR 130,
AND THEN I'M GOING TO RELEASE THE VALVE EVER SO SLOWLY
AND FEEL IT COME BACK.
IT ACTUALLY CAME BACK AT ABOUT 116.
AND THEN I CAN LET IT OUT, ALL THE AIR.
SO IT'S NOT SO TRAUMATIC TO HIS ARM.
SO I'M THINKING THAT HIS BLOOD PRESSURE IS GOING TO BE AROUND 120 OVER SOMETHING.
SO I'M GOING TO PUMP IT UP AND LISTEN TO HIS PULSE, AT ABOUT 150.
NOW IT DOESN'T HAVE TO BE, LIKE, 150 EXACTLY.
YOU CAN PUMP IT TO 160 AND IT'S NOT THAT BIG A DEAL.
BUT THE POINT IS YOU'RE NOT GOING TO 200
AND BLOWING HIS ARM UP, OKAY?
SO IF YOU GO TO 140, YOU'RE LIMITING YOURSELF.
YOU WANT -- ESPECIALLY AS A BEGINNER YOU WANT TO GIVE YOURSELF
A GOOD 30 MILLIMETERS TO WORK WITH
BECAUSE SOME OF YOU ARE GOING TO RELEASE THAT VALVE TOO FAST,
AND IT'S GOING TO GO WHOOSH. YOU KNOW.
IT GIVES YOU A LITTLE TIME TO GET IT COMING DOWN TO THE RATE YOU WANT.
NOW HERE'S WHAT I'M AIMING FOR.
I'M GOING TO PUMP UP THIS VALVE NOW.
BY THE WAY AFTER YOU'VE DONE A CHECK LIKE THAT,
YOU HAVE TO WAIT A FULL 60 SECONDS FOR THE ARM TO RECUPERATE.
SO HE NEEDS A REST PERIOD.
YOU'RE GOING TO PUMP THE VALVE UP NOW. I'M GOING TO PUMP IT TO 150-ISH.
AND THEN I'M GOING TO RELEASE -- HERE'S THE NEEDLE ON THE GAUGE, RIGHT?
I'M GOING TO RELEASE IT AND I WANT THE NEEDLE TO GO DOWN LIKE THIS
EVER SO STEADILY AND ABOUT THAT SPEED.
AS IT'S GOING DOWN, YOU'RE GOING TO START LISTENING
FOR WHAT WE CALL KOROTKOFF SOUNDS.
AND IT'S THE BEATING OF THE HEART, THAT FIRST PRESSURE.
IN YOUR BOOK, IT TELLS YOU ABOUT THE FIVE PHASES.
WE'RE GOING TO BE HAPPY TO HAVE TWO.
OKAY. I WANT YOU TO LISTEN TO THESE PARTICULAR TWO.
THE FIRST IS REGULAR BEATING.
THE FIRST TWO CONSECUTIVE BEATS.
BOOM. BOOM. BOOM. BOOM.
AND THEN WHEN IT STOPS, OKAY? LET ME TALK TO YOU A LITTLE BIT ABOUT THAT.
IT GOES ALL THE WAY UP AND YOU HEAR NOTHING AT 150.
YOU START LETTING THE VALVE OUT AND ALL OF A SUDDEN IT GOES PHOOW PHOOW PHOOW PHOOW.
OKAY?
WHEN IT STARTED GOING PHOOW PHOOW PHOOW
THAT WAS YOUR SYSTOLIC. THAT'S THE NUMBER YOU WANT TO READ.
THESE ARE IN INCREMENTS OF TWO.
DON'T TRY TO GET AN ODD NUMBER, IT'S ALWAYS AN EVEN NUMBER WHEN YOU'RE VISUALIZING IT.
AND SO LET'S SAY, IT COMES --
THE BIG SLASHES ARE IN TEN'S AND THE LITTLE ARE IN TWO'S.
SO 114 PHOOW PHOOW PHOOW.
WHEREVER IT GOES SILENT, THAT IS THE DIASTOLIC.
IT'S THE RESTING PULSE OF THE BLOOD PRESSURE.
AND YOU'RE GOING TO PICK UP THE LOWER NUMBER WHICH MAY BE 60, GIVE OR TAKE, OKAY.
