# Blood Pressure - Even Numbers or Any Number?



## Jon

So... the question was asked by an EMT Student at the volunteer squad:

Why do we only measure blood pressure in even numbers.

My answer was simply "thats the way it is done"... and I hate giving that answer, so I said I'd look into it... and so I come here.


To take it a step further - all the lovely electronic machines we have now measure "exact" numbers... I.E. 119/81 vs. 120/80 - Do/Should you round up/down to get an even number when documenting those pressures.


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## KEVD18

manual guages are marked in even numbers. its not feasible to have an odd number in your answer.

automatic machines have a computer to process the results and are fairly well unlimited.

if it is within your services policies to obtain v/s with auto machines, then i see no reason to change the result. quite the opposite in fact. that would be falsifying a treatment record, wouldnt it? you would be writing down that you got a pressure of 116/64 when in fact you got 115/63.  to me, thats no different legally than plain making it up


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## MMiz

On the rig/on scene if I were to report an odd numbered blood pressure reading it would be considered falsifying a patient's record, as I've yet to find a manual sphygmomanometer with markings for odd numbers.

In the clinical/hospital setting with electric/automated machines it's possible to get an odd number for a reading.


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## Jon

MMiz said:


> On the rig/on scene if I were to report an odd numbered blood pressure reading it would be considered falsifying a patient's record, as I've yet to find a manual sphygmomanometer with markings for odd numbers...


 
But... But.... what if it IN BETWEEN the markings?


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## traumateam1

Like others have said.. the manual ones are only marked with even numbers. 0, 10, 20, 30, 40 etc. Where as the electrical/monitoring ones have a computer in them to interpret the data and get near exact numbers, thus you get even and odd numbers.


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## MMiz

Jon,  I'm a highly calibrated numbers-reporting machine that would never take a reading that was even a point off.

I really don't think it's a big deal either way, but I'm sure someone will burst into this thread with a five page response as to why you've broken EMS code 8675.309.  I won't be that person


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## traumateam1

Jon said:


> But... But.... what if it IN BETWEEN the markings?



I dunno about you.. but a difference of 1 mmHg isn't going to make that big of a difference *pre hospital*. So, if something falls on 131, writing 130 or 132 isn't going to make a difference.. besides, can you honestly catch it in between the two even numbers?


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## MSDeltaFlt

Jon said:


> But... But.... what if it IN BETWEEN the markings?



*Who cares*?  NIBP's are not accurate.  Never have been.  Never shall be.  Even their specs say they aren't.  The most accurate blood pressures are:

1. A properly zeroed arterial line, and

2. A manual BP.

Manual cuffs are marked in even numbers, true.  But even if you have a one digit margin of error, it will matter about as much as the price of milk.  Which is *absolutely none*.


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## Jon

Thanks MMiz and MSDeltaFlt...  I was just playing devil's advocate.


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## Ridryder911

Agreed, even numbers. It is part of "chart" etiquettecy.

R/r 911


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## Jon

Ridryder911 said:


> Agreed, even numbers. It is part of "chart" etiquettecy.
> 
> R/r 911


even for auto cuffs... and any idea why, Rid?


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## aidan

We were told that if we take it manually (with stethoscope/sphygmomanometer) it has to be an even number, but if we take it with an electronic sphygmomanometer, we can write down an odd number as long as we also write that it was taken electronically.


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## tydek07

aidan said:


> We were told that if we take it manually (with stethoscope/sphygmomanometer) it has to be an even number, but if we take it with an electronic sphygmomanometer, we can write down an odd number as long as we also write that it was taken electronically.



Not to steal the thread... but your signature made me laugh "aidan" haha, love it

Palin, Palin, Palin... **shakes head**


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## aidan

tydek07 said:


> Not to steal the thread... but your signature made me laugh "aidan" haha, love it
> 
> Palin, Palin, Palin... **shakes head**



Thanks! B) hahaha.. yeah..*shakes head in agreement!*


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## Code 3

traumateam1 said:


> I dunno about you.. but a difference of 1 mmHg isn't going to make that big of a difference *pre hospital*. So, if something falls on 131, writing 130 or 132 isn't going to make a difference.. besides, can you honestly catch it in between the two even numbers?



