# Im bad with blood pressures



## GraysonK (Aug 7, 2006)

I am....awful at getting patients blood pressures (Im discovering)

Any advice?

I usually just...cant hear it, I dont know whether I've positioned my stethoscope wrong, or if Im just not listening well enough

And Im not sure which sound to record systolic on, as I often hear a very faint noise that is nothing like the "pffts" later heard, that is in line with their pulse...



Any advice- besides practice more?


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## MariaCatEMT (Aug 7, 2006)

GraysonK said:
			
		

> I am....awful at getting patients blood pressures (Im discovering)
> 
> Any advice?
> 
> ...




*I'm sure you'll get much better answers than mine, but here goes. When I take pressures I use the correct sized cuff (generally for adults it's like this: regular cuff for under 200 #, large cuff for over 200 #). Too large or small a cuff can adversely affect your reading (higher or lower by many points). Once I have the cuff firmly (not loose nor too tight) and before I inflate it I always check for a pulse distal from the cuff. I place my steth bell on the pulse point, then inflate the cuff (unless I suspect otherwise generally to about 200), and release the air slowly...sometimes releasing the air too quickly can keep you from hearing well. Anyway.....other than that, practice, practice practice! Takes time, especially in noisy environments to pick it up. If you are a student, let your instructor know you're having trouble too. He or she will be glad to help you, give you tips, etc. I can do it (check BP's) faster than I can try to explain it in here. I hope I explained it OK. Good luck.*


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## doc5242 (Aug 7, 2006)

just Palpate it, the bottom number doesnt mean anything anyway.


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## DT4EMS (Aug 7, 2006)

Try this:

Once your cuff is on, palpate the pules first. Tap the bell on your steth to make sure it is in proper position.

Place the bell at the exact point where you felt the pulse. If you are still haveing trouble, and it doesn't hurt your patient, straighten their arm out. 

Also if it is in the back of the ambulance where you are having trouble, keep your elbows from touching your legs/knees. The vibration comes up through your  legs making it difficult to hear.


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## gradygirl (Aug 7, 2006)

Make sure the bell of your scope is turned on. We had a "mysterious" string of unattainable BPs due to the fact that someone kept turning off the bells.


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## doc5242 (Aug 7, 2006)

TCERT1987 said:
			
		

> Make sure the bell of your scope is turned on. We had a "mysterious" string of unattainable BPs due to the fact that someone kept turning off the bells.




thats funny..did you know that bill cosby was once a navy corpsman, he was kicked out for "gundecking"  or making up blood pressures.


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## Tincanfireman (Aug 7, 2006)

Try a different stethoscope if you've been using the same one, or try a different type.  Some folks won't go near a Sprague with a ten-foot pole, while others swear by them. I know this might ignite a firestorm of controversy, but it seems to me that spending a few $$ more provides a better result, too. Another trick is to put your palm under the pt's elbow and (gently!!) hyperextend it; especially helpful when your pt is on the large side.  Also, (as stated here earlier) practice is essential; when you finally get a method that works you will wonder how you ever had trouble before. The trick is to find what's "right" for you.


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## Ridryder911 (Aug 7, 2006)

doc5242 said:
			
		

> just Palpate it, the bottom number doesnt mean anything anyway.


What ? 

I am sure you were kidding .... as well palpating is only a "guess" of what perfusion level is and it has never been scientifically proven to near accurate.  

As others have described are very good suggestions and  here is some form an oldmedic.. 

Like others have described be sure to be able to "palpate"  the pulse first.. not doing so, means you are not probably placing the diaphragm at the proper spot. Remember, as well BP actually has 4 Korotkoff sounds. The first initial true pulsation you hear is the systolic. 

I suggest, as well to actually practice to hear brachial pulses, without BP cuffs, get used to what pulsation actually sounds like. Many hold the extremity slight upon to avoid road noise, or wrapping extremity and bell in a pillow wrapped around to attempt to muffled outside noises. 

The old saying practice makes perfect, after you have attempted over 100 then I would be really concerned. 

Good luck,
R/r 911


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## doc5242 (Aug 8, 2006)

Ridryder911 said:
			
		

> What ?
> 
> I am sure you were kidding .... as well palpating is only a "guess" of what perfusion level is and it has never been scientifically proven to near accurate.




1. yes I was,

2. korotkoff sounds, you will not hear in the AC, unless you listen over the heart or carotid. looking for differentals between S1-S4, which in this case does not apply to the original question, seeing as how it is above the EMT-B level. 

not trying to start a flame war, just thought I'd elaborate on your response, because at the Basic Level your not going to be able to do anything about a Mean Arterial Pressure difference if you take a manual, my personal rule of thumb, if you cant get a manual by the second try, palp it, the hospitals will take there own anyway.


