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 --