"Other" vital signs

[rocket]

Hi all,

I recently found this little snippet on an emergency medicine PA message board. It was part of a set of "golden rules" presented by an ER PA:

19. SpO2 and FSBSs ARE vital signs

(The original thread is on a forum that is for "members only" of that mesage board. Let me know if you want me to copy/paste the original list of golden rules here to save the effort of signing up on yet another board just to view one topic)

SpO2 and Finger Stick BGL are two things that even EMT-Bs can do in many states. I've heard the good and bad about their use/misuse/overuse/underuse by EMS folks here and in other areas too. What are your thoughts on these two? do you agree with the PA author and consider them to be "vital signs"?

-Trevor

[Eydawn]

Yes, they are "vital signs"... but so is an rbc count, if you want to think about it hard enough. The more pertinent one is a bgl. That shows you something definite- this person has too little, just enough, or way too much sugar. That, in the case of too little, you can do something about.

Problem with SPO[sub:b5518071f0]2[/sub:b5518071f0]'s is they are subject to error (think carbon monoxide poisoning) and too many techs will try to treat the machine and not the patient. Is it a good number to have if you know the context and how to interpret it correctly? Yup. Some folks aren't real familiar with it though.

Wendy

NREMT-B

CO EMT-B

MI EMT-B

[JPINFV]

SpO2 can give you a hint on if the patient is hypoxic, but there are other factors that would give you a "false" (ex. CO, cyanide, low H&H) reading or chief complaints where the SpO2 is irrelevant for treatment (ex major trauma, chest pain, etc). EMT-Bs aren't educated enough to understand what that number means and when to ignore it.

[Ridryder 911]

I totally disagree, with the key word "vital".. are knowing Spo2 and FSBS on all patients vital.... we better add EtCo2 (to me ventilation is just as important). If the patient is not diabetic, and does not have symptoms of such.. should we checking each patient? No!

This would be like performing an EKG on a stubbed toe..

One could argue, what about finding out they were hypo or hyper...again, if we hooked up monitors on everyone, look at all the arrhythmia's we could find.

They missed a real vital sign.. and one that is important.... temperature.

Be sfe,

R/r 911

[09E]

Our management insists on regular anal probing................ :ky: :bootyshake:

[Spock]

I am currently a co-editor of a textbook and wrote the chapter on assessment and vital signs. I included pulse rate, respiratory rate, BP, SPO2, temperature, and pain scale rating. I chose these because limited technology is required and the text is for entry level professionals. For advanced professionals with the necessary technology I would add ETCO2. Frankly, if you are advanced level and able to intubate you should have and use waveform capnography. No ETCO2 means no intubation.

Live long and prosper.

Spock

[AZCEP]

Geez, with all of the education, I figured someone would include Level of Consciousness.

All the numbers in the world don't do you any good if you don't know what an individual patient looks like normally. SpO2 and BGL are great for documentation, but if you are unable to assess how the patient is "abnormal" the gathered information is going to be lost on you.

We have all seen this situation. Blood pressure is down because of too large a cuff being used. Altered heart rates because of psychogenic reasons. Increased respiratory rates for the same. "Normal" blood glucose levels and the patient looks hypoglycemic. Low SpO2 because the extremity is cold or the ambulance is bouncing down the road.

If your assessment determines that something is wrong, then the numbers should back this up. If not, wait a few minutes, and they will.