# taking BP



## mysterl33 (Mar 5, 2007)

Hey,

So yesterday we learned how to take blood pressure but my instructor went through it kindof fast. So can anybody help me understand what exactly I should be looking for?


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## firecoins (Mar 5, 2007)

you inflate up the cuff and place the scope on the artery.  You listen for the beat to start. Thats the systolic pressure.  When the beat stops again.  Its the diastolic pressure.


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## HorseHauler (Mar 5, 2007)

or you put the cuff on and hit the button and watch the numbers pop up... those are my favorite :lol:


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## firecoins (Mar 5, 2007)

yeah electric cuffs are easier.  If you could only do those on the exams


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## BossyCow (Mar 5, 2007)

Make sure you have good contact with the scope on the artery.  

Also, make sure your knee isn't resting on the railing on the gurney... lol  the road vibration can drown out the pulse.  

I recommend for all my students to just practice on everyone they know. Not just over and over on the same person but fat arms, skinny arms, old arms, muscular arms, kids arms. 

A lot of the problems that new EMT's have are based on them expecting everyone to be the way they are in the book.  People's anatomy is very different and getting used to finding pulses in odd little nooks and crannies is part of learning the craft.


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## Ridryder911 (Mar 5, 2007)

Ask and you shall receive!.. Seriously, most EMT's do not really know the steps of taking a blood pressure, which can be very important !


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## BossyCow (Mar 5, 2007)

Great visual aid Rid.  Do you have a link to it so I can print out a nice clean copy?


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## Ridryder911 (Mar 5, 2007)

A very good site, with insight of how and why you are hearing what you are hearing, much more than diastole and systole as well as how to correct pittfalls of taking a BP.

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


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## Nycxice13 (Mar 5, 2007)

Ridryder911 said:


> Ask and you shall receive!.. Seriously, most EMT's do not really know the steps of taking a blood pressure, which can be very important !


Never used all those steps, and my readings have been spot on.....


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## Ridryder911 (Mar 5, 2007)

I m sure you heard accurate blood pressures. However you actually never understood and really performed an accurate auscultated BP. Even though one could hear the "lubb dubb" at 140, one should be able to understand Korotkoff sounds. The same analogy of CPR could be made. Someone performing compressions correctly would be performing accurate CPR; however not knowing the steps and rational values is what separates us from common laymen and being a health care professional. 

Majority of EMT's are not trained and educated even in the simplicity of taking blood pressures because we continue to water down the EMT course to a first aid level, with the reasoning "they don't need to know this, because they won't understand"... which is nonsense. 


All these steps should be well understood to have an understanding of the steps of blood pressure. This is the  correct  way to perform taking a blood pressure... knowing the *accurate and proper* steps only demonstrates one understanding of assessment techniques. 

R/r 911


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## Trumajunkie (Mar 5, 2007)

The thing that really helped me is palpating the brachial artery. Do it every time before you inflate the cuff. It makes things alot eaiser, especially when going 55 with sirens blarring.


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## mysterl33 (Mar 6, 2007)

so just to clarify


Put the BP Cuff on so that it inflates over the artery
Palpate the pulse on the wrist
Place the stethoscope near the artery and begin to pump the BP Cuff
Listen for the artery to stop beating and take the number which because the systolic pressure
Start releasing the pressure slowly and listen for the artery to beat again this number is the diastolic pressure
Release the pressure all the way, take the cuff off, record the numbers.

is that about right?


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## Ridryder911 (Mar 6, 2007)

In summary yes.. remember auscultated BP are only an approximation. Each persons hearing varies. It takes a *lot* of practice. 

Palpation is an alternative way; whenever there is too much ambient noise and unable to auscultate a BP. Remember, you are only getting am approximate systolic reading. 

Good luck in school!

R/r 911


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## mysterl33 (Mar 6, 2007)

thank you everybody ^_^  now time to bother people with my BP cuff and Stethoscope h34r:


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## Alexakat (Mar 6, 2007)

...and don't be shy to pump up the cuff again if you're not sure.

When I first started, I thought I had to be all fast about it...but it's ok to take your time & get it right.  You will be in situations where it's loud & difficult.  Practice until it's 2nd nature (like everyone said, practice on your family, friends, etc...)

The basic skills are REALLY important (getting pulses, B/Ps, respirations, checking pupils, etc.).  If your instructor glosses over anything, ask questions...lots of them!  If you're shy in class, make sure you ask after class or during your instructor's office hours.


