# Trick to hear BP Better in the Moving Rig???



## EMSslick536 (Mar 20, 2011)

Hey Guys,

Was told by an RN and a few of my buddies a way to hear BP's more loudly for all of that annoying background noise in the rig.

1.) Assess the BP, if heard correctly the following steps are not needed. If not heard, or heard incorrectly, continue with the following steps.

2.) Ask the pt. to clench his/her fists in a ball and then retract them again (aprox. 3 - 4 times)

3.) Reposition the BP cuff.

4.) Assess BP again, you will hear the pulse a lot louder.

Just a little tip for all of the frustrated crew that can't hear BP's with background noise very well...


----------



## HotelCo (Mar 20, 2011)

EMSslick536 said:


> Hey Guys,
> 
> Was told by an RN and a few of my buddies a way to hear BP's more loudly for all of that annoying background noise in the rig.
> 
> ...



How are you going to know if you hear it "incorrectly"? 

Side note: Once had a partner tell me the pt's BP was 64/93. I asked if he mean 93/64, and he was convinced that not only could he hear the bottom number first, but that he could read between the lines on the BP cuff.


----------



## EMSslick536 (Mar 20, 2011)

HotelCo said:


> How are you going to know if you hear it "incorrectly"?



I'd guess by not hearing it or it being very faint.


----------



## EMSslick536 (Mar 20, 2011)

HotelCo said:


> How are you going to know if you hear it "incorrectly"?
> 
> Side note: Once had a partner tell me the pt's BP was 64/93. I asked if he mean 93/64, and he was convinced that not only could he hear the bottom number first, but that he could read between the lines on the BP cuff.



Haha, yea that's what they told us at CFR class.. If you get a odd number reading.. you probably need more help than the pt. sitting in front of you. haha


----------



## 18G (Mar 20, 2011)

I get the concept of the fist pumping but highly doubt that would make much difference. The best method is practice. The more blood pressures you take the more you will be able to pick out the sounds in amidst the mix of other ambient noises. 

And sometimes you just can't hear it in the ambulance. I personally love NiBP


----------



## usalsfyre (Mar 20, 2011)

Ultrascope. I got mine a month ago and I think I'm in love :wub:.


----------



## TransportJockey (Mar 20, 2011)

Glad to see more people drinking the koolaid  I can't wait to get mine back from Ultrascope





usalsfyre said:


> Ultrascope. I got mine a month ago and I think I'm in love :wub:.


----------



## 94H (Mar 20, 2011)

Palp?

Especially in BLS if the systolic number is in a normal range it should be fine


----------



## exodus (Mar 20, 2011)

94H said:


> Palp?
> 
> Especially in BLS if the systolic number is in a normal range it should be fine



Erhm, no...

But the BP cuff on as normal, palp the brachail, search for it until you feel it, and put the center of your Steth bell there it will be loud every time.  Also, make sure your steth is tight enough. Very little outside noise should come through.

This is assuming the BP is decent as far as palping it to find the artery, otherwise just guess by looking at anatomy...


----------



## HotelCo (Mar 20, 2011)

exodus said:


> Erhm, no...



You beat me to it!


----------



## Wyoming Medic (Mar 20, 2011)

Just remember that taking a BP (or hearing anything through a stethoscope) is like listening through a drum.  Excess skin/fat or anything that prevents a flat and solid physical connection with the stethoscope will hamper the sound conduction.

Remember the 2 soup cans and string phones we made as kids.  If the line was REALLY tight, you could kind of hear each other.  But if it was sloppy and saggy, then no sound conduction.

The other trick that helped me in a rig was where my knees were.  If I was kneeling beside the gurney, my knees would be on the floor and I would get more ground vibrations which would make it harder.  My bony knees conducted vibrations throughout my skeletal system.

