ExRx.net

Phirst post! Love the sight and everything that everyone has contributed to it.

My question is for the people who have or is working in a clinical cardiopulmonary rehabilitation center.

I want to know what their policy on the checking of vital signs during exercise. Currently, I am the only physiologist and I work with 2 other nurses. Now, one of them is glued to the telemetry monitor and the other... well, the other is kinda/not really the director and is busy doing other "need to know" things.

I feel as if I am too occupied w/ checking these vitals and I don't spend enough time with the patients. I run 4 classes back-to-back with 12 patients in all of them. I check a pre-, peak, & post- BP/HR for every single one of them and although I feel that that info is important.... its not important when you have had the patient there for over 8 weeks and the numbers are no different than they were the first time when the came in.

Please someone help me out with ballet of vital signs that I currently perform.

I'm just a dumb ass farmer who likes to pick up heavy things. I can't help you.

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Thanks TimD.

I'm just a jungle doctor who likes to pick up heavy things. I don't think you need to get vs that much on pt you've had that long, but what do I know about big-city rehab stuff?

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Our greatest fear should not be of failure, but of succeeding at things in life that don't really matter.--Francis Chan

Maybe one of the trainers can speak to that, but that's an area I really haven't examined in much detail. Nobody here has done cardiopulmonary rehab work as far as I know. Supposing that I was thrown into this situation for some reason. I would probably have everyone wear a heart monitor the whole time, and have an assistant go around and take blood pressure, while I focus on the training. The assistant could note the heart readings at the same time. That seems the logical course of action, with the limited knowledge I have.

I would think that the institution that you're working for would have protocols, and that it wouldn't be optional for you anyway.

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Our greatest fear should not be of failure, but of succeeding at things in life that don't really matter.--Francis Chan

I think Ironman hit it with the electronic monitor. If you don't have modern tools, then manually checking the vitals is important. You may not see a change from one workout to another and it may seem unimportant, but if a cardiac event happens, your checks might pick up on it early and save someone's life. The problem is what happens an hour after the exercise is over. That's when a lot of cardiac events happen. People sometimes die during the exercise, it's just as likely that they will collapse in the locker room. If each individual has their own monitor, they can wear it 24/7 and have an alarm set if something goes out of a safe range. I know if I was in that state, the few bucks a monitor costs would be easy to justify. Health insurance probably would pay for it.

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Let thy food be thy medicine, and thy medicine be thy food.~Hippocrates
Strength is the adaptation that leads to all other adaptations that you really care about - Charles Staley
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Thanks TimD

Actually, I think wearing a monitor during rehab exercise is way over kill. Remember this is rehab, not acute recovery. These are people who have experienced some event, have had some intervention, have probably had post-event stress testing to define their limits, and are in a graded program of exercise. Vital signs are a very crude measure of anything cardiac, and wouldn't be likely to provide any warning anyway. It's probably superfluous to take them in this setting at all.

But surely, there is data in the cardiac rehab literature (which is extensive) to answer this? This just seems like a wheel that shouldn't have to be reinvented by a bunch of exercise fanatics. A person who works in a cardiac rehab program should have access to much more expert advice then us. In fact, he or she shouldn't have to be asking around to anyone about this. It should just be part of the program's protocol. Do they really leave their employees to decide things like this? Would you want to send your father to a cardiac rehab program where the employees didn't know how often to take vital signs, and so go on-line and ask a bunch of non-professionals? And yeah, as far as cardiac rehab goes, I'm pretty much as non-professional as anyone here.

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Our greatest fear should not be of failure, but of succeeding at things in life that don't really matter.--Francis Chan

I'm going to address Jungledoc's post, because it had somewhere close to a content that I was looking for.

A while ago, I was referred to this site by the ACSM website; I looked at the content and thought it to be some good stuff. Granted, I have spent more of my time working than actually reading the forum posts that have been put up because its just mainly dealing with a bunch of gym rat b.s., anyways.... but, I am one myself (don't get offended).

Doc, your post starts out positive and then takes a dive like a Japanese kamikaze fighter pilot. I'm stumped. Why the insecurity?

As you could imagine, these are older people who have had anywhere from a stent placement to a heart replacement (and every where in between). Upon investigation of the ACSM guidelines of cardiac rehabilitation specifically about checking BPs... there is nothing concrete about it. So, this is where I reached out to (I was hoping) some professionals in the field of clinical physiology, to help me with a conundrum that I was experiencing. If there were a concrete answer, I wouldn't have thought to come to AN INTERNET FORUM to ask for help.