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## Ridryder911 (Aug 8, 2006)

Actually, all blood pressures have distinct korotkoff sounds, (the true and proper way to auscultate blood pressures at any location) and they are not routinely auscultated as an apical heart tone and or carotid artery as checking for bruits, APMI, thrill etc.. Since the only way to obtain such sounds is increasing arterial obstruction and releasing pressure for flow. This is as well should not to be confused with systole, or diastole sounds such S1, S2 and definitely not to be confused with adventitious heart tones such murmurs, clicks or the gallops as you described.  

Blood pressures should be taught with korotkoff sounds, as it was originally taught in the national curriculum even 25 years ago. That is part of the problem in EMS education, we have diluted down the EMT and Paramedic programs and assuming that one has to be specially trained to have an understanding of basic patient assessment skills. This is even routinely taught even at the LPN level. Let's teach it right the first time, so there will be no confusion when one increases their education level.

Thinking the ... "the hospitals will take their own anyway".. is true, however; it is the responsibility of the EMT, Paramedic or whatever level to obtain and maintain a set of vital signs. Critical ill, trauma patients, etc. should have at least vital signs obtained every 5 to 10 minutes if not more, dependent on the situation, so a trend can be obtained. 

Yes, I definitely agree that after attempting a manual, one could attempt to obtain a palpated pressure, however; hopefully you should attempted using doppler prior to this last resort. (yes, EMS should carry dopplers on every unit). Palpated pressures do give a guessamation of what the systolic might be, and does not really reflect the resting arterial pressure in which is so important.

Blood pressures as well as all vital signs are a essential part of patient assessment tools, such named as vital, since they reflect the patients condition. Yes, they can difficult to obtain at periods, due to ambiance road noise, bumps, extrication tools, etc. Practice does make perfect, and practicing on every patient increases your skills and knowledge.  

R/r 911
RN,CCRN, CEN, CCEMT/P


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## lfsvr0114 (Aug 19, 2006)

Everyone hears differently with different stethoscopes.  You may have to try different types and brands to find one for you.  Also, try different eartips on the stethoscope you are using.  I use soft ones and they seem to make a better seal in my ears.

Also, try putting a towel under your feet or under the arm, (between your hand and them), to try and cancel the outside noise to hear better.


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## fyrdog (Aug 19, 2006)

1. Make sure you have the right sized cuff . A pedi cuff doesn't mean only for pedis, the little 70 year old probably would need a pedi cuff. 

2. Palpate the brachial pulse as a land mark to place the bell of your scope. 

3. Feel for the radial pulse as you inflate the cuff. GO 10 to 20 mmhg higher after you can not feel the radial pulse anymore and place scope on your landmarked spot in step 2.

4. Slowly deflate the cuff and listen carefully. Pump it up again slowly if you have to. Don't hesitate to yell at everyone who talking while you do this. (Why when I listen the lungs sounds and I say take a deep breath, someone asks the patient "what is your middle intial?")

5. Try different scopes, maybe your partner will let you try theirs. Be nice and clean the ear pieces when you are done (after the call)

I have good success with the cheap sprague scope. I have owned Littmans and I didn't notice the difference. I know some swear by Littman. The elcheapo $8.00 scope I gave to my kids to play with and took their fisher price one because it worked better so don't be super cheap on a scope but a modestly priced one may work for you.


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## EMTBandit (Sep 6, 2006)

Heres some information if you want to know more or need help.

http://www.nda.ox.ac.uk/wfsa/html/u11/u1106_01.htm


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## xrsm002 (Aug 7, 2012)

What about using electronic stethoscopes to auscultate pressures on the road


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## Handsome Robb (Aug 7, 2012)

xrsm002 said:


> What about using electronic stethoscopes to auscultate pressures on the road



The only time I have used an electronic scope I didn't like it. Way too much background noise. 

I've come to the conclusion that I don't like dual headed scopes either.


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## JPINFV (Aug 7, 2012)

[redacted]


2006 thread. Mind the...


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## RustyShackleford (Aug 14, 2012)

Old thread is old


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## exodus (Aug 24, 2012)

At least he didn't start a new one


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## GaMedic (Aug 29, 2012)

Most direct advice I can offer is... Invest in a good stethoscope. I personally like the Littmann Master Cardiology.. To me it was well worth the investment. I have some hearing deficient in my right ear and had a hard time on some pt's until I shelled out the money for one of those. Now I rarely run into issues...  :beerchug:



http://www.allheart.com/3m-littmann-stethoscope/p/2163-65/


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