Vitals and Venipuncture
Today you do the real work of a medical team: read a patient's vital signs, draw blood on a training arm, and decide what's going on. It starts with one patient — Marco Torres. Everything you measure goes on your Patient Chart. Doctors write everything down. So do you.
Clinicians work with sharp tools and real people every day. A few habits keep everyone safe:
- Handle sharps with care. When you finish with a needle, it goes straight in the sharps container.
- 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 arms use simulated blood, and a facilitator works them alongside you.
- Treat your partner like a patient. Quiet voice, gentle hands, and tell them what you're 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.
- 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. Run each skill on your partner, then read the results like a doctor.
High blood pressure could explain Marco's dizziness and chest tightness — it's the number-one risk factor for a heart attack. The manual cuff: pump it up and listen through a stethoscope. The automatic cuff: press start and it reads for you. Learn both.
- Resting BP. Cuff snug on the bare upper arm, just above the elbow. Sit still and quiet. Read with each tool and record both. Within 5 mmHg is excellent; more than 10 apart, re-check 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) | Diastolic (bottom) |
| ✅ 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 |
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?
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, then switch.
Tingling and dizziness can mean the brain and nerves aren't communicating properly. PERRLA means Pupils Equal, Round, Reactive to Light, Accommodation.
- 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. 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.
Partner sits with legs hanging free. Tap gently just below the kneecap and 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's why reflex testing is one of the fastest ways to check spinal cord integrity.
When bloodwork is ordered, a phlebotomist draws from a vein. There are two training arms, and groups rotate through them with a facilitator. The arms have 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: your reading, the normal range, and whether it lands inside or outside.
- 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. 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%)
- Pupils: equal and reactive
- Reflexes: normal, both sides
- 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 together — his symptoms, history, smoking, and these numbers. What do you think is going on with Marco, and what should happen next?
- 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?
🔎 Career exploration, at your table. Every skill you used today is somebody's job. Here's a paramedic's shift to set the scene:
- Pick the two that surprise you or that you'd want to learn more about.
- Talk it out: why those two? Which could you start fastest? What's one step you could take while you're 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.
First step: a California community college EMT course, then Paramedic. Pay: EMT ~$45K, Paramedic $60K+.
Today's tie: the pulse oximeter is their whole world. They keep people breathing.
First step: a California community college Respiratory Therapy degree. Pay: ~$90K in CA.
Today's tie: takes vitals every single shift and is usually the first to catch trouble.
First step: a community college or CSU nursing program, add a BSN to specialize. Pay: ~$100K–$130K in CA.
Today's tie: the venipuncture arm you tried. They draw the blood every diagnosis depends on.
First step: a California phlebotomy certificate (a few weeks) — a common stepping stone into nursing. Pay: ~$45K–$55K.
Today's tie: the first person you meet at any hospital. They register patients and guard the records.
First step: a Patient Access / medical front-office certificate. Healthcare has a door for every kind of person. Pay: ~$40K–$50K.
Today's tie: pulls every number together, names the diagnosis, and decides Marco's plan.
First step: a bachelor's, then a PA program or medical school (like a UC medical school). Pay: PA ~$120K, Physician $200K+.
You read a patient like a clinician and drew blood like a pro. You've got the hands and the eyes for this — go far with them.