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## Alexakat (Mar 6, 2007)

se0u1sk said:


> so just to clarify
> 
> 
> Put the BP Cuff on so that it inflates over the artery
> ...



Clarification:
The pulse on the wrist (radial) is to be used when you're getting a palpated pressure.  You wouldn't use your scope for that...

The pulse on the inside of the arm (brachial) is to be used when you're obtaining a B/P by auscultation (with your scope).  Even though you're going to listen, palpating the brachial pulse before pumping up the cuff helps you get oriented with the whole area.


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## fm_emt (Mar 6, 2007)

Ridryder911 said:


> Palpation is an alternative way; whenever there is too much ambient noise and unable to auscultate a BP. Remember, you are only getting am approximate systolic reading.



Palpation is also a great tool for lazy firefighters. If they hand you a sheet with vitals and the BP says "120/P" - take your own set of vitals.


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## Recycled Words (Mar 6, 2007)

When I first started, I had a lot of difficulty getting it on my first shot. If you don't get it the first try, feel free to try a second time. If you think the BP you got was a bit off, try again.

The worst thing you could possibly do is make up the numbers. If you can't get it, ask your partner for a hand.


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## Emtgirl21 (Mar 7, 2007)

so ridryder911 do you enjoy working with an EMT partener or you prefer a paramedic?


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## FF/EMT Sam (Mar 7, 2007)

Recycled Words said:


> The worst thing you could possibly do is make up the numbers. If you can't get it, ask your partner for a hand.



^^^^One of the smartest things ever said on this forum.  

Also, you can hear most people's BP by listening in the center of the interior elbow.  However, some people's arteries are off to one side.  If I'm having trouble getting a BP, I release the cuff completely and feel the joint with two fingers.  Often, I can feel it elsewhere (usually closer to the patient's body), and I put the stephoscope there and try again.

Getting a BP usually isn't that hard, but it takes some practice.  Good luck!


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## Ridryder911 (Mar 7, 2007)

Emtgirl21 said:


> so ridryder911 do you enjoy working with an EMT partener or you prefer a paramedic?




I really don't care what level you are, and work with all levels. As long as you perform good patient care and are proficient. Being friendly to patient, families, and other members of the patient care party. I believe anyone can learn at all times, so being stagnant is one of the most hidden dangers is in this profession.


R/r911


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## Airwaygoddess (Mar 8, 2007)

And once you locate the spot, mark an X on it, makes it easier to find it again and when checking pulses anywhere on the body esp. trauma calls X marks the spot for rechecks as needed.


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## Jon (Mar 15, 2007)

fm_emt said:


> Palpation is also a great tool for lazy firefighters. If they hand you a sheet with vitals and the BP says "120/P" - take your own set of vitals.


Palpation can be useful.... and is often better than nothing... but I'd beware any B/P that is 120/80 or 120/p!


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## Medic's Wife (Mar 15, 2007)

Question- do you all find the readings from the automatic cuffs any more/less accurate than doing it the good old fashioned way?  I can be a little skeptical of technology at times....


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## Jon (Mar 15, 2007)

Medic's Wife said:


> Question- do you all find the readings from the automatic cuffs any more/less accurate than doing it the good old fashioned way?  I can be a little skeptical of technology at times....


Depends. If I get ONE manually, and the machine gives something close, than I've got no problem. If it gives me something that is WAY off what I heard, I don't trust the machine.


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## Airwaygoddess (Mar 15, 2007)

^_^ I'll do manual BP's over auto any time, My ears have not let me down yet!


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## mysterl33 (Mar 16, 2007)

ok another question. when we're listening through the stethoscope, are we listening for a wheesing sound or a regular "thump"?


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## Recycled Words (Mar 16, 2007)

You should hear both a whooshing sound and a thump, but you count by the thumps


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## 94accord (Jul 10, 2007)

se0u1sk said:


> so just to clarify
> 
> 
> Put the BP Cuff on so that it inflates over the artery
> ...



Relatively correct... with some minor modifications. Honestlyi surprised Ryder did not comment on it.
I find it easier to get both pressures on the release of air as opposed to trying to get the systolic as your are inflating the cuff. Not only does this make your reading more accurate, but it also decreases the ammount of time that the PT has decreased or no bloodflow in their arm.