WM


----------



## exodus (Mar 20, 2011)

Wyoming Medic said:


> Just remember that taking a BP (or hearing anything through a stethoscope) is like listening through a drum.  Excess skin/fat or anything that prevents a flat and solid physical connection with the stethoscope will hamper the sound conduction.
> 
> Remember the 2 soup cans and string phones we made as kids.  If the line was REALLY tight, you could kind of hear each other.  But if it was sloppy and saggy, then no sound conduction.
> 
> ...



Another one, put the balls of your feet on the gurney foot rail, and lift your heels off the floor, and keep the tubes of the steth from touching anything. All reduces vibration.

Honestly.... To me, taking a pulse is much harder XD


----------



## bigbaldguy (Mar 20, 2011)

I'm still a little confused by the no odd number thing. It seems to me our job is to be as accurate as possible when taking vitals but I've been told by "old hands" that we never report a odd reading, but if the needle is sitting right between two numbers when you hear it then why would you round up or down, why wouldn't you put down the actual number it was at?


----------



## HotelCo (Mar 20, 2011)

bigbaldguy said:


> I'm still a little confused by the no odd number thing. It seems to me our job is to be as accurate as possible when taking vitals but I've been told by "old hands" that we never report a odd reading, but if the needle is sitting right between two numbers when you hear it then why would you round up or down, why wouldn't you put down the actual number it was at?









You can tell when the needle is exactly in the middle of the lines when doing a blood pressure?


----------



## exodus (Mar 20, 2011)

HotelCo said:


> http://184.72.239.143/mu/aefcfb8f-285e-3a08.jpg
> 
> You can tell when the needle is exactly in the middle of the lines when doing a blood pressure?



Almost time for a new sphyg, or to re-calib


----------



## 18G (Mar 20, 2011)

It's way too difficult to see in a bouncy ambulance when the needle is between two narrow lines which is why its always an even number reading unless using NiBP (automatic BP).


----------



## usalsfyre (Mar 20, 2011)

HotelCo said:


> How are you going to know if you hear it "incorrectly"?
> 
> Side note: Once had a partner tell me the pt's BP was 64/93. I asked if he mean 93/64, and he was convinced that not only could he hear the bottom number first, but that he could read between the lines on the BP cuff.





EMSslick536 said:


> Haha, yea that's what they told us at CFR class.. If you get a odd number reading.. you probably need more help than the pt. sitting in front of you. haha





94H said:


> Palp?
> 
> Especially in BLS if the systolic number is in a normal range it should be fine





18G said:


> It's way too difficult to see in a bouncy ambulance when the needle is between two narrow lines which is why its always an even number reading unless using NiBP (automatic BP).


This kinda stuff is also why I laugh when people start ranting about how bad NIBP is. The honest fact is I trust NIBP FAR, FAR more than a lot of partners I've had. The insistence that "my ears are better than a machine" when said parties ears have been assaulted by sirens and diesel engines for years makes me smile....


----------



## usalsfyre (Mar 20, 2011)

HotelCo said:


> You can tell when the needle is exactly in the middle of the lines when doing a blood pressure?



How easy is it to read a very accurate B/P period? The only pressure you should trust to be completely accurate is off of a properly transduced a-line with a good waveform. Everything else is really some level of guess.


----------



## HotelCo (Mar 20, 2011)

usalsfyre said:


> How easy is it to read a very accurate B/P period? The only pressure you should trust to be completely accurate is off of a properly transduced a-line with a good waveform. Everything else is really some level of guess.



No argument here...


----------



## clibb (Mar 20, 2011)

You were told by an RN?

-Position the patients arm with palm up
-Straighten the arm
-Put forearm on your knee. Don't touch cot with your knee or you'll still hear background noise.

If you can't hear BP then palp.


----------



## Jim_NJEMT (Mar 20, 2011)

Get a scope that works for you. I switched from a Littman Classic II S.E. to a Littman Master Classic II, reported by Littman to be better acoustically, and it was like day and night. I was amazed!


