# BP Cuffs?



## chilipepper25 (Aug 12, 2010)

What's the norm on a truck? Is it the old fashioned stethoscope/pump method or are electronic ones typically used? It would seem that an electronic one would be more accurate and less of a hassle (not saying it's much of a hassle anyway) in a noisy environment. Sorry if this is a foolish question, I'm just curious.


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## Shishkabob (Aug 12, 2010)

It wholly depends on the agency.


NIBP (automatic) cuffs are getting more prevalent because they are built in to the new cardiac monitors, but it is still generally recommended that the first pressure be manual.


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## Sassafras (Aug 12, 2010)

We have both but I prefer the manual because I feel I can "hear" the difference between a bump and a heart beat better than the automatic can differentiate.


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## mar7967 (Aug 12, 2010)

We have NIBP on our trucks...but we are highly encouraged to get at least one manual during the call (preferable first). I usually take one or two manual, and switch to the NIBP during transport.


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## sir.shocksalot (Aug 12, 2010)

chilipepper25 said:


> What's the norm on a truck? Is it the old fashioned stethoscope/pump method or are electronic ones typically used? It would seem that an electronic one would be more accurate and less of a hassle (not saying it's much of a hassle anyway) in a noisy environment. Sorry if this is a foolish question, I'm just curious.


I just read a study that found a significant difference between manual and automatic cuffs, I don't think it was a huge difference but it was "statistically significant". Anyway like others have said we have both, on more routine pt's where pinpoint accuracy in a B/P is not necessary and I'm feeling lazy I'll use the NIBP machine. If I need a pressure to base my treatment or impression on I'll use a manual.


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## MMiz (Aug 12, 2010)

Even though our ALS rigs had automatic cuffs on their LifePak 12s, I can't ever remember it being used for an initial assessment.  I found that using a manual cuff only takes a few seconds after you've been doing it long enough.


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## MasterIntubator (Aug 12, 2010)

We have both ProPaq and LP15 with NiBP, but by personal choice I do all manual BPs. ( quicker ( less movements ), less painful, and I use the BP as a tourniquet as I can titrate the pressure to the vein )


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## Akulahawk (Aug 12, 2010)

I've had access to both... and frankly, while I prefer manual (same reasons as MI) I really don't care which one I use. I try to get a manual on scene and an NIBP shortly after so that I can compare the two, if NIBP is available. After that, I care more about the trend and response to interventions than the actual numbers.


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## Dominion (Aug 12, 2010)

We carry manual and automatic (built into our LP15's).  I LIKE to get a manual first, I hate to say it doesn't always happen but I think probably 90% of the time I get a manual first.  After I get my manual I put them on the automatic and let it do it's thing while I do all my other stuff.  If it's in the neighborhood of the patients pressure I let it be.  If it starts to get whacky or the patients condition starts to change I switch back to manual if I have the hands (atleast grab a quick palp if I can).  

NIBP is a good tool but you can't rely on it and as always treat your patient not the monitor.


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## livewiremaxx (Aug 16, 2010)

For us on our medic rigs, and basic rigs we have Manual.  For our ALS rigs we have monitor as well as manual.  I prefer starting out with Manual, transfering over to auto and then seeing them match up.  Then I know the accuracy of the reading. 

Its always wierd going in to do ER time and have them all hooked up Auto and never once do a manual.


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## medicRob (Aug 16, 2010)

MMiz said:


> Even though our ALS rigs had automatic cuffs on their LifePak 12s, I can't ever remember it being used for an initial assessment.  I found that using a manual cuff only takes a few seconds after you've been doing it long enough.



I will usually get my first pressure manually on the scene, once we get in the rig, I will set the Zoll to Auto NIBP and my interval to q5.


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## Sassafras (Aug 16, 2010)

sir.shocksalot said:


> I just read a study that found a significant difference between manual and automatic cuffs, I don't think it was a huge difference but it was "statistically significant". Anyway like others have said we have both, on more routine pt's where pinpoint accuracy in a B/P is not necessary and I'm feeling lazy I'll use the NIBP machine. If I need a pressure to base my treatment or impression on I'll use a manual.



I dunno what we are counting as statistically.  Our on board automatics are at least 10 pts higher which can mean the difference between interventions in some cases.


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## EMS49393 (Aug 16, 2010)

NIBP stands for "non-invasive blood pressure."  Manual and automatic blood pressure cuffs are both NIBP methods.

I use both. I get my own pressures, not that I don't trust my EMT's but I'm a little OCD in my assessment. After a manual I'll set the auto cuff but if it gives me an off the wall reading I'll recheck it manually. I generally have no difficulty hearing even in the back of a running ambulance.


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## hocomedic (Sep 15, 2010)

When im on scene, like in someones house we generally dont take our lifpak 12 unless its a cardiac call. I get a manual bp first, then proced with the call then i get the NIBP in the ambulance once we get in and once when we reach the ER.


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## FreezerStL (Sep 16, 2010)

I'm in the boat with everyone else....

I've seen the Lifepak 15s we use be off by a fair margin. I will always get a manual first, then set up the auto as I'm hooking up the pulse Ox and ECG and compare the results when I'm finished.

