# Automatic blood pressure cuffs...



## JJR512

I'm looking for a recommendation for an automatic blood pressure cuff with a certain set of features. I'm talking about the devices that just take a blood pressure (most also display a pulse but that's not important), some of which can be found in a Wal-Mart or local pharmacy for $50-70. But these units come with a cuff, and usually you can get a larger cuff, but I think the cuffs made for them are the only ones that will work, because they don't use regular connectors.

So I'm wondering if anyone knows of a device that inflates a cuff, deflates it, and displays a blood pressure, uses a standard type of cuff connector so that multiple sizes of cuffs can be used or disposable cuffs can be used for isolation patients, and, if possible, can be set to automatically take the BP at defined time intervals. I can live without automatic operation at timed intervals feature, and I can probably live without the automatic inflation feature (these use a standard bulb and are inflated manually, but deflated automatically during the measurement phase). Also, the device has to be durable enough for ambulance use, and, of course, it has to work on batteries.

A full-blown vitals monitor (even without cardiac monitoring) is too expensive for me (these devices usually start at about $2500), and I already have a decent pulse oximeter, anyway.

I want an automatic BP cuff device to use at my pay job with a commercial ambulance company, where most patients are routine taxi rides. We are required (by company policy) to take two sets of vitals, even if the trip is just one minute across the street (which actually happens a lot). Sometimes I can get vitals at the originating or destination facility, but there isn't always an actual medical facility at either end of the trip, or it's not always possible, so I'm just looking for a way to make my work easier.


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## Jon

I've seen co-workers at transport Co's use the inexpensive ones from Wal-Mart... I've never been impressed with them, though. I know that ADC has a digital B/P display that is supposed to "assist" in getting a B/P.

My favorite thing is to work with  a medic... then I get to use the LP12 for vitals


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## Grady_emt

I say use the full LifePack12 and put them on the 12lead, SpO2, ETCO, and NIBP, then you get a full set of vitals, and you could have one of those little Stat blood-gas meters to!!!  And then you could put in an arterial line and get a "live" bp once you had them all hooked up.

Whats wrong with actually taking a manual BP, and actually checking their pulse?


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## KEVD18

sure, get an auto bp cuff from walmart and proceed to take and record inaccurate bp's until the end of time all the while losing the skill of actually taking a manual bp.


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## medicdan

I am not going to argue about skills, but I have seen what you are looking for...

http://www.nonin.com/products.asp?ID=9&sec=5&sub=3
http://www.casmed.com/740.html


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## MMiz

I worked for a private ambulance service that required two BPs per transport.  Critical patients got one every five minutes, and normal transports got one every fifteen.

Is it really that hard to grab a BP?  I'd grab one BP before we left, using the NH's or hospital's machine, and then one in the rig.  If it was a long transport, then I'd leave the BP cuff on the pt until we got to the location.  I think your money could be better spent on many other devices, but automated BP cuffs are inaccurate and expensive.


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## JJR512

Grady_emt said:


> Whats wrong with actually taking a manual BP, and actually checking their pulse?


There's nothing wrong with doing either; I never said there was. Actually I never even said anything about checking the pulse at all. No machine that I know of can tell me if a pulse is regular, irregular, strong, weak, etc. But while manually checking the pulse can tell me the quality of the pulse, manually checking the BP doesn't tell me anything other than the numbers, which can be gotten easier and faster with a machine. Provided the machine is accurate...



KEVD18 said:


> sure, get an auto bp cuff from walmart and proceed to take and record inaccurate bp's until the end of time all the while losing the skill of actually taking a manual bp.


Well, I think I made it pretty clear that I didn't want a cheap unit from Wal-Mart, but in case I didn't: I don't want a cheap unit from Wal-Mart. Or a cheap unit from anywhere. Talking about cheap as in low quality. I do need something relatively inexpensive; I'd love to get either of the units *emt-student* found, but I don't have $2500 to spend.

