When it's time to stop relying on equipment and use our senses

No amount of study can teach you some things. Case in point: earlier today I was working with some students to anaesthetise a patient and when I asked her to check the patient's heart rate, the student in charge of checking vital signs raced to place a pulse oximeter. I decided not to say anything, carefully watching the big dog's chest wall rise and fall, and the heart thumping away visibly against the chest wall so that I could easily count the rate. The pulse oximeter placement was a struggle for the student and a minute passed as she attempted to get a consistent reading, trying different locations, and fiddling with the wires. I quickly and silently used my stethoscope to listen to the heart and chest sounds, and digitally compared bilateral femoral pulse rates, then I visually checked mucous membrane colour and digitally assessed capillary refill time to assure myself that cardiac output was normal and that the patient was ok with normal heart rate and respiratory rate and pattern. I watched silently as the student looked quizzically at the monitor. ‘The heart rate is 45,’ she said. ‘Isn't that a bit low?’