Second, the Diastolic pressure is not when you hear the sounds again. After you have inflated your cuff, you would start deflating the cuff. When you hear the sounds start, thats your systolic. Continuing to deflate the cuff, when you hear the sounds again, THAT is your diastolic pressure. 

I hope this clarifies a possible missunderstanding.


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## Jay114 (Jul 10, 2007)

94accord;53115
 Continuing to deflate the cuff said:
			
		

> I thought when the sounds stop, or change (become "dull") that was your diastolic.


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## 94accord (Jul 10, 2007)

Jay114 said:


> I thought when the sounds stop, or change (become "dull") that was your diastolic.



you got me... thats what happens when you are coming off a 24 hour with only 12 hours down before another 24 lol... thank you for correcting my oversight.


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## MRE (Jul 11, 2007)

I am in the middle of a Basic class too, and my instructor has come up with a good way to get us to practice taking vitals.  He handed out a sheet with every student's name on it and spaces for their vitals.  By the end of the course we need to hand in the completed sheet in order to pass.  So in effect we need to take about 20 sets of vitals on all different types of people.  Besides the basic respiratory rate, pulse, and BP, we are also doing lung sounds and pupils.  Supposedly we have one person in the class with unequal pupils that we have to find too.

I thought this was a really easy but effective way to give everybody practice doing vitals on a variety of body types.  If anyone thinks this would help them or their class, please pass the idea on to your instructor.


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## Teufulhunden0321 (Jul 11, 2007)

Inflate the cuff to at least 200...let the air out about 2 mm a second...the first thump you hear is the systolic. and the last thump you hear is the diastolic


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## Airwaygoddess (Jul 13, 2007)

Another good way to practice is to take your BP cuff and stethoscope and practice taking them in a moving car with your friends and family.  You will be surprised at how much harder it is to listen with all of the backround noise.  Another tip is once you can hear the BP, take your pen an make a small x on the spot.  This way it will go a little faster when rechecking the BP.  It is also a great tip when checking for pulses and you need to do rechecks for trauma and medical calls  for the arms and legs. Pulses-Motor-Sensation= PMS.  Hope this helps!


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## Tincanfireman (Jul 13, 2007)

All good stuff here, and now practice, practice, practice!  In addition, don't be surprised if you come up with some elevated numbers in your older (probably >30 yo) friends and family.  Hypertension is truly a silent disease and many people have no idea that they are walking around with dangerous numbers.


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## Thanach (Jul 14, 2007)

Tincanfireman said:


> All good stuff here, and now practice, practice, practice!  In addition, don't be surprised if you come up with some elevated numbers in your older (probably >30 yo) friends and family.  Hypertension is truly a silent disease and many people have no idea that they are walking around with dangerous numbers.



Or you can get the routine call (i.e. Dialysis Txp) that turns to hell and back cause you take their BP and it's oh, say 70/40 when it's usually in the 120's over the 70's, and by the time you get to the hospital that's five minutes away it's even lower...


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## Emtgirl21 (Jul 14, 2007)

been there done that


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## Thanach (Jul 15, 2007)

Emtgirl21 said:


> been there done that



yep, me too, ain't those the fun ones?

although, they can suck too, you've had a busy day of s:censored:ty stupid pointless calls, and then you get one last easy one that turns out to be the worst of the day

i'm sure you know that feelin...


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## Airwaygoddess (Jul 15, 2007)

Dialysis patients have a very complex medical history and these folks are sick, period.  This is why it is important to montior these patients very closely pre and post dialysis treatment.  Besides the fluid overload and eletrolyte issues, there could and can be also diabetic problems as well, i.e. low blood suger.  There are times that these patients have too much fluild removed and they are too dry, resulting in a very low BP or their blood sugers are very low due to not eating before their treatments (they can have nausea during their treatments)  Please remember that any patient can crash at any time, no matter if the call is "routine" or "bull poop".


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## RedZone (Jul 15, 2007)

Medic's Wife said:


> Question- do you all find the readings from the automatic cuffs any more/less accurate than doing it the good old fashioned way?  I can be a little skeptical of technology at times....



_In general_, less accurate.  I find they tend to err on the high side fairly routinely, especially some of the older models.  I've had problems at some facilities when I bring them hypotensive patients.  