1mmHG can mean the difference between whether or not you administer NTG 0.4mg SL along with 1" NTG ointment for a cardiac C/P pt.


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## aidan

Code 3 said:


> 1mmHG can mean the difference between whether or not you administer NTG 0.4mg SL along with 1" NTG ointment for a cardiac C/P pt.



Really? Could you elaborate a little? I didn't even think it was possible to get a BP down to the exact mmHg. If it is possible, I sure doubt my ability to do it! Even releasing 2-3mmHg/second, it still goes too fast for me to see the EXACT spot where the radial pulse returns or goes away..


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## Code 3

aidan said:


> Really? Could you elaborate a little? I didn't even think it was possible to get a BP down to the exact mmHg. If it is possible, I sure doubt my ability to do it! Even releasing 2-3mmHg/second, it still goes too fast for me to see the EXACT spot where the radial pulse returns or goes away..



What's there to elaborate? You should have a protocol for NTG with a set B/P reading of greater than or equal to a number. The post I quoted was regarding rounding up the number if you catch it in between readings and how it does make a difference.


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## aidan

Code 3 said:


> What's there to elaborate? You should have a protocol for NTG with a set B/P reading of greater than or equal to a number. The post I quoted was regarding rounding up the number if you catch it in between readings and how it does make a difference.



Ah okay. I can't picture a medic being so 100% confident in the BP cuff to not administer NTG based on 1 mmHg, though.


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## VentMedic

aidan said:


> We were told that if we take it manually (with stethoscope/sphygmomanometer) it has to be an even number, but if we take it with an electronic sphygmomanometer, we can write down an odd number as long as we also write that it was taken electronically.


 
Exactly.   That way other professionals don't have to guess whether you are using an electronic device or don't know how to read the  sphygmomanometer which is commonly in even number increments.


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## aidan

VentMedic said:


> Exactly.   That way other professionals don't have to guess whether you are using an electronic device or don't know how to read the  sphygmomanometer which is commonly in even number increments.



Ahh ok..yeah.. if someone were to assume you used a manual cuff and wrote down an odd number, it'd definitely hurt your credibility . I hadn't thought of that, thanks.


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## reaper

Code 3 said:


> What's there to elaborate? You should have a protocol for NTG with a set B/P reading of greater than or equal to a number. The post I quoted was regarding rounding up the number if you catch it in between readings and how it does make a difference.




That's going a little to far! Considering that there is a +/-2 on any cuff, I don't think you have to much to worry about with that.


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## Code 3

Yes, I know. I was going for the technicality


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## Sasha

A little off topic, but.... Since I've started working in the field, I have been absolutely amazed by the number of new EMTs who get throguh EMT school with out actually being able to take an accurate BP and falsify their BP readings.


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## aidan

Sasha said:


> A little off topic, but.... Since I've started working in the field, I have been absolutely amazed by the number of new EMTs who get throguh EMT school with out actually being able to take an accurate BP and falsify their BP readings.



Seriously? I honestly taught myself, a month before my EMT class even started, by watching Youtube videos hahaha


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## Sasha

aidan said:


> Seriously? I honestly taught myself, a month before my EMT class even started, by watching Youtube videos hahaha



Seriously. I've taught one, and a couple others have told me so and so yelled at them and re-taught them blood pressures. Simply astounding. 

I learned how to in a health science class in high school, but we used the palpation and watching for needle jump. Needle jump is far less accurate than asculatating, but I practiced ausculatating that since I started EMT school on anyone who could and would sit still long enough.

The sound of velcro strikes fear into my grandpa's heart!