I don't think that taking an automatic BP on many of my patients will erode my skill at taking a manual BP. Furthermore, as I'm not looking for a cheap low-quality unit, I doubt the accuracy will be too far off, and, more to the point, the accuracy of the unit is of very little importance. The vital signs I take are not seen by any medical staff handling the patient; the staff at the receiving facility, if they care what the vitals are at all in the first place, will use the vitals on the patient's discharge summary from the hospital. Most of my patients are discharges from hospitals to nursing homes. On the other hand, if I'm taking a patient _to_ a hospital, or for _any_ reason I suspect the patient is not medically stable, I would do a full set of vitals manually. But for the vast majority of my taxi rides...Saving some time with the BP gives me more time to do the BS paperwork. Callous? Maybe. But I transported 30 patients over the last three days of 12-hour shifts. Even if only a quarter of them get manual vital signs taken, I'm probably still taking more manual vitals signs in a week than the average volunteer EMT-B takes in a week, so I doubt my skills are eroding.


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## KEVD18

i know your not setting out to get a cheap pos, but for what you want to spend, thats what your going to get. nobody makes an accurate, durable auto bp cuff for short money. the cheap ones do not stand up well to being bounced aroun the ambulance and quickly lose their calibration(if they were accuratley calibrated to begin with)

what you want is an automatic vitalsigns monitor that you hook your pt up to, set the parameters as to when to take signs and what not. thats 2g's or better.

your fighting a losing battle. you cant get what you want for waht your willing to spend.


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## Flight-LP

JJR512 said:


> There's nothing wrong with doing either; I never said there was. Actually I never even said anything about checking the pulse at all. No machine that I know of can tell me if a pulse is regular, irregular, strong, weak, etc. But while manually checking the pulse can tell me the quality of the pulse, manually checking the BP doesn't tell me anything other than the numbers, which can be gotten easier and faster with a machine. Provided the machine is accurate...
> 
> 
> Well, I think I made it pretty clear that I didn't want a cheap unit from Wal-Mart, but in case I didn't: I don't want a cheap unit from Wal-Mart. Or a cheap unit from anywhere. Talking about cheap as in low quality. I do need something relatively inexpensive; I'd love to get either of the units *emt-student* found, but I don't have $2500 to spend.
> 
> I don't think that taking an automatic BP on many of my patients will erode my skill at taking a manual BP. Furthermore, as I'm not looking for a cheap low-quality unit, I doubt the accuracy will be too far off, and, more to the point, the accuracy of the unit is of very little importance. The vital signs I take are not seen by any medical staff handling the patient; the staff at the receiving facility, if they care what the vitals are at all in the first place, will use the vitals on the patient's discharge summary from the hospital. Most of my patients are discharges from hospitals to nursing homes. On the other hand, if I'm taking a patient _to_ a hospital, or for _any_ reason I suspect the patient is not medically stable, I would do a full set of vitals manually. But for the vast majority of my taxi rides...Saving some time with the BP gives me more time to do the BS paperwork. Callous? Maybe. But I transported 30 patients over the last three days of 12-hour shifts. Even if only a quarter of them get manual vital signs taken, I'm probably still taking more manual vitals signs in a week than the average volunteer EMT-B takes in a week, so I doubt my skills are eroding.



Wow, someone is not loving their job today!

Look, you can't have your cake and eat it too. If your not willing to be proficient in your skills and rely on some machine to tell you what you want to know, then you WILL have to pay for accuracy. If not, you get the Walmart POS. Live with it or do your job. If your employer wanted automatic BP's, then they probably would have provided you with the appropriate machine. I think your just being lazy. It takes less than a minute to get vitals, you save ZERO time by using a machine and it WILL water down your skill and ability to PROPERLY assess vitals. Using paperwork as an excuse is just pathetic. Your a Basic, you work for a private company, you do horizontal taxi rides; therefore you will have a high rate calls. If its too much for you, you can always make more working in another industry...........