A manual BP will only take a minute. You'll also get valuable information your monitor will not show: Is the frequency regular? Is the pulse pressure weak? ....  ^_^


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## NepoZnati (Sep 18, 2010)

Sassafras said:


> I dunno what we are counting as statistically.  Our on board automatics are at least 10 pts higher which can mean the difference between interventions in some cases.


Yesterday my Pt had 212 systolic (measuring with auto BP cuffs) but manually (according to my partner) he had 174... That much difference?! When I question MD about why they use auto BP cuffs if/when are so unreliable and they always use manually check, she gave me no real answer except "convenience" and "speed".


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## lightsandsirens5 (Sep 18, 2010)

MMiz said:


> Even though our ALS rigs had automatic cuffs on their LifePak 12s, I can't ever remember it being used for an initial assessment.  I found that using a manual cuff only takes a few seconds after you've been doing it long enough.



We have Zoll Ms with Auto NIBP, but nobody uses them. They read so much different than manuals do. Besides, like Matt said, with practice, a manual can be very quick. I have actually raced the machine and I consistently can beat it and still get an accurate B/P.


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## TonyB (Sep 20, 2010)

*all on prefrence*

i personally like doing it manual. you have complications with electronic ones cause your always bouncing everywhere and vibrations. but of course its up to agency and what you like.


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## Trip (Sep 26, 2010)

chilipepper25 said:


> What's the norm on a truck? Is it the old fashioned stethoscope/pump method or are electronic ones typically used? It would seem that an electronic one would be more accurate and less of a hassle (not saying it's much of a hassle anyway) in a noisy environment. Sorry if this is a foolish question, I'm just curious.



My fire/rescue company is still old school and does it manually. The company I work for does both and company policy is the first one be manual. I prefer to get the first one and third one manually as it can back up the accuracy of the NIBP on our monitors.


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## emt_irl (Sep 26, 2010)

theres no hardline rule with my company but i prefare taking it manually myself so i dont loose the skill.


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## JJR512 (Sep 26, 2010)

hocomedic said:


> When im on scene, like in someones house we generally dont take our lifpak 12 unless its a cardiac call. I get a manual bp first, then proced with the call then i get the NIBP in the ambulance once we get in and once when we reach the ER.



Howard County's policy is the first is always manual.


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## MrBrown (Sep 27, 2010)

Manual has its place to build and retain the skill of getting a pressure however if the patient is really sick or you have a lot of things to do then I will go with the NIBP.


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## Charmeck (Oct 15, 2010)

We only take manuals, though our monitors have the funtionality of an automated one.  I like to hear my BP if I'm basing a treatment off of it.


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## nakenyon (Oct 15, 2010)

Running on a vollie BLS truck, We exclusively carry normal old-fashioned BP cuffs as we don't have a cardiac monitor with the built in NIBP cuff. However, when we rendezvous with ALS, I usually try to have at least one or two manual pressures before we rendezvous and attach the NIBP cuff.


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## Medic41Mike (Oct 17, 2010)

JJR512 said:


> Howard County's policy is the first is always manual.



It is a County Policy that all BP's must be obtained manually for San Joaquin County as well. This includes ALS, BLS as well as any Inter-facility transfer.

Being on a Medic Unit for the past 5 years, I have seen countless mis-readings by the NIBP by +or- at least 10 points. + or - 10 points can make a huge difference in examing a Pt for orthostatics as well as other procedures. In the end, we try to stay away from the NIBP when examing Pt Vitals.

What's also sad is, I was a FTO (Field Training Officer) and I couldn't believe how many new hires could not conduct a Manual Blood Pressure. When I asked why, many stated, "Oh, we just used the Automatic One" in our EMT class. Makes me think what the heck kind of school did you go to???


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## izmedaemt (Nov 6, 2010)

i have seen the nibp give a bp of 200/70 when the manual was 114/60 you be the judge


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## VirginiaEMT (Nov 6, 2010)

I instructed a preceptor to always get a manual B.P. and pulse first. It teaches them to feel for irregularities in the pulse, and they can also hear some abnormal rythyms through ausculating the B.P.


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## Cohn (Nov 6, 2010)

My dept has a NIBP and Manuals.

I like to get my first with a NIBP just so I can be doing other things when it is thinking and if I have time to do a manual I do so I can stay fresh with it.

NIBP is nice to have it cuts down on the time it takes to get initial vitals.

I have also come to learn that when the NIBP does not read the first time that the second time it tries and reads and gets a number it is usually wrong, in that case I just do manual.


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## TransportJockey (Nov 6, 2010)

Unless it's a crazy scene I'll get the first one manually and then see what the monitor gives me. If it's close (+/- up to 5 points) I'll go with it for the call


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## clibb (Nov 6, 2010)

I will take a manual on scene, then one or two during transport depending on ETA. 
If I can't get a BP, then I'll use the NIBP.


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## emtchick171 (Nov 6, 2010)

For my initial B/P I ALWAYS take it manually, just more accurate than an electronic/automated. However, after I take my manual, I place the automated cuff on (from the heart monitor)...and keep a constant check on their B/P throughout transport.


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## DarkStarr (Nov 8, 2010)

izmedaemt said:


> i have seen the nibp give a bp of 200/70 when the manual was 114/60 you be the judge



something like this would be disputed with the first manual BP, and being so off the wall, would be verified with another manual.


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