Does anyone else ..

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EMTJosh9

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Ok ......... This is going to sound like i'm a total idiot but ... Does anyone else have trouble taking BP's on very large individuals ? ... They always scream when i'm pumping it up ...
 
Can be more difficult trying to hear something through a bunch of fat. Throw them on the monitor if you have one available. Or tell them to be quite.
 
The patient is as nervous as you are.
Proper sized cuff.
Don't inflate to 300mm.
Always warn the person of the pressure on their arm.
Elevate the arm slightly and straighten it out if you can, this will bring the vasculature closer to the surface.
The brachial artery is biased towards the medial side of the arm until it branches, adjust your stethoscope placement slightly towards the body.

If they're SCREAMING, just stop. It's not worth it.
 
Worst case you can grab a BP on their forearm. It wont be as accurate but it will give you something to work with
 
I have had issues and grabbing the leg cuff (adult XL) has helped.
As stated earlier BP by palp works as well.
- Just my opinion and what I say should never reflect on the companies I work for..
 
If people (obese or not) are screaming when you take their BP, you are doing it wrong.

Have someone teach you the right way to take a BP.
 
I'll have to look it up again but I read a study that taking a BO in a forearm of an obese patient is typically more accurate due to the poor fit on the micro. A little Google-fu may lead you to the study as well
 
Also if you are having a hard time you can do it bi-palp. Find their radial pulse and pump cuff up until it disappears, release the air and once you feel the pulse again that is your systolic. Gives you an idea, but not something to get in a habit of.

X2 what REMI said
 
Remi said:
If people (obese or not) are screaming when you take their BP, you are doing it wrong.

Have someone teach you the right way to take a BP.
Click to expand...
Umm, what he said.
You don't need to inflate the cuff above 180-200 for most patients. If they scream, you're hurting them. For a less than necessary diagnostic tool. They don't want you to take a BP, then don't take a BP until you can do it right. Ask a partner, ask an FTO, as your EMT instructor. And make sure you're using the right size cuff.
Are they awake, making sense when they talk to you, good color? What are you going to with a BP then? It's always frustrating when we show up with fire and they want to delay me getting my patient to the truck so they can get a BP. It's not going to tell you anything you couldn't deduce by other means...
 
Take one by palp ( forearm, radially for very obese). If they are screaming in pain, your either not using a proper size cuff, or inflating the cuff way to much.


I am also familiar with people screaming and throwing a fit when I put the BP cuff on and it's literally so under inflated I could slide it off their arm. In that case I document that patient was non-compliant with obtaining a blood pressure and I put EXACTLY how much the cuff was inflated, and how lose it was.

Similarly, I had a young patient, with a known pill (opiate) problem with no noticeable injuries, no elevated vitals, in a clear voice tell me they were in a 10/10 pain. They proceeded to freak out when I applied the tourniquet to attempt to get IV access. This tourniquet was not that tight ( no skin bunching, etc) They REQUESTED I give nebulizer fentanyl. It didn't happen. If you KNOW someone is just completly full of it ( like if the cuff is so loose it's slipping down their arm) be professional, but be stern. I can be a fun, easy going medic. But If I know a patient is being a pain just for the sake of being whiny and making my life more difficult, i don't do them any favors and I am very stern. Always professional, though.
 
Wow holy auto correct typos.. lol was a bit tired bouncing on bart when I wrote that last post. Still need to find the study. I'll look this evening
 
gotshirtz001 said:
Most people here likely won't know what BART is... Awkward.
Click to expand...

When I moved to the San Francisco area, suffice it to say my long-distance friends/family were perplexed when I told them I would be "riding BART."

Better still, why ride when you can bounce?
 
I don't feel like location of the sphygmanometer and size of the patient should significantly affect the accuracy if you are using the correct size and the bladder is centered over the artery. Even on obese individuals, the antecubital isn't that fatty. I suspect you are having difficulty hearing the korotkoff sounds because you are not placing the bell at the antecubital. I see a lot of people putting the bell superior to it and frequently partially under the cuff too. I imagine this would make it harder to hear (especially on bigger people). You can use the forearm alternatively. The cuff will work the same way by exerting pressure against the (radial) artery creating turbulant blood flow so you can note at what pressure this begins and ends at.

A lot of people use the diaphragm of the stethoscope. Last I checked, the AHA recommended that the bell. People mistakenly believe this is for pediatrics only because of the size. On some scopes, such as Littmans, it doesn't matter which side you use. In my experience, it doesn't sound any different whether you use the bell or diaphragm, but some people have told me it does make a difference for them.

Are you also doing a palpated blood pressure to determine appproximately what their systolic is? I usually take a palpated blood pressure inflating the cuff, increase about 20 mm Hg above that, and then listen while I deflate. You can listen and palpate as you inflate too. This should ensure that you are not pumping it too high.

Communicate with your patient that you will be taking their blood pressure and there may be some discomfort. It should not be so uncomfortable to the point that they are screaming.
 
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