Take a moment and read the "Progression of EMS thread". You may witness some correlation.................


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## JJR512

Flight LP, I think there is a slight miscommunication or misunderstanding somewhere. "If your not willing to be proficient in your skills and rely on some machine to tell you what you want to know" -- I don't think the two (manual skill vs. automated) are mutually exclusive as is implied here. Taking a BP manually is so easy; it's like turning on a TV with the button on the set vs. the button on the remote. If you use the remote all the time, do you forget how to turn it on from the button on the set? I don't think so. Using the remote is a couple seconds faster. Using an automatic BP cuff _is_ a couple seconds (maybe 10 to 15?) faster, despite continued insistence to the contrary ("you save ZERO time by using a machine")--Putting the cuff on the patient and taking it off takes the same amount of time either way, and the actual reading of an automatic unit may actually be somewhat slower than what you or I could do manually, but my point is that while the automatic unit is doing it's thing, I'm free to do something else, like count respirations or get a history or meds list from the patient. That's a time savings, and it's real.

"If your employer wanted automatic BP's, then they probably would have provided you with the appropriate machine."-- Oh please. They want us to wear blue pants and black shoes or boots, but they don't supply those. They want us to to turn in nice and neat paperwork, but they don't supply clipboards. They want us to come to work clean and shaved, but they don't give us soap or razors. They want us to maintain our skills and education, but they don't pay for that.

"...therefore you will have a high rate calls. If its too much for you..." I wasn't complaining about my high call rate. I get extra money for every call I do beyond a certain quota. Rather, I was using my call volume to illustrate my point that despite wanting to take automatic vitals for a certain percent of my patients, I still see so many patients, and would get manual vitals on a certain percent of them that probably comes out to more patients than the average volunteer sees in the same time period. The overall point there is that I'm taking manual vitals at least as often, possibly more often, than the average volunteer EMT, thus begging the question: How will my skills erode when they're being practiced so often?

KEVD18, I'm beginning to suspect you are right that there is nothing better than a $50 simple automatic BP unit without stepping up to a full $2500 vital signs monitor.


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## emtrubal

*Auto Bp*

Well leave it to EMS perfessionals to insult a person's skill level when they just want to make life a little easier on themselves. In fact the second Korotkoff phase is commonly inaudible (meaing your systolic an be up to 40mmHg off) and maunal B/P's are very supseble to error. This is especially true in prehospital care when your trying to listen to a B/P in a ambulance that hasn't had a tune up in 20 years with sirens going. 

In fact the reason that clincs (which are a nice stable, quiet environment) use auto B/P cuffs is to eleminate the error of missing the first to Korotkoff phases.  And have a more standardized care because no two people take BPs the same( leading to differences of about 15mmHg).

So to answer your question, without questioning your skill level, I have yet to see a reliable, cost effective Automated BP cuff. If you find one let me know.


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## Explorer127

*automatic bp cuffs*

do any of u use them? what do you think of them and how accurate are they, also...just out of curiosity does any1 know how they work?


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## mikie

We personally don't use them but I would always trust my ears over a machine like that, especially in the back of a moving ambulance.  

Treat the pt not the monitor


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## KEVD18

hey. i notice your a fairly new member, so just to be sure your aware of it, i though i'd pass this along.

theres a search feature activated by the search button on the toolbar at the top of the page(fourth from the right). some of the more common topics have been brought up, hashed out, buried and brought up again so many times its nauseating. some of our forum member are very intelligent men and women representing every level of medical provider across the world. their combined knowledge is staggering. but some people will only take the time to answer a question so many times before they begin to ignore it, thus depriving a new member of their vast experience and knowledge. i suggest you try to search for threads concerning your topic. you'll find we've been all through this one dozens of times.

and welcome to the nut house.


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## skyemt

in a nutshell,

they can be wildly inaccurate...

should never be used for baseline vitals, and we almost never use them at all...