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## aidan

Sasha said:


> Seriously. I've taught one, and a couple others have told me so and so yelled at them and re-taught them blood pressures. Simply astounding.
> 
> I learned how to in a health science class in high school, but we used the palpation and watching for needle jump. Needle jump is far less accurate than asculatating, but I practiced ausculatating that since I started EMT school on anyone who could and would sit still long enough.
> 
> The sound of velcro strikes fear into my grandpa's heart!



I "practiced" too. All my family members had bruises by the end of my EMT class. I've learned the palpation method, but I was under the impression one can't take diastolic BP with just palpation.. it's possible to take diastolic with the needle jump method though, right? Just whenever the needle stops jumping?


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## Sasha

aidan said:


> I "practiced" too. All my family members had bruises by the end of my EMT class. I've learned the palpation method, but I was under the impression one can't take diastolic BP with just palpation.. it's possible to take diastolic with the needle jump method though, right? Just whenever the needle stops jumping?



That's what I was told. but I notice in the ambulance the needle jumps all the way down  And no diastolic by palp, it's whatever/palp


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## medicdan

Code 3 said:


> 1mmHG can mean the difference between whether or not you administer NTG 0.4mg SL along with 1" NTG ointment for a cardiac C/P pt.



I would think that any medic worth their cert would retake the BP after a few seconds or on the other arm before giving NTG for a baseline BP like that.


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## aidan

Sasha said:


> That's what I was told. but I notice in the ambulance the needle jumps all the way down  And no diastolic by palp, it's whatever/palp



Haha, maybe its the shakiness of the road moving the needle (if you mean you were moving) or else maybe the ambulance cuff is more sensitive? :unsure:


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## Sasha

emt-student said:


> I would think that any medic worth their cert would retake the BP after a few seconds or on the other arm before giving NTG for a baseline BP like that.



Or establish a line for the "OH crap! Squeeze the bag!" moment. The protocols where I work are a minimum of 100mmHg systolic, I've seen medics give it at 95-90mmHg with a line popped in case they bottom out.


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## Code 3

emt-student said:


> I would think that any medic worth their cert would retake the BP after a few seconds or on the other arm before giving NTG for a baseline BP like that.



Okay, okay people I wasn't talking real-world application. Just playing devil's advocate for the argument of reading "in between" measurements and whether or not it would make a difference. Case in point, when you take the NR exam and the question is regarding administration of NTG and you select a systolic B/P of 88 or 89 instead of 90 or 92 then _technically_ you got the question wrong.


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## SES4

*BP Numbers.*

Okay.  So.... I work as a CNA (Certified Nursing Assistant) in both the hospital and nursing home settings.  That said, I have taken my fair share of BP's and I agree with RidRyder that it is GENERALLY chart ettiquecy to record even numbers.  Also, regarding what Sasha said about new EMT's inability to take BP and having to be trained on the job, it must be an epidemic in the healthcare industry.  Seriously, I am constantly amazed at the number of supposedly trained professionals who are inept in accurately taking BP's.  

Thank god for the automatic cuffs and machines that calculate everything for us (makes my life and job A LOT easier HAHA) but I think occasionally everyone should take a manual BP just to keep that skill because basically if you do not use it consistently you lose it or get VERY rusty.


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## aidan

SES4 said:


> Okay.  So.... I work as a CNA (Certified Nursing Assistant) in both the hospital and nursing home settings.  That said, I have taken my fair share of BP's and I agree with RidRyder that it is GENERALLY chart ettiquecy to record even numbers.  Also, regarding what Sasha said about new EMT's inability to take BP and having to be trained on the job, it must be an epidemic in the healthcare industry.  Seriously, I am constantly amazed at the number of supposedly trained professionals who are inept in accurately taking BP's.
> 
> Thank god for the automatic cuffs and machines that calculate everything for us (makes my life and job A LOT easier HAHA) but I think occasionally everyone should take a manual BP just to keep that skill because basically if you do not use it consistently you lose it or get VERY rusty.



