# Auto BP Low



## LukaPL (Jan 31, 2009)

we had a call to a very low BP patient. When we came toa nursing home nurse told us that BP was 56 /20. Before calling med unit I checked it and it was 130/68. I thought that Im wrong so I checked three times and result was this same, then I asked my partner to check it too and difference was very small 132/66. We asked nurse who checked the BP, she said that she used the electronic one. When she went to bring it i checked other vitals and pt had very irregular HR, she had cardiac history. Long story short, three electronic pressure cuffs showed very low BP but with regular cuff was within normal limits. I was thinking  that arrythmia could made BP go low. Anyone any thoughts?


----------



## MMiz (Jan 31, 2009)

I created a new thread for your situation.  Hopefully someone has some feedback for you.


----------



## artman17847 (Jan 31, 2009)

depending on the type of electronic measuring device that is being used, most electronic type of B/P machinces measure the pressures that are created in the arteries by the pulse or "pulse pressure" therefore a pt experiencing a severe dysarrthmia as in a very irregular pulse can make it difficult for the machine to properly obtain a reading. So the answer to your question is yes an irregular pulse can cause inacurate readings.


----------



## Aidey (Jan 31, 2009)

I use Auto BPs at work all the time and if the cuff is loose, over clothing, or a lot of fat it can throw the results off too. I've noticed some of ours are very picky, and you have to put the cuff on where it is anatomically supposed to go or you get strange results. So if that little arrow that says "Place artery here" is on the back of their arm the results could be off too.


----------



## medic417 (Jan 31, 2009)

Aidey said:


> I use Auto BPs at work all the time and if the cuff is loose, over clothing, or a lot of fat it can throw the results off too. I've noticed some of ours are very picky, and you have to put the cuff on where it is anatomically supposed to go or you get strange results. So if that little arrow that says "Place artery here" is on the back of their arm the results could be off too.



You mean thats not just for decoration?  Sad how many times I have seen that when people claim BP is some wild number that doesn't match up with with patients S/S's.


----------



## marineman (Feb 1, 2009)

Machines can and will be wrong, that's why most areas require at least the first BP to be done manually then see if the machine at least comes close to what you get. 

Like was mentioned there is a variety of things that can cause the incorrect reading in the machine so trust your judgment and look at the patient and that can give you a pretty good idea if the machine is accurate or not.


----------



## Aidey (Feb 1, 2009)

medic417 said:


> You mean thats not just for decoration?



You wouldn't _believe _the number of times I encounter that a day while at work. I'll hear someones BP alarm go off, and go and check them and it says 52/26 and the patient is sitting there watching TV. I'll look at the cuff and the arrow is pointing to the back of their elbow, and the cuff is really low on their arm. A quick re-adjust and it's a miracle! Their BP is normal again.


----------



## LukaPL (Feb 1, 2009)

yeah I have to be careful with those electronic cuffs
Last night nurse almost yelled at me that I dont believe her about  vitals she performed
she insisted that I dont have to check them because she did.
Finally I told her to let me earn my buck. It helped


----------



## EMTinNEPA (Feb 1, 2009)

I trust a BP cuff and a set of ears over a robo-nurse any day.  I do not trust technology.


----------



## Sasha (Feb 1, 2009)

Little hint from my IFT experience: Just because they wear scrubs doesn't mean they know how to check a BP. I NEVER trust the "last set" a nursing home RN/LPN/CNA gives me because too many times I've gotten a 122/84, done my own and get a systolic in the 150's or the 80's.

And also on that note, I never trust the BP I get from my partner unless I've worked with them before for the same reason.

Always do your own manual BP first. Easiest way to never get burned.


----------



## Doug (Feb 1, 2009)

I have found that in extreme bradycardia auto cuffs may read low.  As the mmHg may drop significantly between beats.  I have reproduced this effect while taking a BP the "right" way and letting the pressure out too quickly.  Auto cuff is usually fine for  "healthy" individuals.


----------



## rhan101277 (Feb 1, 2009)

They use auto cuff at the hospitals all the time.  I never see a manual bp taken.


----------



## BossyCow (Feb 1, 2009)

rhan101277 said:


> They use auto cuff at the hospitals all the time.  I never see a manual bp taken.



Probably because they are counting on that manual BP you took in the rig as a baseline.


----------



## mycrofft (Feb 2, 2009)

*Or they are falsifying their VS's.??*

Just today a pt with extremely good cardiovascular status (actual BP 102/56, pule 56 regular, very fit, runs miles a week except when incarcerated) caused the "nurse on a stick" as some folks call them to give us a BP of 83/57.
No matter if your VS resemble the earlier ones, make sure you did them right, then report 'em. It's the "incredible" changes which can signify a patient getting worse very fast.


----------



## Doug (Feb 2, 2009)

I've had other problems with auto cuffs and nurses.
Brought in a flooding CHF'r with BP 300+ sys. (pumped it up to 300 and still had strong pulse.
  Brought the pt in and the nurse put her on the auto.  It failed to read.  She then proceeded to ask me why I put NTG paste on soemone who is so hypotensive they don't register.  I said your auto cuff doesn't go high enough it tops out at 250 sys. So she hits the button again and proceeds to wipe off the paste.  Same BP result will not register.  I said take a manual pressure, your cuff is set to release at 250.  She ignores me 3 more times.  Finally the Dr. comes in  (he used to be a paramedic believe it or not) the nurse tells him "He brought the pt in with paste on and gave lasix now i  can't get a pressure"  I finally looke at the Dr. and told him the same thing. Finally HE goes and gets the man. cuff tries it...sure enough 290 sys.  I found out later that they called and confirmed with equip maint. that yes indeed the auto cuffs were set for 250 max.  They later reconfigured one to go to 310mmHg and labeled it "For Use With Extreme Hypertension"


----------

