# Mean Arterial Pressure (MAP)



## EMT B (May 1, 2013)

would you say monitoring map is a bls skill or an als skill? justify yourself either way. after we get some discussion going ill let you know what i think.


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## chaz90 (May 1, 2013)

The way it's used in EMS it's just a formula applied to blood pressure. Depends on the reason you're monitoring MAP. If it's an academic exercise, BLS attend. If there's a reason you're concerned about MAP, it may be ALS.


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## JPINFV (May 2, 2013)

chaz90 said:


> If there's a reason you're concerned about MAP, it may be ALS.



If you're concerned about MAP, than your concerned about blood pressure, and thus it should be a paramedic level call.


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## Bullets (May 2, 2013)

I do, I have an app that calculates. As a BLS provider it is one more piece of the assessment that helps me determine sick or not sick and request ALS accordingly. It's gotten to the point I can recognize a bad MAP without using the calculator


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## Arovetli (May 5, 2013)

I'd say it is something all levels should be aware of. I'm not sure it qualifies as a 'skill'...


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## Trailrider (May 5, 2013)

This is the knowledge of an ALS practioner.  You must learn how to crawl before you can walk.  I don't see the point in learning something like this or about something like  ECMO or ABGs when the basics are forgotten.  That's just my .1 cent of advice.


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## Handsome Robb (May 5, 2013)

EMT B said:


> would you say monitoring map is a bls skill or an als skill? justify yourself either way. after we get some discussion going ill let you know what i think.



At the BLS level what all are you planning to do for the patient with a :censored::censored::censored::censored:ty MAP?


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## ExpatMedic0 (May 5, 2013)

Robb said:


> At the BLS level what all are you planning to do for the patient with a :censored::censored::censored::censored:ty MAP?



ya, only MAP the EMT needs is to drive the ambulance..... Wait Wait, I kidd I kidd.... :rofl::rofl:

If you want to get ahead of the game and look into it, good for you. I am not sure how much information a normal Paramedic textbook has on MAP but I am pretty sure its covered more in Critical Care Paramedic text with extra detail. Don't quote me on that I just got my UMBC AAOS textbook in the mail so Ill get back to you on it.


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## Trailrider (May 5, 2013)

EMT B said:


> would you say monitoring map is a bls skill or an als skill? justify yourself either way. after we get some discussion going ill let you know what i think.





I'm patiently waiting for your reply.


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## DesertMedic66 (May 5, 2013)

Robb said:


> At the BLS level what all are you planning to do for the patient with a :censored::censored::censored::censored:ty MAP?



Drive faster?


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## Trailrider (May 5, 2013)

Forget the MAP, diesel infusion TKA!


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## jgreenemtp (May 31, 2013)

My mother with no medical training can calculate a map with her Walmart blood pressure cuff. MAP is BLS. What you do about it is ALS. I would argue that a great many ALS providers couldn't tell you a normal MAP or where a MAP should be on a particular patient's condition, for example CHI.


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## EMT B (May 31, 2013)

Yikes! Sorry about my lack of a reply I totally forgot about this thread! It didn't seem to get as much discussion as I had hoped it would, it appears it isn't as big of a controversy as I thought it would be. I got into a discussion with a few other providers that thought it should be a BLS skill on the grounds that it is just another vital sign. I wouldn't know how it would be applied at the ALS level much less the BLS level! I agree that it is an ALS skill.


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## Carlos Danger (May 31, 2013)

EMT B said:


> would you say monitoring map is a bls skill or an als skill? justify yourself either way. after we get some discussion going ill let you know what i think.



MAP is simply blood pressure. 

I'm confused as to why it would be an "ALS skill"?


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## Achilles (Jun 1, 2013)

Halothane said:


> MAP is simply blood pressure.
> 
> I'm confused as to why it would be an "ALS skill"?



What are you going to do as a basic?


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## MSDeltaFlt (Jun 1, 2013)

It's not just knowing what a normal MAP is.  The key is knowing what to do if it's too high, why wouldn't you want it to get too low (knowing what too low is is also important), and how much would you want to lower it if it is too high.

So yes.  Knowing what it is and how to calculate is a basic skill, just simple math really.  Knowing how to treat it... well, that's a little more complicated.


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## Carlos Danger (Jun 1, 2013)

Achilles said:


> What are you going to do as a basic?



The same exact thing I would do to treat DBP & SBP. Which is usually nothing.

