Session 1: Vitals
Welcome to Mini Med School. Over the next two days you will do the real work of a medical team: read vital signs, close a wound, run instruments through a keyhole, and make the hardest call in medicine.
It starts with one patient. His name is Marco Torres, and everything you learn today feeds the Final Case tomorrow. No experience needed. The tools are the same ones used in every ER in the country.
Everything you measure goes on your 📋 Patient Chart, the packet in front of you. Doctors write everything down. So do you.
Clinicians work with sharp tools and real people every day. A few good habits keep everyone comfortable and safe:
- Handle sharps with care. When you finish with a lancet or needle, drop it in the sharps container so it stays out of everyone's way.
- Go easy with the penlight. A quick 1 to 2 seconds in the eye is all you need.
- The reflex hammer taps the tendon, just below the kneecap, not the kneecap itself.
- Blood stays in the training arm. The venipuncture station uses a simulated arm with fake blood, and your facilitator works it right alongside you.
- Treat your partner like a patient. Quiet voice, gentle hands, and tell them what you are about to do before you do it.
You are Marco's medical team. Before you touch a single instrument, you need to know his story.
Why he's here: dizzy for 3 days, chest tightness when he climbs stairs, tingling in his left arm.
History: smokes half a pack a day, long hours in a high-stress job, his father had a heart attack at 52, and his doctor recently flagged elevated blood sugar.
Talk it out in your group and record answers on your 📋 Patient Chart (Vitals page):
- What concerns you most about Marco, and why?
- If you were the ER team, what would you check first?
- What does his family history tell you?
Vital signs are the first language of a clinician. A handful of numbers tell you in sixty seconds whether a patient is stable or crashing. You will run each skill on your partner, then read the results like a doctor.
- 1 automatic BP cuff and 1 manual cuff + stethoscope
- 1 fingertip pulse oximeter
- 1 penlight, 1 reflex hammer, 1 pupil gauge card
- Alcohol wipes
- 📋 Patient Chart, Vitals page
High blood pressure could explain Marco's dizziness and chest tightness, and it is the number-one risk factor for a heart attack. There are two ways to measure it. The manual cuff: you pump it up and listen through a stethoscope. The automatic cuff: you press start and it reads for you. Learn both, then pick one you trust.
Tool 1, manual cuff and stethoscope:
Tool 2, automatic cuff:
- Resting BP. Wrap the cuff snugly on your partner's bare upper arm, just above the elbow. Sit still and quiet. Take a reading with each tool. Record both. How close did they agree? Within 5 mmHg is excellent. More than 10 apart, re-check your technique.
- Stress BP. Do 2 minutes of jumping jacks, then measure again right away.
- Recovery BP. Wait 3 minutes, measure once more. Coming back near resting quickly is a sign of a fit heart. Switch roles and repeat.
| Category | Systolic (top number) | Diastolic (bottom number) |
|---|---|---|
| ✅ Normal | Below 120 | and below 80 |
| Elevated | 120 to 129 | and below 80 |
| Stage 1 High | 130 to 139 | or 80 to 89 |
| Stage 2 High | 140 or higher | or 90 or higher |
| 🚨 Crisis, call 911 | 180 or higher | and/or 120 or higher |
If either number lands in a higher band, that is the patient's category. Use this chart when you read Marco's numbers in Phase 4.
Low oxygen can cause dizziness. This checks whether Marco's blood is carrying enough oxygen to his brain.
Clip the sensor on your index finger. Wait about 10 seconds for a stable number. Record your SpO₂ (oxygen %) and pulse (heart rate). Try a different finger. Does it change?
Keep the sensor on. Write down your resting numbers. Now take 5 to 10 slow, deep breaths and read again. Did your oxygen move? Did your pulse? Most healthy people already sit near 100%, so the oxygen barely climbs, but watch what your heart rate does as you slow down and relax. Record before and after.
Now switch and measure your partner too. You are charting both of you today, and Marco later.
Normal: SpO₂ 95 to 100% (below 95% is low). Pulse 60 to 100 BPM at rest (above 100 means the heart is working hard).
Marco's chest tightness could be his heart or his lungs. The stethoscope lets you listen to both.
- Heart. Clean the earpieces with an alcohol wipe. Insert them angled forward, toward your nose. Place the flat side on the upper-left chest. Listen for LUB-DUB.
- Lungs. Listen at the front (both sides), then the back (both sides). You should hear quiet, even breathing. Note what you hear at each spot. Switch and repeat.
Tingling and dizziness can mean the brain and nerves are not communicating properly. PERRLA means Pupils Equal, Round, Reactive to Light, Accommodation.
Pupil exam:
- Size. In normal room light, are both pupils the same size? Use the gauge card. Normal is 2 to 4 mm. Record both eyes.
- Light. Dim the lights. Shine the penlight into one eye from the side and watch both pupils shrink together (the consensual response). Repeat on the other eye.