SO AS SOON AS THERE'S NO SOUND,
YOU CAN LET IT GO ABOUT 10 MILLIMETERS OF MERCURY DOWN JUST TO BE SURE.
THEN YOU'RE GOING TO RELEASE THAT VALVE AND LET IT DEFLATE ALL THE WAY
SO THAT THAT ARTERY CAN HAVE A BREAK, OKAY. THAT'S WHAT YOU'RE LISTENING FOR.
WHEN YOU GET REALLY A GOOD EAR, YOU'LL BEGIN TO DISTINGUISH THOSE DIFFERENT PHASES.
SOMETIMES YOU HEAR THINGS LIKE THIS.
OKAY? THAT FIRST PHOOW DOESN'T COUNT
BECAUSE IT'S NOT CONSECUTIVE BEATING.
BUT SOMETIMES YOU'LL GET THIS PHOOW.
SOMETIMES YOU CAN DISTINGUISH NO SOUND OR PITCH WHATSOEVER.
IT'S ALL THE SAME PHOOW, PHOOW, PHOOW, PHOOW
DONE. YOU'RE DONE.
THIS IS WHAT ELSE YOU MAY SEE.
THE DIAL'S COMING DOWN AND IT STARTS GOING LIKE THIS.
PHOOW, PHOOW, PHOOW.
WHAT'S THE NUMBER?
THE PHOOW OR THE...?
- THE NOISE. - THE NOISE.
DON'T BUY INTO THIS, BUT I LOVE IT WHEN IT STARTS DOING THAT,
BECAUSE I'M LIKE, "HERE IT COMES, HERE IT COMES, HERE IT COMES."
AND PHOOW, PHOOW, PHOOW.
OKAY. IT'S A SOUND, NOT A SIGHT.
OKAY. THIS IS WHAT I DON'T WANT TO SEE ON YOUR DIAL.
YOU CAN'T GET A GOOD READING THAT FAST.
THIS IS WHAT I DON'T WANT TO SEE ON YOUR DIAL.
RIGHT ABOUT NOW THE STUDENT STARTS GOING...
AND I'M GOING, "COME ON, LET IT DOWN." IT HURTS, OKAY.
SO, KEEP IT MOVING...
STEADY. ALRIGHT.
ALRIGHT, ENOUGH ALREADY. LET'S DO THIS THING.
YOU WON'T BE ABLE TO HEAR A THING, BUT I'M GOING TO SHOW YOU SOMETHING.
I JUST WANT YOU TO SEE HOW I PUMP IT AND HOW I HOLD IT.
NOW, HIS ARM IS ON MY LEG AND SO IT'S REAL EASY FOR ME TO STABILIZE.
MY DIAPHRAGM GOES RIGHT ABOVE MY BRACHIAL ARTERY, NOT UNDER THE CUFF.
AND ALL OF THIS JUNK OVER TO THE SIDE.
I HAVE THE BULB IN MY HAND. I'M GOING TO TWIST IT.
IT'S SNUG, BUT NOT TIGHT.
I'M GOING TO PUMP UP...
TO 150-60 AND THEN RELEASE.
106/76.
AS SOON AS I -- THE 76, IT WAS OUT, OUT.
I LISTENED A LITTLE TO 70. RELEASE IT, LET IT GO.
AND THAT'S THE READING FOR HIM.
THE OTHER WAY I CAN HOLD --
HE'S JUST GOT HEAVY OLD ARMS AND I'M LIKE, "WHOA."
TO HOLD LIKE THIS, IF YOU PUT ON YOUR HIP.
I PUT MY HAND UNDERNEATH HIS ELBOW, POP IT UP.
AND I STABILIZE LIKE THIS.
AND SO HE'S STABLE AND RESTING, BECAUSE YOU DON'T WANT HIS ARM ALL TENSE.
YOU WANT HIM RELAXED. AND SO I CAN JUST POP IT UP HOLD
AND THEN DO IT LIKE THAT IF I DON'T HAVE A PLACE TO PUT MY LEG, OKAY.
ALRIGHT, WE'LL TRY TO --