# BP Question



## Maxzl (Oct 31, 2009)

What is the normal BP (or how do you decide what it should be)?

Thanks


----------



## Vince (Oct 31, 2009)

Depends on the Patient!

Normal is around 120/80! My wife is around 100lbs so her normal bp is around 105/70. If you have a low or high BP start by asking the PT do you normally have low or High BP!

It also states in your book what a normal range is for a general PT.


----------



## Maxzl (Oct 31, 2009)

I was told several times that there's some formula for it. like their age + 100. Does anyone have any insight into that?
Max


----------



## medicdan (Oct 31, 2009)

BPs (and all vitals) are about trends. Its all about now compared to then (or normal). THere is no such thing as a "normal" BP, so calling it 120/80 is a fallacy. Ask your patient what it was last when they were at the doctor. 

Dont just take one BP while with a patient. Take one on scene, one in the truck, one as you are pulling up to the ER, and one at triage. How have they changed? Is it normal?


----------



## VentMedic (Oct 31, 2009)

Maxzl said:


> What is the normal BP (or how do you decide what it should be)?
> 
> Thanks


 


Maxzl said:


> I was told several times that there's some formula for it. like their age + 100. Does anyone have any insight into that?
> Max


 
Dear EMT student, 

Are these homework questions?

If so, I would suggest you review the material you have been assigned. 



Maxzl said:


> I just wanted to make sure I knew how to properly measure blood pressure, we didn't spend to much time on in class so I just wanna make sure.
> Please tell me if anything's wrong


 
http://www.emtlife.com/newreply.php?do=newreply&p=181188

As per the other BP thread you started, if you did not spend much time on BPs, get your instructor to review.    Ask the instructor to clarify what he/she wants you to know for normals for testing purposes.    Chances are if you are having questions, the other students will also.  BPs are extremely important as are the other vital signs and the class should not just skip lightly over them.


----------



## MrBrown (Oct 31, 2009)

"Normal" is highly over-rated.  The old "normal" that was taught for years was 120/80 which is I think was more "average" than "normal".

Age + 100 is what the maximum systolic should be I think; I've heard that somewhere too but best to look it up coz I could be wrong; it's known to have happened before!

My personal opinion is that blood pressure is a more a diagnostic tool and generally helpful indicator of circulatory status than something to get all ruffled about being "not normal" in the prehospital environment.


----------



## EMT.Hart (Oct 31, 2009)

MrBrown said:


> Age + 100 is what the maximum systolic should be



I have heard that before also.


----------



## trevor1189 (Nov 1, 2009)

Usually once you take a blood pressure if you say it out loud your patient (assuming they are alert) will comment on it if it is very far off from what they normally get. I have also had pts. say it is usually high/low before I start to inflate the cuff. 

If you get something very far off from 120/80 ask the pt. how their pressure usually is.

120/80 seems to be the believed normal by the general population, but it doesn't mean someone with 130/85 is necessarily elevated.

Also consider the age/weight of pt. a 400 pound bariatic patient isn't likely rocking 120/80. ;-)

Another thing to consider is the difference in systolic and diastolic (pulse pressure) ie. 120/80 PP is 40 mmHg. Many EMTs seem to not know pulse pressure is and don't consider it.


----------



## EMT.Hart (Nov 1, 2009)

Pulse Pressure... Never heard of it. Care to elaborate?


----------



## trevor1189 (Nov 1, 2009)

EMT.Hart said:


> Pulse Pressure... Never heard of it. Care to elaborate?





> Blood pressure readings are given in two numbers. The top number is the maximum pressure your heart exerts while beating (systolic pressure), and the bottom number is the amount of pressure in your arteries between beats (diastolic pressure). The numeric difference between your systolic and diastolic blood pressure is called your pulse pressure. For example, if your resting blood pressure is 120/80 millimeters of mercury (mm Hg), your pulse pressure is 40 — the difference between 120 and 80.
> 
> Research suggests that an elevated pulse pressure may be a strong predictor of heart problems, especially for older adults. Generally, a pulse pressure greater than 60 mm Hg is abnormal.
> 
> The most important cause of elevated pulse pressure is stiffness and reduced elasticity of the aorta, the largest artery in the body. This may be due to high blood pressure or fatty deposits on the walls of the arteries (atherosclerosis). The greater your pulse pressure, the stiffer and more damaged the vessels are thought to be. Other conditions — including severe anemia and overactive thyroid (hyperthyroidism) — can increase pulse pressure as well.


 ~ http://www.mayoclinic.com/health/pulse-pressure/AN00968

Research it a little bit, there are plenty of internet articles on it. It was one of those little things that was mentioned once in my EMT class and never again.


----------



## Shishkabob (Nov 1, 2009)

Except pulse pressure doesn't only have to do with the hearts condition and the blood vessels.  You can have a widening pulse pressure because of Cushings Triad with ICP.


----------



## trevor1189 (Nov 1, 2009)

Linuss said:


> Except pulse pressure doesn't only have to do with the hearts condition and the blood vessels.  You can have a widening pulse pressure because of Cushings Triad with ICP.



Yet another thing that was not covered in my class, but I had to learn on my own.

(irregular resps, widened pulse pressure, bradycardia = Cushing's triad = possible ^ ICP)

^ ICP may have you thinking brain hemorrhage (possibly from trauma), stroke and many other things.


----------



## EMT.Hart (Nov 1, 2009)

Interesting. Thanks for your input!