- Accommodation. Hold a finger 30 cm from your partner's face. Have them look at your finger, then a distant object. Both pupils should change together.
Patellar reflex:
Partner sits with legs hanging free. Tap gently just below the kneecap. Watch for the knee jerk. Test both knees. Do they match? Grade each: 0 absent, 1+ weak, 2+ normal, 3+ brisk, 4+ hyperactive.
Your patellar reflex fires in about 50 milliseconds, faster than a blink. The signal never reaches your brain; it loops through the spinal cord and back. That is why reflex testing is one of the fastest ways to check spinal cord integrity.
Marco's doctor flagged elevated blood sugar. A glucose meter reads blood sugar from a tiny finger prick. This station is optional and always supervised. If your program is not doing finger pricks, your facilitator demonstrates it and you record the sample value shown.
Glucose ranges (fasting): Normal 70 to 99, Prediabetic 100 to 125, Diabetic 126 or higher, Low (hypoglycemia) below 70 mg/dL.
When bloodwork is ordered, a phlebotomist draws from a vein. There is one training arm for the whole room, and groups rotate through it with your facilitator. The arm has artificial veins filled with simulated blood. No needle ever touches a person.
Feel for the vein, a soft, bouncy tube in the inner elbow. Tourniquet above the site. Wipe with alcohol. Insert at a 15 to 30 degree angle, bevel up. Your facilitator guides each step.
Raw numbers don't help a patient. You have to figure out what they mean by comparing them to normal ranges. Your 📋 Patient Chart has a comparison table, one row per vital sign, with a column for your reading, the normal range, and whether it lands inside or outside.
Work through it as a group:
- Which of your readings landed outside the normal range?
- What could cause an abnormal reading like that?
- Look at your BP before and after the jumping jacks. What happened, and what does a fast recovery tell you about the heart?
You practiced on each other. Now here are the actual numbers from Marco's ER visit. See if your instincts were right.
- Blood pressure: 158/94 (normal below 120/80)
- Heart rate: 92 BPM (normal 60 to 100)
- SpO₂: 96% (normal 95 to 100%)
- Fasting glucose: 118 mg/dL (normal 70 to 99, prediabetic 100 to 125)
- Pupils: equal and reactive
- Reflexes: normal, both sides
Your team's preliminary assessment (on your 📋 Patient Chart):
- Compare Marco's BP to the chart in Station A. What category is he in?
- Which of his vitals worry you most, and why?
- Pull it all together: his symptoms, his history, his smoking, and these numbers. What do you think is going on with Marco, and what should happen next?
Keep this chart. Marco's case is not over. His vitals come back tomorrow when you scrub in for his surgery, and again in the Final Case.
Scan the code with your phone camera, or use the board below. As a team, post your one-line call on Marco:
- What BP category is he in?
- What is the one thing you would do next?
Quick reflection, on your chart:
- What surprised you most today?
- Which skill was hardest, and what made it difficult?
- If you were Marco, what would you want your medical team to do next?
Every skill you used today is somebody's job, and a lot of those jobs start right here in the Des Moines area. Here is a paramedic's shift to set the scene:
Scroll through the cards below together as a class. Then, with your partner:
- Pick the two that surprise you or that you would want to learn more about.
- Talk it out: why those two? Which one could you start the fastest? What is one step you could take while you are still in high school?
- Share back: tell the class one career and one thing about it that surprised you.
Today's tie: reads vital signs on the worst day of someone's life.
Iowa first step: DMACC EMT course, then Paramedic. Ride with a local ambulance, or fly with UnityPoint LifeFlight or MercyOne Air Med.
Pay, roughly: EMT $40K, Paramedic $55K and up.
Today's tie: the pulse oximeter is their whole world. They keep people breathing.
Iowa first step: DMACC Respiratory Therapy degree. Works ICUs and ERs, running ventilators.
Pay, roughly: $65K.
Today's tie: takes vitals every single shift and is usually the first to catch trouble.
Iowa first step: DMACC Nursing degree, then add a BSN later if you want to specialize.
Pay, roughly: $65K to $80K.
Today's tie: the venipuncture arm you tried. They draw the blood that every diagnosis depends on.
Iowa first step: DMACC phlebotomy certificate in about 4 to 5 weeks. Many use it as a stepping stone into nursing.
Pay, roughly: $38K to $45K.
Today's tie: the first person you meet at any hospital. They register patients and guard the records.
Iowa first step: DMACC Patient Access certificate. Proof that healthcare has a door for every kind of person.
Pay, roughly: $37K to $45K.
Today's tie: pulls every number together, names the diagnosis, and decides Marco's plan.
Iowa first step: a bachelor's, then Des Moines University in West Des Moines: a doctor (DO) or a 26-month PA. DMU is the nation's top producer of primary-care doctors.
Pay, roughly: PA $115K, Physician $200K and up.