The protocol is specific about wearing telemetry monitors ----> We follow that. There is even protocols about when to check the patients during exercise ---> I follow that also.

Do they really leave their employees to decide things like this?

Yes, why wouldn't they? Have you ever worked in a hospital? Do you even know how one of these departments are run? Can I educate you on how, specifically, mine runs? At the top is the CEO of the hospital (Not a doctor... a MBA.) He wouldn't help me here with this decision. Next a department chair over the whole cardiopulmonary and neurological department. Again, a MBA. Again... no help. Next, wait for it... wait... the MEDICAL director. The leading cardiologist. Hey Vitruvian.... Why don't you ask him for advise? I have. He has told me what is a good time to check and not check. But, the nurse that is in charge of the Cardiac Rehab thinks just because he tells me when and when not to... that he is too busy running his practice and we need to find out what other practices are doing with their program.


Would you want to send your father to a cardiac rehab program where the employees didn't know how often to take vital signs, and so go on-line and ask a bunch of non-professionals?

Don't chastise me troll. Seriously? Are you really serious? Why the negativity? Again, reassess yourself. There is no need for this "cuntiness". Because that is exactly what you are being right now. Do you even know what the third leading cause of death? Its medical malpractice only behind heart disease and cancer. That's doctors making wrong decisions about your health. You know what? Doctors ask other doctors for recommendations all the time. And to think that I was naive enough to think that we are all in this TOGETHER. One another helping each other. So, next time you have the audacity to question me and how I practice at my job.... re-evalutate yourself first. It was apparent by your previous post that you had nothing to contribute to this topic to begin with. And since you displayed this at the beginning, there was no reason to interject with your ignorant OPINION.

There's a lesson in how to win friends and influence people.

We're all just trying to help each other and share experiences. Jungledoc gets sensitive when people ask for medical advice here since this is not the appropriate way to get it. You should have medical over-watch and that should be your primary source. if your dept is dysfunctional, that's another story. We can all sympathize with you, but that still doesn't make this the right place to get second opinions.

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Let thy food be thy medicine, and thy medicine be thy food.~Hippocrates
Strength is the adaptation that leads to all other adaptations that you really care about - Charles Staley
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Thanks TimD

VitruvianMan, I can reply to your post with an excerpt from said post.

There is no need for this "cuntiness".

Let me put things differently. Someone who works at a civil engineering firm logs on to a site for construction workers and asks what type of beam should be used for the 4th floor of a new high-rise. One of the construction grunts answers, "well, we really don't know--this is something that you should either already know, or have someone better than us to ask. Would you knowingly go into a building designed by engineers who had to ask construction grunts about I-beam." And then the OP gets crude.

Audacity to question YOU? Hahaha! YOU are the one who came here asking your question. You are the one who essentially said that you had no idea about this; I merely pointed out that you either should, or should have someone better than a bunch of gym rats to ask. Now you acknowledge that you have a policy from your medical director, but that you and the other staff just don't like his opinion. "The medical director of the cardiac rehab program says this, but we'd better ask the gym rats just to be sure."

So yeah, I'll chastise you. I've re-evaluated myself, and I still think that you should either know the answer to your question, or have a better source than a bunch of gym rats. I also think that you are rude, crude and not all that bright.

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Our greatest fear should not be of failure, but of succeeding at things in life that don't really matter.--Francis Chan

gotta love the internet. Some guy comes on asking how to do his job then gets all bent out of shape when people say he should already know.

I surely agree with your general sentiment, but I think you are a little too harsh on the guy. The thread started with him saying:My take on it is that we have a case of someone who wants to get some more knowledge by asking people who might have experience in this area, not necessarily to implement it as is but maybe as a starting point for the medical stuff to consider as an alternative to a procedure he has some reservations about. In a forum where advice about medical issues is given without knowing the patient (e.g. "you don't need statins...", "don't worry about eating saturated fat", "aerobic exercise is a waste of time" etc.), I guess the underlying assumption is that the given opinion should serve as a starting point for more research, probably consulting with the other person's physician, rather than an operating instruction.

+1

Unneccesary flaggelating - clogging up the Internet since 1995.

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You'll never walk alone, safe in the wide open arms of hell.