----------



## juxtin1987 (Nov 2, 2009)

The other important thing to remember (especially for testing purposes) is Hypertension or Hypotension (as well as tachycardia, bradycardia, tachypnea, bradypnea etc.) are meaningless terms if the patient isn't symptomatic. By definition the average adult BP is NOW 130/90 up from the previous 120/80 (due to a rising obese population in the US) Again, based off the national average of BP Hypertension begins at a systolic of 140 and Hypotension at a systolic of 110. But as i stated above hypotension and hypertension don't mean anything to a patient who's asymptomatic, it's simply their baseline BP.

Hope That Helps


----------



## Shishkabob (Nov 2, 2009)

Not so true, juxtin.

Most VS can be put in 2 categories:  relative(asymptomatic) and absolute(symptomatic).  Absolute = absolutely not right, hence symptomatic.  

I'm relatively bradycardic.  I have a heart rate of 52.  That's brady no matter how you spin it.  But it's not absolutely bradycardic, meaning it's asymptomatic.  I have no negative effects at 52bpm as my BP is 120/80, my norm.


----------



## juxtin1987 (Nov 2, 2009)

Linuss,

I agree with you 110%, but for NREMT-B purposes, you're bradycardic below 60 Tachycardic above 100 etc. Let him pass registry before he learns how to treat patients.


----------



## CountryEMT-bGurl (Nov 3, 2009)

*Formula*

I am pretty sure it is Age + 100 for males up to age of 50, then Age + 80 for females up to age 50. And this is there systolic number. The normal disystolic for both males and females for the normal range are the same for this formula. Can't remeber what range they gave for it though...hmmm.


----------



## EMSLaw (Nov 3, 2009)

Linuss said:


> Not so true, juxtin.
> 
> Most VS can be put in 2 categories:  relative(asymptomatic) and absolute(symptomatic).  Absolute = absolutely not right, hence symptomatic.
> 
> I'm relatively bradycardic.  I have a heart rate of 52.  That's brady no matter how you spin it.  But it's not absolutely bradycardic, meaning it's asymptomatic.  I have no negative effects at 52bpm as my BP is 120/80, my norm.



Even if we've already taken the patient history, if I get an abnormal reading from a patient (well, abnormal in my eyes), then I will... ask the patient! 

BP is high, "Sir, do you have high blood pressure normally?"  If their pulse is 52, but they've mentioned how well they did in the last NYC marathon, I'll probably be less concerned than if it was someone like me who hasn't run a mile recently.


----------



## RESQ_5_1 (Nov 3, 2009)

Normal is relative to the pt. I have had Pts with Diastoilic pressures hovering just above 90 and Asymptomatic. However, I keep a close eye on that BP and my pt for any changes. 

And, just for the record, I am 5'6" and 195 lbs. I smoke just under a pack a day and live for the next bacon fix. And, before any non-smoker's automatically triple that number, trust me on the accuracy. I'm not in any denial. I have been a smoker for 20+ years. My average BP is around 136/80. And, my average resting pulse is around 72 S/R. 

When I was 24, I had my wisdom teeth removed under IV sedation. When I was in recovery, I was awakened by an alrm on the vitals machine. It seems my HR dropped to 42. The nurse that came over to silence the alarm never even stopped the conversation she was having with the other nurse and didn't even look at me. But, since the alarm woke me up, and I was concious enough to see that my HR was 42, I guess it wasn't a problem.

Normal for textbook is whatever is in your textbook. IE; 120/80. Normal for your pt is whatever is normal for your pt. Take at least 3 sets of vitals if possible, and get as accurate a history as possible.


----------



## Melclin (Nov 4, 2009)

EMT.Hart said:


> Pulse Pressure... Never heard of it. Care to elaborate?



Learn to google man 

On the topic of triads and pulse pressures, beck's triad (depending on how you phrase it I suppose) involves a lowered pulse pressure (and generally lowered arterial pressure), muffled heart sounds and Jugular Venous Distension = Cardiac tamponade.


----------



## Mountain Res-Q (Nov 4, 2009)

Melclin said:


> Learn to google man
> 
> On the topic of triads and pulse pressures, beck's triad (depending on how you phrase it I suppose) involves a lowered pulse pressure (and generally lowered arterial pressure), muffled heart sounds and Jugular Venous Distension = Cardiac tamponade.



It amazes me how many noobies have not been taught terms like pulse preasure, Becks Triad, or Cushing Triad.  I have even been laughed at (as if I was pulling legs) when I informally quiz recently certified EMTs on things like the s/s of Becks Triad...  Sad really...  But then again...  "Education" and all that... -_-  I mean, what is the point of taking a BP if you can't interpret what the numbers mean or how that information factors into the other s/s that you see?


----------



## juxtin1987 (Nov 4, 2009)

Melclin said:


> Learn to google man
> 
> On the topic of triads and pulse pressures, beck's triad (depending on how you phrase it I suppose) involves a lowered pulse pressure (and generally lowered arterial pressure), muffled heart sounds and Jugular Venous Distension = Cardiac tamponade.



_On the topic of triads and pulse pressures, beck's triad (depending on how you phrase it I suppose) involves a lowered *ARTERIAL PRESSURE* (and generally lowered *PULSE PRESSURE*), muffled heart sounds and Jugular Venous Distension = Cardiac tamponade._

Fixed!


----------