The newer models seem to be more accurate.  I agree with what Jon said.  I also find the automatic machines are great for monitoring usage, and much less useful for triage or acute care use.  If I'm monitoring hemodynamic status, I'm perfectly ok using a machine that has an error tendency, as long as it's consistent.

That's the same feeling I have about BPs by palp.  Just tonight I had a critical APE patient.  I ended up administering 5 sublingual nitros, nitropaste, and lasix (I know... lasix is going out of style these days).  Plus he was already being treated for pneumonia.  I was extremely concerned about his BP, but I already had three auscultated BPs so I was perfectly comfortable with palping the rest..... at that point I'm less interested in the actual pressure than I am with monitoring his general hemodynamic status.


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## Tincanfireman (Jul 15, 2007)

Good points, Goddess; not to mention the reduced circulation, peripheral neuropathy, and (oftentimes) cardiac issues (CHF) that these patients can present with, not to mention improper bandaging of the shunt site with the associated heavy bleeding, fluid overload in the lungs, and hypoxia if their O2 isn't maintained for the several hours of treatment.  Kind of turns the "Renal Roundup" into somewhat of a wild rodeo when you have a patient like that!


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## RedZone (Jul 15, 2007)

Teufulhunden0321 said:


> Inflate the cuff to at least 200...let the air out about 2 mm a second...the first thump you hear is the systolic. and the last thump you hear is the diastolic



200 might be a little on the painful side for some patients.  

The PROPER way is to palp first and then inflate 20-40 mmHG over ther palped systolic to auscultate.  

In practice, I generally listen while I inflate to a range of about 100-120 where I would expect to hear thuds on a good majority of patients... then I inflate more until I don't here them anymore... deflate slowly until the thuds return (systolic) and continue deflating until thuds go away (diastolic).


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## eggshen (Jul 16, 2007)

5 pages of posts on B/P taking. Is it that hard?

Egg


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## Airwaygoddess (Jul 16, 2007)

eggshen said:


> 5 pages of posts on B/P taking. Is it that hard?
> 
> Egg



No just learning good technique and skill.


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## Thanach (Jul 16, 2007)

Airway, methinks we are on the same page, I absolutely agree with you, but not only dialysis patients, any patient with a chronic, severe medical problem should be monitored, no matter how minor or simple the call. you never know what could go wrong.


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## eggshen (Jul 17, 2007)

If someone would like to burn loads of pages on "technique and skill" let's talk about "history taking" for a spell shall we? How about giving our line of work some respect and not cutting loose for days on end regarding something that is really one of the most simple things we do(next to showing up for work). Please, keep in mind that I take no issue with very newly trained people trying to sort this out. However, when there are people with so called "experience" going on about "this way and that way" I hope that I never land up in some other town finding myself with the need to call 911. "Oh good golly!!!!! What should the top number be and what is the best way to recite it!?!?!?" I know full well that this a "BLS" post but please...do not insult those of us that are able to grasp the most humble of tasks. If you need to go back and forth about something that even the most simple of fools can explain I suggest football. 

Egg


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## BossyCow (Jul 17, 2007)

Egg, a discussion like this happens because as new members hit the site, comments are made on old posts and a thread is revived.  If you don't like a particular thread, perhaps you could start one on the topic you would like to see.  

We all have our ways of doing different tasks, even the easy or basic ones.  Hearing a different technique can be educational.  I do a lot of teaching. Often one technique doesn't work for every student.  It's nice to hear a different approach that might work for a student who is having a difficulty with a particular task. 

You will find in EMS that there are a billion ways to 'skin a cat' and everyone has their firmly held opinion on why someone else's method is anything from inefficient to downright dangerous.


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## MICU (Jul 18, 2007)

BossyCow said:


> Make sure you have good contact with the scope on the artery.
> 
> Also, make sure your knee isn't resting on the railing on the gurney... lol  the road vibration can drown out the pulse.
> 
> ...



It is prertty easy to take BP on a healty guys, the real practice is on hard pts. Also try to take the systolic without scope, but with your fingures on the Radial A. you will fill only the systolic, we usally use this method in Trauma when the systolic is more vatial.

Good luck


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## Arkymedic (Aug 14, 2007)

Ridryder911 said:


> I really don't care what level you are, and work with all levels. As long as you perform good patient care and are proficient. Being friendly to patient, families, and other members of the patient care party. I believe anyone can learn at all times, so being stagnant is one of the most hidden dangers is in this profession.
> 
> 
> R/r911



complacency kills


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