# Blood Pressure Question..



## himynameismj (May 16, 2009)

Hey,
I know this is a real new guy kind of question but..
Can you obtain a BP under 80 systolic by Palpation? ex: (42/P)

I keep hearing a lot of people with totally paradoxical answers acting as if they're 100% correct. I want to see if I can find a consensus here.

Thanks.


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## LucidResq (May 16, 2009)

I've always been told that at a certain point you usually lose your radial pulse, so getting a very low BP by palp is impossible. I'm trying to remember exactly what the numbers were.... think that you have to have a minimum systolic BP of 80 to have a radial pulse... something like that. Anyone know what I'm talking about?


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## Buzz (May 16, 2009)

LucidResq said:


> I've always been told that at a certain point you usually lose your radial pulse, so getting a very low BP by palp is impossible. I'm trying to remember exactly what the numbers were.... think that you have to have a minimum systolic BP of 80 to have a radial pulse... something like that. Anyone know what I'm talking about?



I've heard that as well. Never gotten to test it out though.


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## reaper (May 16, 2009)

I have seen radials as low as 60, but never 42!


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## Shishkabob (May 16, 2009)

Lucid, you're thinking of the 80/70/60 rule which has been debunked.


It's supposed to pertain to the radial, femoral, and carotid pulses.


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## Mountain Res-Q (May 16, 2009)

From what I remember:

If the only palpable pulse is the carotid pulse the systolic blood pressure is 60-70
If both the carotid and femoral pulses are palpable the systolic blood pressure is 70-80
If the radial pulse is also palpable the systolic blood pressure is at least 80

However, I recently read something, don't know where, that called this formula into dispute; something about flaws in the research that conclusion, but I don't remember the details, only that this formula was maybe not as acurate.  However, even if these facts are wrong, I would argue that it doesn't seem possible to get a 42 systolic by palp... at least I haven't.


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## trevor1189 (May 17, 2009)

Can't palpate a radial pulse? Thigh cuff on the neck and palpate the carotid. Problem solved. 



just kidding of course.


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## BruceD (May 17, 2009)

trevor1189 said:


> Can't palpate a radial pulse? Thigh cuff on the neck and palpate the carotid. Problem solved.
> 
> 
> 
> just kidding of course.



The sad part is...you had to add that last line...


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## MSDeltaFlt (May 17, 2009)

Mountain Res-Q said:


> From what I remember:
> 
> *If the only palpable pulse is the carotid pulse the systolic blood pressure is 60-70*
> *If both the carotid and femoral pulses are palpable the systolic blood pressure is 70-80*
> ...


 
This is a clear cut case of "never say never, never say always" in regards to the human body.  Because once you do, you will find a human body to prove you wrong; up to and including no ausculatory BP whatsoever but a very faint radial pulse.  Which a pt will lose eventually.  Bullets through a femoral artery tend to have said results.

In my 20+ years of treating the sick and injured, I have seen this formula hardly ever proven accurate.  It is little more than a guess in my exerience and opinion.  

Where ever you feel a pulse, it only means one thing.  That you have a blood pressure that far and that far only.  Where ever you feel a pulse, have good cap refill, and good mentation, then you have a *perfusing* blood pressure that far and that far only.

Giving hard core numbers where you cannot *prove* that there actually are hard core numbers tend to get ripped to shreds by those with J.D. behind their names.


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## AJ Hidell (May 20, 2009)

MSDeltaFlt said:


> Where ever you feel a pulse, it only means one thing.  That you have a blood pressure that far and that far only.  Where ever you feel a pulse, have good cap refill, and good mentation, then you have a *perfusing* blood pressure that far and that far only.


Quoted for emphasis.

A pulse by itself (and a BP too, for that matter) is nothing but an isolated piece of the puzzle.  The old skool theory that you could just grab a pulse and somehow know your patient's hemodynamic stability should be dead and buried.


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## SemiMedic (Jun 7, 2009)

LucidResq said:


> I'm trying to remember exactly what the numbers were.... think that you have to have a minimum systolic BP of 80 to have a radial pulse... something like that. Anyone know what I'm talking about?




Correctomundo!


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## reaper (Jun 7, 2009)

That is not an accurate way of figuring it out. You can have someone with a radial at 60 or have someone that loses a radial at 80. Every pt is different. I wish they would stop teaching that in EMT schools!


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## Shishkabob (Jun 7, 2009)

SemiMedic said:


> Correctomundo!



No... it's not.


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## Luno (Jun 7, 2009)

himynameismj said:


> Hey,
> I know this is a real new guy kind of question but..
> Can you obtain a BP under 80 systolic by Palpation? ex: (42/P)
> 
> ...



You can obtain a BP under 80 systolic by Palpation, the guidelines of 80/70/60 have been disregarded, yet it is amazing that it's still being taught by misguided instructors...   There's a graphical illustration as well as their findings... 

http://www.bmj.com/cgi/content/full/321/7262/673


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## Melclin (Aug 8, 2009)

Luno said:


> You can obtain a BP under 80 systolic by Palpation, the guidelines of 80/70/60 have been disregarded, yet it is amazing that it's still being taught by misguided instructors...   There's a graphical illustration as well as their findings...
> 
> http://www.bmj.com/cgi/content/full/321/7262/673



That article only had some 20 participants and no information on their status: were they under anesthesia etc? And conducted over the course of three years...odd. 

Having said that I disagree with the 80/70/60 because its just absurd, and it's no longer taught in the ATLS for physicians anyway.

Does anyone know of anymore research into the relationship between palpable pulse and perfusion/MAP/BP?


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## Shishkabob (Aug 8, 2009)

Luno said:


> You can obtain a BP under 80 systolic by Palpation, the guidelines of 80/70/60 have been disregarded, yet it is amazing that it's still being taught by misguided instructors...   There's a graphical illustration as well as their findings...
> 
> http://www.bmj.com/cgi/content/full/321/7262/673



It's not just instructors stating it... I've had doctors and nurses quote it as well.


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## usafmedic45 (Aug 8, 2009)

> That article only had some 20 participants and no information on their status



I get annoyed when people assume that you have to have hundreds or thousands of people in a study for it to be valid.  If a finding in a small group is significant enough, you can rely upon the data.  Not that I think you didn't already know this, but rather I am just saying it for the benefit of a lot of the members here who are ignorant of or extremely misguided in regards to statistics.  



> were they under anesthesia etc


Judging by,  "Not all pulses were palpable when a reading was taken because a sterile operating field impaired access to the patients", I would wager they were. 



> The 20 sequential patients studied over the three year period



They probably spread it out in small groups over a period of time eliminate problems with interrater reliability.  If you take a look at the chart showing the distribution of the presence of a pulse across BP, there are a total of thirty points so I wonder if they may have actually had 30 subjects (or they just used patients more than once as the BP changed) and there was some sort of typo in reporting the number of subjects.


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