----------



## rwik123 (Mar 20, 2011)

Get an ultrascope. Do it


----------



## Icenine (Mar 21, 2011)

clibb said:


> You were told by an RN?
> 
> -Position the patients arm with palm up
> -Straighten the arm
> ...



That and a good set of ears and you'll have no issues.


----------



## spike91 (Mar 21, 2011)

If I'm having a hard time hearing a BP, I'll usually take a palp to confirm at least my systolic so that I know if I'm on the right track or not. Otherwise throw some money at a nice scope? Not practical for everyone, but worth a shot.


----------



## exodus (Mar 21, 2011)

rwik123 said:


> Get an ultrascope. Do it


I just ordered mine on saturday  




spike91 said:


> If I'm having a hard time hearing a BP, I'll usually take a palp to confirm at least my systolic so that I know if I'm on the right track or not. Otherwise throw some money at a nice scope? Not practical for everyone, but worth a shot.



You shouldn't have to double check it if it's not immensely off from the pt status :s  I would only double check an NIBP.


----------



## Bosco836 (Mar 21, 2011)

Jim_NJEMT said:


> Get a scope that works for you. I switched from a Littman Classic II S.E. to a Littman Master Classic II, reported by Littman to be better acoustically, and it was like day and night. I was amazed!




Really?  I just upgraded from a Classic II S.E. to a Cardiology III and, although there is a marginal improvement with the Cardio III - I don't find it to be nearly as dramatic as I was expecting.


----------



## BLS4LYFE (Mar 23, 2011)

Turn your stehascope around, so the ears are facing in towads the canal of your ears.  Then, drive your rig into a tree.


----------



## rwik123 (Mar 23, 2011)

BLS4LYFE said:


> Turn your stehascope around, so the ears are facing in towads the canal of your ears.  Then, drive your rig into a tree.



haha? Complete useless and inappropriate post


----------



## Madmedic780 (Mar 23, 2011)

Practice practice practice. Next time you are on shift have your partner turn the engine on in a parking lot and take their blood pressure.


----------



## PanzerKitty (Mar 23, 2011)

My problem was always palpating the pluse in the back of a moving ambulance. Lol.


----------



## DesertMedic66 (Mar 23, 2011)

my problem was doing a BP on the patients right arm. im not good at standing inside a moving ambulance going code 3. add that to getting a BP on the right arm by having to lean over the patient. hit my head on the comparments countless times


----------



## Hockey (Mar 24, 2011)

firefite said:


> my problem was doing a BP on the patients right arm. im not good at standing inside a moving ambulance going code 3. add that to getting a BP on the right arm by having to lean over the patient. hit my head on the comparments countless times



No.


----------



## lightsandsirens5 (Mar 24, 2011)

exodus said:


> I would only double check an NIBP.



Wait...implying that you do invasive blood pressures? 

You do know that using a stethoscope and manual cuff is also an NIBP. 


Sorry.....couldn't resist.


----------



## CIRUS454 (Mar 24, 2011)

usalsfyre said:


> Ultrascope. I got mine a month ago and I think I'm in love :wub:.



How well does this Steth work? I was looking at a Littman Cardiology III but it's not cheap. I would be using mine 95% of the time for breath sounds.


----------



## DesertMedic66 (Mar 24, 2011)

Hockey said:


> No.



Huh?


----------



## rwik123 (Mar 24, 2011)

CIRUS454 said:


> How well does this Steth work? I was looking at a Littman Cardiology III but it's not cheap. I would be using mine 95% of the time for breath sounds.



It outperforms alot of scopes... ask jtpaintball.. i know he has a cardiology and an ultrascope


----------



## usalsfyre (Mar 24, 2011)

firefite said:


> im not good at standing inside a moving ambulance going code 3.


This is the part of that statement I have a major problem
with. Why not just do it in the left?


