Is Your Patient Stable?

[Dustdevil]

One need only spend a day listening to patient reports on the radio to realise that "stable" has become a pointlessly overused, meaningless and misunderstood term in EMS practice. Every patient report you hear that doesn't have sirens screaming in the background claims that the patient is "stable". Many of those with sirens screaming will still claim that the patient's "vital signs are stable". The ironic thing is, when you review the charts of these runs, you usually only see one set of vital signs.

So tell me; if you have only taken one set of vital signs, how can you have the slightest clue as to whether or not they are stable? :roll:

Do you often use this term in your patient reports? If so, what exactly does it mean? And, if asked to demonstrate from only that information you have charted, have you charted enough information to clearly show that your patient (and/or his/her vital signs) are "stable"?

[JakeEMTP]

Depending on transport time, I always have a minimum of 2 sets of vital signs. I thought the current EMT curriculum states " V/S should be taken every 15 min for stable pt.'s and every 5 min for unstable", or a reasonable facsimile thereof. Of course, if I feel I need to monitor the pt. more often, I will. That does not mean staring at the monitor looking for changes in SPO2 numbers. Actually palpating a pulse, taking a manual BP, auscultating lung sounds etc.

As you are aware, I'm new at this. However, my partner is a preceptor and we had a student with us Sunday. Once we had the pt. in the ambulance, the student immediately started hooking the pt. to the monitor. My partner handed her a stethoscope (since she did have her own :roll:) and a BP cuff. "That is how we take a BP, the monitor is for monitoring" she said.

I guess students aren't being taught correctly or, seasoned medics are just lazy. I dunno. But seriously, how hard is it to reach over and press the NIBP button? :?

[sirduke]

I've seen too many cases where the patient's vitals are taken on scene, they are loaded up, and then the EMT, I or P, sits his/her ass in the captains chair and starts report, and never looks at the patient again until they arrive at the hospital.

I prefer the constant monitoring mode myself, palpating the pulse, watching the chest rise, talking to them to gauge their mental state, etc. I don't like or trust the automated cuff as it will give inaccurate readings especially in transit. The old fashioned way works better for me, and if you have old ass ears like mine, and can't hear good bouncing down the road, palpate a B/P.

At least two or three sets of vitals to see any trends, and by taking up time with the patient, you make them feel comfortable, or at least that you are concerned for their wellbeing.

After all, isn't that the reason we are in the back of the truck anyway, the Patient?

As for "stable" well, I've seen several "stable" patients that crashed and died while being described as "stable".

Just one man's opinion.

[JakeEMTP]

After all, isn't that the reason we are in the back of the truck anyway, the Patient?

Exactly. If you (not you sirduke, generic you) don't want to provide pt. care, please leave my profession. We don't need your ilk.

As for "stable" well, I've seen several "stable" patients that crashed and died while being described as "stable".

You are not alone my friend.

[JPINFV]

I used the term when I first started in lieu of "no real changes to V/S," but quickly left it behind for simply saying "no change" (common narrative entry: pt transported in position of comfort. v/s monitored c no (circle with line through it) change (triangle symbol, both on the list of acceptable symbols). By the time I left my old company I was barely using the term "stable" or "unstable"

[Snafu3532]

I think many people mistakenly use the term "stable" for "within normal limits". If a patient has a constant heart rate of zero and it never changes, is this "stable"?

[Dustdevil]

I think many people mistakenly use the term "stable" for "within normal limits".

I agree. That does seem to be what they really mean. And it is a combination of people not being verbally literate enough to understand the significance of what they are saying, as well as a lot of "monkey see - monkey do", imitating what they heard the other monkeys say in their patient reports. Both are really bad signs for our profession.

[defib_wizard]

This reminds me of what my paramedic instructor used to say. "Asystole is the only stable heart rhythm the pt has, their condition cannot worsen! All others have potential to change!"

[Don1977]

My EMT instructor always told us that the word "stable" means nothing he would ask "what is stable?"

[tskstorm]

Isn't a stable something you store horses in?!

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