MAP is simply another way of looking at blood pressure. It gives you the same exact info as DBP and SBP, only presented in a simpler, more meaningful way. MAP is the mean (the "average") of the arterial pressure variations over the course of a single cardiac cycle. 

The calculation commonly used to estimate MAP is simple: (2DBP+SBP)/3. A more accurate formula takes into account heart rate (since the length of the diastolic phase depends on HR), but I don't have it memorized or handy.

If you are going to look at a single number as an indicator of whether BP is adequate to supply systemic perfusion, then it makes more sense to look at MAP then SBP, which is what most people seem to focus on. So if we are really worried about keeping things as simple as possible for basics, then EMT courses should teach EMT's to look at MAP and not even worry about DBP or SBP.


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## VFlutter (Jun 1, 2013)

In situations where MAP is a critical component of care (shock, pressor titration, increasing ICP) I wouldn't even trust NIBP calculated MAP. Especially not the automatically calculated MAP that does not account for heart rate. However, MAP off an Arterial line is a fantastic diagnostic tool.


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## 18G (Jun 1, 2013)

I see no need for an EMT to be worried about MAP. Many Paramedics don't even know what MAP is. 

Personally, I usually only pay attention to it when orders are to maintain MAP >65 with pressors or patient is shocky and getting fluid resuscitation.


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## Rialaigh (Jun 1, 2013)

18G said:


> *I see no need for an EMT to be worried about MAP. Many Paramedics don't even know what MAP is. *
> 
> Personally, I usually only pay attention to it when orders are to maintain MAP >65 with pressors or patient is shocky and getting fluid resuscitation.



I see no reason a medic would treat something based on MAP any different than systolic or diastolic unless (as mention before) your using MAP off an arterial line on an interfacility critical care transport titrating with pressors. It's like being able to diagnose herpes in the field....improves your understanding of medicine (which is wonderful) but from a treatment standpoint...makes 0 difference at all other than maybe delaying transport while you calculate it out with your handy dandy phone...


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## Summit (Jun 1, 2013)

When someone asks what is MAP, most people respond with the approximation of DP + PP/3 (or the more common equivalent). If you want to teach it properly, we should discuss the true value of CVP+(SVR*CO) and how/why we approximate with other values. If one is to treat with data, one must understand the limitations of the data.

For further reading on approximation with heart rate, read this paper:
http://www.ncbi.nlm.nih.gov/pubmed/10727067


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## Ecgg (Jun 1, 2013)

Halothane said:


> The same exact thing I would do to treat DBP & SBP. Which is usually nothing.
> 
> MAP is simply another way of looking at blood pressure. It gives you the same exact info as DBP and SBP, only presented in a simpler, more meaningful way. MAP is the mean (the "average") of the arterial pressure variations over the course of a single cardiac cycle.
> 
> ...



What is the formula for corrected rate that you have?


One study states

MAP = DP + [0.33 + (HR x 0.0012)] x [PP] where SP and DP are systolic and diastolic pressure and HR is heart rate. The current study validates the new MAP formula in the same patient at increasing paced heart rates. 

 PP I think was a mistake and should read SP?

http://www.ncbi.nlm.nih.gov/pubmed/15558774


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## JPINFV (Jun 1, 2013)

Most likely not. Another calculation for MAP is 1/3PP+DP=MAP. It's algebraically the same as 1/3SP+2/3DP=MAP.


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## Ecgg (Jun 1, 2013)

JPINFV said:


> Most likely not. Another calculation for MAP is 1/3PP+DP=MAP. It's algebraically the same as 1/3SP+2/3DP=MAP.



Yeah it's my mistake. PP= pulse pressure (SP-DP).


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## usalsfyre (Jun 1, 2013)

Chase said:


> In situations where MAP is a critical component of care (shock, pressor titration, increasing ICP) I wouldn't even trust NIBP calculated MAP. Especially not the automatically calculated MAP that does not account for heart rate. However, MAP off an Arterial line is a fantastic diagnostic tool.



According to SEVERAL reliable sources the MAP is the most accurate number on an NIBP (not sure of the science/engineering but apparently MAP is what's actually measured). An a-line is obviously ideal but not absolutely necessary by any means.


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## Carlos Danger (Jun 1, 2013)

18G said:


> I see no need for an EMT to be worried about MAP. Many Paramedics don't even know what MAP is.
> 
> Personally, I usually only pay attention to it when orders are to maintain MAP >65 with pressors or patient is shocky and getting fluid resuscitation.



This explains it well.


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