----------



## usalsfyre (Mar 24, 2011)

CIRUS454 said:


> How well does this Steth work? I was looking at a Littman Cardiology III but it's not cheap. I would be using mine 95% of the time for breath sounds.



Didn't have a Cardiology, but I did have a Classic SE. My Maxiscope is easier to ascultate with by a mile.


----------



## Jon (Mar 24, 2011)

I believe Hockey expressed my thoughts, just not quite as eloquently as I'm about to.

There is limited to no need to be unsecured in the back of the truck, and doing so DRASTICALLY increases our own morbidity and mortality should there be some form of adverse event.


----------



## DesertMedic66 (Mar 24, 2011)

usalsfyre said:


> This is the part of that statement I have a major problem
> with. Why not just do it in the left?



It was on a ride out for class. It was an ALS transport where the patient went south on us. Patient had a fancy prostic right arm. So that means there is no left arm to take a BP on.


----------



## usalsfyre (Mar 24, 2011)

firefite said:


> It was on a ride out for class. It was an ALS transport where the patient went south on us. Patient had a fancy prostic right arm. So that means there is no left arm to take a BP on.



:huh:

You mean a prosthetic left arm? 

Standing in an ambulance transporting code 3 is needlessly dangerous. Your preceptors shouldn't be asking you to do this.


----------



## DesertMedic66 (Mar 24, 2011)

usalsfyre said:


> :huh:
> 
> You mean a prosthetic left arm?
> 
> Standing in an ambulance transporting code 3 is needlessly dangerous. Your preceptors shouldn't be asking you to do this.



Yeah that's what I meant. My spelling is horrible. The preceptor asked me to get a BP so he could push a drug (not sure what it was). And I wasn't going to argue with him. If things don't make sence to me then I will ask. But in that case it made sence to get a BP while going code 3...... Well made sence to me.


----------



## cappello91 (Mar 29, 2011)

cool thread, thanks!


----------



## Akulahawk (Mar 31, 2011)

clibb said:


> You were told by an RN?
> 
> -Position the patients arm with palm up
> -Straighten the arm
> ...


Also try to get the arm floated off the gurney rails... Get your heels off the floor. Cradle the patient's arm in a relatively straight position. You want to minimize any vibration that can be transmitted to the arm and steth head. Hopefully you'll be able to hear the sounds even while doing 80+ on bumpy road with the sirens blaring... oh, and make sure you can palpate the brachial artery. Why? You want to center the steth head over it and in the event that you can't hear the sounds, you can easily do a palpated pressure because you know where the brachial artery is.


----------



## Nimrod_BasketCase (Mar 31, 2011)

We practiced taking vitals in the back of the ambulance with lights, sirens, and loud music. I thought it was kinda hard I could barley hear anything plus it was a crazy ride too. They were taking sparp turns, speeding up and stoping, and going over speed bumps fast. I hope I get better at it usually when we do take vitals in the back of the ambulance it's a smooth ride and pretty quite so it's not that hard we also tell the instructors what we got then they give us something different to put on the PCR's.


----------



## Amycus (Apr 2, 2011)

Nimrod_BasketCase said:


> We practiced taking vitals in the back of the ambulance with lights, sirens, and loud music. I thought it was kinda hard I could barley hear anything plus it was a crazy ride too. They were taking sparp turns, speeding up and stoping, and going over speed bumps fast. I hope I get better at it usually when we do take vitals in the back of the ambulance it's a smooth ride and pretty quite so it's not that hard we also tell the instructors what we got then they give us something different to put on the PCR's.



While I sorta understand the logic...if my partner drove like that on an actual call, code 3, priority 1, whatever you want to call it, I'd be on the phone SO fast with my supervisor demanding he be remediated or stripped from driving his head would spin. There's no reason no matter how emergent your patient is you should EVER drive like that. I get the logic of trying to listen in bad situations, but if your instructors are giving you that scenario, it's like they are encouraging reckless driving.


