# BP diastolic = 0



## LightNbolt (Nov 21, 2008)

Our patient was a 23 year old female. I checked her blood pressure via auscultation. I heard the pulse sound for my systolic number, then began to release the air from the cuff. I continued to hear sounds all the way down to 0. I had to do this again, because I couldn't believe what I heard. Again, the pulse continued all the way down to 0. I asked permission to take another BP reading, this time on the other arm. Same scenario. On my sheet I put 112/0. I recall from EMT school, my instructor said we might encounter such a reading.

My Google skills disappointed me, because I wasn't able to find a clear answer. Anyone care to provide some medical background of a diastolic reading of 0? Also should I have been taking notice of a change in pitch? After the call, I told myself I should have listened for a pitch change during the second BP check or when checking the other arm.

Thanks.


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## Code 3 (Nov 21, 2008)

Consult your text book in the chapter regarding vital signs. Somewhere it should state that if you continue to hear sounds all the way down, you mark the diastolic when the sound began to _change_ (ie. went from a "swoosh" to a "thump").


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## Sasha (Nov 21, 2008)

Oh dear. I read that as "systolic=0" I was thinking "That's what we call dead, down here in Florida..."


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## daimere (Nov 21, 2008)

Code 3 said:


> Consult your text book in the chapter regarding vital signs. Somewhere it should state that if you continue to hear sounds all the way down, you mark the diastolic when the sound began to _change_ (ie. went from a "swoosh" to a "thump").



My textbook never mentions that.  That's good to know though.


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## BLSBoy (Nov 21, 2008)

Sasha said:


> Oh dear. I read that as "systolic=0" I was thinking "That's what we call dead, down here in Florida..."



Funny, we call that dead in New Jersey too.


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## Noctis Lucis Caelum (Nov 21, 2008)

I believe Lance Armstrong has a diastolic of 10? or somewhere really low


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## daedalus (Nov 21, 2008)

Next time that happens, put "systolic 112" on your paperwork. Do not put 112/0. You cannot have a pressure of 0 mmhg in the lumen of an artery if the patient has circulating blood. Next time get a second EMT or a Paramedic to check, because reporting impossible vital signs to the hospital staff will cause you to loose rapport with the nurses and doctors.


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## yowzer (Nov 21, 2008)

Code 3 said:


> Consult your text book in the chapter regarding vital signs. Somewhere it should state that if you continue to hear sounds all the way down, you mark the diastolic when the sound began to _change_ (ie. went from a "swoosh" to a "thump").



You're assuming the text book wasn't written for the lowest common denominator.

For example, the one I have handy (AAOS Emergency Care and Transportation of the Sick and Injured, 8th edition):



> Occasionally, when a patient's blood pressure is very low, you will continue to hear pulse sounds from the reading at which they started all the way until the gauge has reached 0. When this occurs, you should record the diastolic pressure as "0" or "all the way down" to indicate that it was not measurable by stethoscope.



Korotkoff sound? What's that?


From what I've seen glancing through someone else's copy, the 9th edition is dumbed down even more... :sad:


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## Code 3 (Nov 21, 2008)

yowzer said:


> You're assuming the text book wasn't written for the lowest common denominator.
> 
> For example, the one I have handy (AAOS Emergency Care and Transportation of the Sick and Injured, 8th edition):
> 
> ...



Yeah maybe it's just a Brady thing. My text book was Brady: Prehospital Emergency Care 7th ed.


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## NJN (Nov 21, 2008)

yowzer said:


> From what I've seen glancing through someone else's copy, the 9th edition is dumbed down even more... :sad:



It is, we used the 9th edition in my class and i had a hard time not falling asleep. It made it too too too simple.


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## Ridryder911 (Nov 21, 2008)

yowzer said:


> Korotkoff sound? What's that?




Okay, one more time. Apperantly EMT's are still * NOT* being taught how to properly take and document blood pressure. 







http://www.emtlife.com/showthread.php?t=4336

Blood pressure first reading would be systolic 100/ - . Problem is with that high of pressure one has a diastolic just *improper assessment*.


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## berkeman (Nov 21, 2008)

Ridryder911 said:


> Okay, one more time. Apperantly EMT's are still * NOT* being taught how to properly take and document blood pressure.
> 
> 
> 
> ...



Sorry, too many typos in your post to understand what you are trying to say.  Care to post again with edits?  This EMT is pretty good at recording vitals, including in the amblance over speed bumps, and at rock concerts, and with a Pt who won't sit still....


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## Ridryder911 (Nov 21, 2008)

Okay maybe a reading class to an additional how to take blood pressure class. 

One would NOT have a zero diastolic pressure with a systolic pressure of > 100mm/hg. I don't care how good they *claim * to be! 

If you do not hear the true Korotkoff sounds, then you are not taking a thorough and accurate blood pressure. If you do not know what those are, then you were not taught how to accurately and medically to take an accurate blood pressure. Period. 

Practice and learning how to distinguish ambient noise and those of the arterial sounds has to be practiced as well as tricks of the trade such as pillow around the limb, allotment of the limb to rest away from noise makers such as stretchers and road noise. 

Can you understand that? As well, look at the posts to refer to. This has been discussed several hundreds of times. 
R/r 911


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## daedalus (Nov 22, 2008)

When the hearts not beating, there is still blood in the artery! It does not disappear. Perhaps a physics/fluid dynamics class is in order but you CANNOT have a pressure of 0 mmhg in a tube with fluid in it! Repeat that a few times, rinse, and than repeat again.

Have your partner check. 

Realize that if you push this as the god almighty truth because your "good" at vital signs, your going to be put in your place quickly. Imagine a doctor doing her first echocardiogram read and telling her attending that the patient has no heart, and its the truth because I am very good at reading echos.


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## berkeman (Nov 22, 2008)

Ridryder911 said:


> Okay maybe a reading class to an additional how to take blood pressure class.
> 
> One would NOT have a zero diastolic pressure with a systolic pressure of > 100mm/hg. I don't care how good they *claim * to be!
> 
> ...



Thanks for the clarification; yes that helps.  I just honestly didn't understand what you were trying to say with:

"Blood pressure first reading would be systolic 100/ - . Problem is with that high of pressure one has a diastolic just improper assessment."

BTW, that steeles.com website you posted a link to in that older BP thread is very good.  Thanks for it:

http://www.steeles.com/catalog/takingBP.html

.


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