Geez, it's not thoracic surgery! 
listen for brachial pulse.
listen for brachial pulse to go buh-bye.
done!


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## SES4

aidan said:


> Geez, it's not thoracic surgery!
> listen for radial pulse.
> listen for radial pulse to go buh-bye.
> done!



Oh Aidan for some it is akin to thoracic surgery it seems!


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## BossyCow

DO NOT USE NEEDLE JUMP FOR B/P.. LEARN THE SKILL! 

Kev.. I need the head banging jpg.. please!


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## SES4

*Indeed.*



BossyCow said:


> DO NOT USE NEEDLE JUMP FOR B/P.. LEARN THE SKILL!
> 
> Kev.. I need the head banging jpg.. please!



Indeed.  Agreed.


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## aidan

BossyCow said:


> DO NOT USE NEEDLE JUMP FOR B/P.. LEARN THE SKILL!
> 
> Kev.. I need the head banging jpg.. please!



^_^.
It's harder for me to get my needle to jump than it is to auscultate


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## Sasha

BossyCow said:


> DO NOT USE NEEDLE JUMP FOR B/P.. LEARN THE SKILL!
> 
> Kev.. I need the head banging jpg.. please!



I don't use the needle jump method, it was just my observation in the ambulance it tends to bounce alllll the way down. I said that's how we were taught in high school health science class, probably because we didn't have stethescopes. I asculatate!


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## Scout

Sasha said:


> A little off topic, but.... Since I've started working in the field, I have been absolutely amazed by the number of new EMTs who get throguh EMT school with out actually being able to take an accurate BP and falsify their BP readings.




120/palp, times 3 on a record sheet. always a crowd pleaser


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## WuLabsWuTecH

I'm surprised no one has mentioned significant figures!!!

I have always been taught to estimate to one more place than is difinitively marked.  Learned it in high school chemistry, and have used it ever since in any science setting where measurements are required.  I have and will continue to use odd numbers when taking a bp reading.  If the number falls in such a range that an odd number is required when using 3 significant figures (2 sigfigs for under 100 torr) then I will report that odd number.


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## danguitar12345

*The EMT Student Who Asked*

Thanks Jon, I Joined to see this and got my answer. Thanks Again


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## Aileana

I believe it's already been said, but I've been taught that the use of even numbers when obtaining a BP manually is all about significant figures/digits. Since with a manual sphygomomanometer, we can't guarantee accuracy beyond the nearest even number, it's left at that, and has since become chart etiquette. However (from what I've seen anyways), automatic sphygomomanometers are assumed to be capable of reading to the nearest whole number accurately, so both odd and even numbers are acceptable to use. (As always, if I am incorrect in any of this, please let me know)


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## Shishkabob

As I have been taught, first BP is always manual just to eliminate the possibility of the auto being wrong and not knowing.


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## Veneficus

Linuss said:


> As I have been taught, first BP is always manual just to eliminate the possibility of the auto being wrong and not knowing.



I would submit that is one way of doing it, but the automatic BP devices have come a long way from the earlier unreliable models. Unless I get an outrageously high reading, an extremely low reading, an outlier to the trend, or unless the machine says error I go with it.

Still do manual for Ankle/Brachial indexes of course.


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## Anomalous

Next question is:

When was the last time you calibrated your manual cuff?


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## MSDeltaFlt

Anomalous said:


> Next question is:
> 
> When was the last time you calibrated your manual cuff?



When the BP needle is resting within the circle at the bottom of the manometer while deflated, it's calibrated.


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## lightsandsirens5

traumateam1 said:


> I dunno about you.. but a difference of 1 mmHg isn't going to make that big of a difference *pre hospital*. So, if something falls on 131, writing 130 or 132 isn't going to make a difference.. besides, can you honestly catch it in between the two even numbers?



Yea you can catch it. If you are willing to let the pressure out of the cuff over a period of 7 1/2 minutes.


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## Shishkabob

Veneficus said:


> Unless I get an outrageously high reading, an extremely low reading, an outlier to the trend, or unless the machine says error I go with it.