----------



## DesertMedic66 (Apr 2, 2011)

Amycus said:


> While I sorta understand the logic...if my partner drove like that on an actual call, code 3, priority 1, whatever you want to call it, I'd be on the phone SO fast with my supervisor demanding he be remediated or stripped from driving his head would spin. There's no reason no matter how emergent your patient is you should EVER drive like that. I get the logic of trying to listen in bad situations, but if your instructors are giving you that scenario, it's like they are encouraging reckless driving.



If it was a class about driving then yes I could see it encouraging reckless driving. But since the focus of the lesson is on taking vitals inside a unit going code 3 then it's not really encouraging it. They are just making it as hard as possible for you do get a set of vitals. I have never been in a rig that went smoothly while going code 3. I have been in 2 situations where we could have crashed even tho the operator was doing everything correctly and legally.


----------



## Akulahawk (Apr 2, 2011)

Nimrod_BasketCase said:


> We practiced taking vitals in the back of the ambulance with lights, sirens, and loud music. I thought it was kinda hard I could barley hear anything plus it was a crazy ride too. They were taking sparp turns, speeding up and stoping, and going over speed bumps fast. I hope I get better at it usually when we do take vitals in the back of the ambulance it's a smooth ride and pretty quite so it's not that hard we also tell the instructors what we got then they give us something different to put on the PCR's.


Driving like that is NOT appropriate for learning to do vitals. It IS perhaps (briefly) appropriate to strap a new driver into the gurney to teach them how NOT to drive. EVER. Driving recklessly to simply learn to do vitals? Not appropriate.


----------



## rhan101277 (Apr 3, 2011)

Experience.  That said, do it as much as possible in the back of a moving rig.  The more you do it, the better you can pick it out.


----------



## ZombieEMT (Apr 4, 2011)

My solution was to buy a new stethoscope, even though I could not afford it. If you run enough calls, its not really an option. If you can not hear the BP, not really a good things. I went from cheap piece of crap to a Littmann Master Classic, works like a charm.


----------



## 82nd medic (Apr 4, 2011)

If someone already said this then ignore it, but you can get a guestimated BP without a stethoscope. Just look at when the needle starts and completely stops bouncing. Subtract 5 from the start and add 10 to the end. One of my PAs taught me that and it's decently accurate


----------



## usalsfyre (Apr 4, 2011)

82nd medic said:


> If someone already said this then ignore it, but you can get a guestimated BP without a stethoscope. Just look at when the needle starts and completely stops bouncing. Subtract 5 from the start and add 10 to the end. One of my PAs taught me that and it's decently accurate



I can't believe people admit to this stuff sometimes....

How do you account for needle bounce from movement instead of arterial pressure changes?


----------



## Akulahawk (Apr 4, 2011)

usalsfyre said:


> I can't believe people admit to this stuff sometimes....
> 
> How do you account for needle bounce from movement instead of arterial pressure changes?


While that's the basic idea behind oscillometric methods of obtaining a BP, our eyes aren't sensitive enough to detect road bump vs patient flexing muscles vs arterial pressure changes.


----------



## usalsfyre (Apr 4, 2011)

Akulahawk said:


> While that's the basic idea behind oscillometric methods of obtaining a BP, our eyes aren't sensitive enough to detect road bump vs patient flexing muscles vs arterial pressure changes.



That's what I mean. A transducer and software algorithm is able to detect and filter that stuff. A possibly miscalibrated gauge and your eyes might have a bit harder time...


----------



## 82nd medic (Apr 5, 2011)

usalsfyre said:


> I can't believe people admit to this stuff sometimes....
> 
> How do you account for needle bounce from movement instead of arterial pressure changes?





Akulahawk said:


> While that's the basic idea behind oscillometric methods of obtaining a BP, our eyes aren't sensitive enough to detect road bump vs patient flexing muscles vs arterial pressure changes.





usalsfyre said:


> That's what I mean. A transducer and software algorithm is able to detect and filter that stuff. A possibly miscalibrated gauge and your eyes might have a bit harder time...



Never said it was the best way to do something but it is a possibility. Needle bounce from arterial pressure change should have a pretty constant pattern unless the patient has an irregular pulse, while the other things you listed don't. Just apply some common sense and you can atleast get some idea of what the BP is... Which is better than nothing right? Do all ambulances have that equipment? If not then again: it's better than nothing.


----------



## medicstudent101 (Apr 5, 2011)

Sure, it might be better than nothing. If you're going ahead and doing a BP like that, there's no reason you shouldn't take it by palp. It's much more accurate and there's nothing useful you can really be doing with one extra hand except going for the BP over palp.


----------



## ffemt8978 (Apr 5, 2011)

82nd medic said:


> Never said it was the best way to do something but it is a possibility. Needle bounce from arterial pressure change should have a pretty constant pattern unless the patient has an irregular pulse, while the other things you listed don't. Just apply some common sense and you can atleast get some idea of what the BP is... Which is better than nothing right? Do all ambulances have that equipment? If not then again: it's better than nothing.



Yeah, that will stand up pretty well when you go to administer a drug based upon a "better than nothing" BP.  :wacko:

If you can't get an accurate BP, you're better off documenting that you are unable to obtain one instead of making a WAG.


----------



## 82nd medic (Apr 6, 2011)

ffemt8978 said:


> Yeah, that will stand up pretty well when you go to administer a drug based upon a "better than nothing" BP.  :wacko:
> 
> If you can't get an accurate BP, you're better off documenting that you are unable to obtain one instead of making a WAG.



I can't name a single medication that needs a BP range so close that being off by 5-10 would be a definative contraindication. Can you? Again: common sense applies, If that guestimated puts you in the clear then go for it. If it's close than don't. Either way, it's not all that more innacurate from a manual BP, especially when there are outside noises, and those are considered more than accurate enough to push meds.


----------



## 82nd medic (Apr 6, 2011)

usalsfyre said:


> How easy is it to read a very accurate B/P period? The only pressure you should trust to be completely accurate is off of a properly transduced a-line with a good waveform. Everything else is really some level of guess.



^^^ just to bring up what someone else already said. And yes palp is more accurate, but it doesn't give you diastolic. Hell do both, nothing says you can't use palp for establishing the systolic (which most medications, especially at the BLS level are based off of) and needle-bounce for getting as good an idea as possible for diastolic.


----------



## JPINFV (Apr 6, 2011)

82nd medic said:


> I can't name a single medication that needs a BP range so close that being off by 5-10 would be a definative contraindication. Can you? Again: common sense applies, If that guestimated puts you in the clear then go for it. If it's close than don't. Either way, it's not all that more innacurate from a manual BP, especially when there are outside noises, and those are considered more than accurate enough to push meds.




The problem is that the margin of error is already +/- 3 for most cuffs, which really works out to a +/- 6. After all, if you're first reading is 120 and the second is 126, it could always be holding steady at 123. Of course this brings us to the fact that when you round you lose an additional number to error anyways.


----------



## 82nd medic (Apr 6, 2011)

JPINFV said:


> The problem is that the margin of error is already +/- 3 for most cuffs, which really works out to a +/- 6. After all, if you're first reading is 120 and the second is 126, it could always be holding steady at 123. Of course this brings us to the fact that when you round you lose an additional number to error anyways.



No argument here, luckily BP is just a guideline not an absolute


----------



## IrightI (Apr 17, 2011)

My vote is for a Littman Master Cardiology B)


----------



## HotelCo (Apr 17, 2011)

IrightI said:


> My vote is for a Littman Master Cardiology B)



And what are they going to do when their Master Cardio breaks/vanishes/is hit by a meteorite? 

Practice, practice, practice. You'll get it.