True story;  My first ride out on an ambulance had a few BLS calls where I had to do BP so they would trust me, then we get a priority 3 sick person.

We head out there, guy semi-conscious on his bed, and the medic tells me to take a BP.  I end up getting a 290/130... needless to say, I was a bit hesitant at stating what I thought I got... but they believed me and it matched perfectly with the auto back in the truck.


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## Veneficus

Linuss said:


> True story;  My first ride out on an ambulance had a few BLS calls where I had to do BP so they would trust me, then we get a priority 3 sick person.
> 
> We head out there, guy semi-conscious on his bed, and the medic tells me to take a BP.  I end up getting a 290/130... needless to say, I was a bit hesitant at stating what I thought I got... but they believed me and it matched perfectly with the auto back in the truck.



so did you take it more than once and got the same number or just go with the original?

If I took a BP twice and got similar numbers I would call it accurate and be done.


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## frogtat2

*bp odd or evn?*

I have read through this article thread and here is what I think, for what its worth.

We have machines that take blood pressures that come up with odd numbers consistently.  Our manual cuff are marked in even numbers.  

I personally don't see a difference between a systolic pressure of 130 vs 131. What I think is important is the trend.  Is it getting better or worse?  In pre-hospital care, that difference of 1 isn't going to change my decision on patient care, while a difference in 10 could/would.


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## Veneficus

frogtat2 said:


> I have read through this article thread and here is what I think, for what its worth.
> 
> We have machines that take blood pressures that come up with odd numbers consistently.  Our manual cuff are marked in even numbers.
> 
> I personally don't see a difference between a systolic pressure of 130 vs 131. What I think is important is the trend.  Is it getting better or worse?  In pre-hospital care, that difference of 1 isn't going to change my decision on patient care, while a difference in 10 could/would.



May I just inquire what SPB tell you about a patient?


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## mycrofft

*"Needle jump" is not a measurement, it's a reassurement your scope's working.*

In case someone didn't see my rants about VS monitors, I was told by a Welch Allyn tech that a 5 mmHg variance in diastolic between serial measurements on the same pt was acceptable. How does THAt work? ("It is intended as a screening tool, Nurse Mycrofft") he said).
All our monitors (we have three iterations, OK, Bad, and Expensive Bad) read out in odd numbers. The manual cuffs read out in even numbers.


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## Explorer127

I have always been taught to round up--I actually believe the EMT textbooks says that, not that it would actually make a difference..


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## Anu

*Taking vitals*

Hello Everyone,

I am wondering if anyone is aware of any methods or techniques that can be used to get a clear, audible, pulse when taking a patient's blood pressure.

I am preparing for my exam next month, and was looking into doing some ride-along time with my local ambulance company.  I'd like to be able to get out there and get this right..

Bodies come in all different shapes, sizes, and conditions, and while it might be easy to find a pulse right away on certain people, it has proven to be a challenge on others.  Like on very old, withering women, with barely any meat on their bones, who can barely support having the cuff wrapped around their arm.  :unsure:

Any ideas?


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## medic417

Luvadea said:


> Hello Everyone,
> 
> I am wondering if anyone is aware of any methods or techniques that can be used to get a clear, audible, pulse when taking a patient's blood pressure.
> 
> I am preparing for my exam next month, and was looking into doing some ride-along time with my local ambulance company.  I'd like to be able to get out there and get this right..
> 
> Bodies come in all different shapes, sizes, and conditions, and while it might be easy to find a pulse right away on certain people, it has proven to be a challenge on others.  Like on very old, withering women, with barely any meat on their bones, who can barely support having the cuff wrapped around their arm.  :unsure:
> 
> Any ideas?



Practice practice practice.  If you are hard of hearing an electronic steth may help.  But most is just learning anatomy and you will find the brachial and be able to hear.  Sometimes placing the edge of the steths bell under the cuff helps some to hear better.


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