----------



## SD EMT OPS (Apr 27, 2011)

make sure the PT is not resting arm the stretcher in the rig. put it on your leg or suport it with your arm to eliminate a lot of artifact


----------



## nonsense (Apr 27, 2011)

rest the patients arm or elbow on your knee, and get your heel off the floor (so you're toe is on the floor but you're still sitting), this allows bumps in the road and what not to somewhat be dampened. It's a trick someone showed me once, you could try it and decide for yourself if it really works.


----------



## bigmoosewi (Apr 27, 2011)

To better hear in a moving rig, put your feet up on the cot.  Sound is nothing more that vibrations.  By putting your feet on the cot, (they only need to be on legs of the cot not on the PT or anything like that) you are putting a barrier between you and the floor of the ambulance.  The cot will absorb a ton of vibrations.  A little trick my instructor learned at the Wisconsin EMS Association Conference that he passed along to us.  I tried it and it makes a world of difference.  The other thing you could do is use an automated BP cuff.


----------



## blogspoter507 (Apr 27, 2011)

I thought this was funny I actually had a student I was training do the exact same thing....Just for fun I told her to do it again and she still gave me an odd number.....People are funny sometimes because they thing when they don't know how to do something they can just bs their way out of it....This may be true in other lines of work but in EMS you will most likely   get your hand called..... But still quite funny .


----------



## Theone (May 27, 2011)

HotelCo said:


> How are you going to know if you hear it "incorrectly"?
> 
> Side note: Once had a partner tell me the pt's BP was 64/93. I asked if he mean 93/64, and he was convinced that not only could he hear the bottom number first, but that he could read between the lines on the BP cuff.



Do tell how he passed his state test lol


----------



## JPINFV (May 27, 2011)

Ashleena said:


> agreed...thanks...


Agreed with what?


----------



## EXPERTrookie209 (Jun 6, 2011)

Along with the resting your feet on the gurney/resting pt's elbow on knee, I like to hold my bell against their arm with the palm of my hand or the meaty part of my thumb. It may just be me but I guess I've got squeaky joints and every time my fingers move i hear a bunch of noise through my scope :sad:


----------



## bigmoosewi (Jun 7, 2011)

The last post works as long as you have a single bell.  If you have a 2 sided bell you may actually hear your own heart.


----------



## TransportJockey (Jun 7, 2011)

Keep in mind if you're cupping your hand over the steth, some scopes, like my Ultrascope, are pressure sensitive. Push too hard and you will hear NOTHING at all


----------



## medicsb (Jun 7, 2011)

Some of the have probably already been mentioned, but...

Sometimes the best trick is to time your BP assessment with a stop at a traffic light.  If you absolutely need to auscultate a BP (i.e. you don't want a palpated BP) and you cannot hear it, the best thing to do would be to have the person driving pull over.  Also it is always helpful to palpate the location of the brachial artery before measuring the BP.

Or, maybe I can track down the EMT that was able to palpate a diastolic pressure (insert facepalm here) and he can fill us in on his "trick".


----------



## rowdybear (Jun 9, 2011)

*2 cents*

i found that if i pick my heels off of floor of rig it cuts down on noise


----------



## rhan101277 (Jun 9, 2011)

It mostly take lots of practice.  You get where you know what you are listening for and you can pick it out.


----------



## ArcticKat (Jun 9, 2011)

EMSslick536 said:


> Haha, yea that's what they told us at CFR class.. If you get a odd number reading.. you probably need more help than the pt. sitting in front of you. haha



Why?  I can get odd numbers all the time.  If I hear the korotkoff sounds while the needle is between the lines, then it's an odd number.  The sounds don't always come when the needle is directly over a line.  Besides, taking a blood pressure is hardly an exact science.  Take a 100 practitioners and you'll get 100 different BPs, but they'll be pretty close.


----------



## phideux (Jun 9, 2011)

I try to get a manual baseline before we go, after that it's up to the LifePack to check BP for me.
As far as a manual pressure in a moving ambulance, I think a good scope and practice is the answer.


----------



## IAems (Jun 9, 2011)

*Baseline Vital Signs*



phideux said:


> I try to get a manual baseline before we go.



Exactly right.  In addition to the aforementioned (raise your heels or put your feet on the gurney and rest the patient's arm on your knees - which really does help by the way), you _always_ need to have a baseline blood pressure.  Never leave a scene without a set of vital signs, with the one exception of patients in extremis (and even that is only really applicable to BLS providers).  If for no other reason, and there are plenty, it will give you a good idea of where to expect your Korotkoff sounds.  I also make a habit of both auscultating first and palpating second while transporting (in order to confirm the systolic reading).


----------



## RocketMedic (Jun 12, 2011)

A good stethoscope and practice.


----------



## vamike (Jul 3, 2011)

I couldn't get a bp on a pt the other night in the back of the ambulance and asked the als person on board to try.   He got one.  Afterward he told me to auscultate the brachial pulse before putting on a bp cuff.  He said if you know where to place the steth you will better auscultate the bp.  I have been trying to hear a brachial pulse with my steth but no luck.  Any input?


----------



## DesertMedic66 (Jul 3, 2011)

vamike said:


> I couldn't get a bp on a pt the other night in the back of the ambulance and asked the als person on board to try.   He got one.  Afterward he told me to auscultate the brachial pulse before putting on a bp cuff.  He said if you know where to place the steth you will better auscultate the bp.  I have been trying to hear a brachial pulse with my steth but no luck.  Any input?



I think your partner meant to palpate for the pulse so you know where to put the steth.


----------



## jjesusfreak01 (Jul 3, 2011)

vamike said:


> I couldn't get a bp on a pt the other night in the back of the ambulance and asked the als person on board to try.   He got one.  Afterward he told me to auscultate the brachial pulse before putting on a bp cuff.  He said if you know where to place the steth you will better auscultate the bp.  I have been trying to hear a brachial pulse with my steth but no luck.  Any input?



Sometimes you just can't get it. Every patient is different. Young healthy patients with good veins are easy most of the time. Old pts with CHF, PAD/PVD, DM, etc are going to tend to be harder. If you palpate for the pulse, put your scope over that, and still can't hear it you might just be outta luck for that patient.


----------



## Icenine (Jul 4, 2011)

Bob Page says,

Use the bell (soft touch w/ littmann tuneable)

And keep the scope away from the cuff.  Putting the bell under the cuff will do you no favors.


----------



## vamike (Jul 4, 2011)

Yeah this PT was a 73yo male  bp of 80/40.  He was already in agonal breaths.  Got his bp while in nursing home but couldnt in the truck.  Ill try palpating for the pulse and make sure i keep the steth out from under the cuff.  Thanks all.


----------



## LoneStarSoldier (Aug 1, 2011)

82nd medic said:


> If someone already said this then ignore it, but you can get a guestimated BP without a stethoscope. Just look at when the needle starts and completely stops bouncing. Subtract 5 from the start and add 10 to the end. One of my PAs taught me that and it's decently accurate



I've used this method too in a field environment. However, I think that in the field is the only situation where this method would be useful when noises and things are going on around you (like more urgent patients presenting or you not being able to stay in one spot for very long). Otherwise, if you can get an automated or manual BP with a stethescope, go for it. But you're right this is better than nothing. Even if all you can definitively say is 'The Pt. is not going into shock, and his vitals are stable' that's better than nothing.


----------



## Boredderob (Aug 18, 2011)

Yeah, it's really late, whatever.

Float the arm by placing the patient's elbow on your knee. Put your weight on to the ball of your foot and let the patient's hand hang freely, slightly overextending the elbow. The patient's hand should be bouncing a bit against the tension as the rig moves. In my experience this works with any quality stethoscope.

Obviously, don't do this if the arm in question is injured or if the patient is restrained.


----------