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## Explorer127

KEVD18 said:


> hey. i notice your a fairly new member, so just to be sure your aware of it, i though i'd pass this along.
> 
> theres a search feature activated by the search button on the toolbar at the top of the page(fourth from the right). some of the more common topics have been brought up, hashed out, buried and brought up again so many times its nauseating. some of our forum member are very intelligent men and women representing every level of medical provider across the world. their combined knowledge is staggering. but some people will only take the time to answer a question so many times before they begin to ignore it, thus depriving a new member of their vast experience and knowledge. i suggest you try to search for threads concerning your topic. you'll find we've been all through this one dozens of times.
> 
> and welcome to the nut house.




oo ok, thanks. i actually never noticed that search button before..


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## emtwacker710

yea, we have a lifepack12 and we usually get a manual BP on scene then hook them up to the BP cuff and pulse ox on the lifepack12 and if we notice the BP that the machine takes os way off from our manual we will do manuals the rest of the transport, we have had it go wrong a few times but it was actually the cuff that went bad...


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## KEVD18

please dont in any way let what i had to say deter you from asking questions and participating. that wasnt my intention at all. but if you search first, you'll get more info and the same topic wont be dragged out again.

rereading my previous post it seemed a little harsh to me, so if it was read that way, i apologize.


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## Airwaygoddess

*Automatic blood pressure machines*

Automatic BP machines can have their place and be used as part of patient care, but the fact is this, if the machine gives a reading that is considered critical, it must be rechecked manually.  It is important to always start with a  manual set of vital signs.  As mentioned before, automatic machines can malfunction, giving readings that are completely off.  This can be due to many reasons, the blood pressure cuff not properly placed on the arm, wrong size cuff placed on the patient, batteries not properly charged, leaks in the bladder of the cuff,( this happens quite often especially with disposable cuffs that are "patient one time use only")   or the connector tubing itself.  It is important to have machines calibrated on a regular bases, especially if the machine has been dropped accidentally. 
  If there is any question of accuracy of the patient"s vital signs, then you must recheck them manually, if this means the patient requires vital signs rechecked Q five minutes then that is what needs to be done.  Part of providing good patient care, starts with a strong patient assessment with manual vital signs.


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## lfsvr0114

We must get an auscultated baseline pressure first.  The monitors can not tell the difference between someone moving and heartbeat like a real live person can.  If we are the least bit doubting on the pressure, we do them all manually.


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## MSDeltaFlt

omarsobh said:


> do any of u use them? what do you think of them and how accurate are they, also...just out of curiosity does any1 know how they work?



My flight company uses them, but only for trends.

I like them, but you never trust them with blind faith.

There isn't a NIBP made that is accurate.  Even the manufacturer will say in the literature that it is not accurate, and shouldn't be considered accurate.

As far as how they work, it depends on the manufacturer.  They vary.  You'll have to look at the specific model's specs.


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## Katie

we them on our lifepack 12's, but not a separate machine.  from what i've seen they are *usually* in the right area.  i usually try to get my initial manually though, and check if the results don't seem reasonable


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## makphisto

We don't use autocuffs, we do it all manually.  Then we get the pt to the ER and they slap an autocuff on them.  :glare:


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## mikie

so does anyone know how they work?


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## Ridryder911

mikie333 said:


> so does anyone know how they work?



They sense the arterial pulsations and thus get the numbers... 

R/r 911


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## paramedix

Some of our buses used to have them...long ago, but they have all been taken off the vehicles.

One of our main reasons for removing them from the buses, they cost too much to repair and maintain.

Some of our ECG monitors have the built in NIBP, but I havn't seen seen them in use. I personally prefer the manual system for pre-hospital care. 

Regarding calibration of the system, I am sure that the bumps in the vehicle do affect the system much more than the system in hospital.


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## firemedic7982

*Nibp*

I think all are in agreement that Manual BP's are the way to go. 

NIBP's are for the most part innacurate, and only decent for trending. 

HOWEVER that being said, not all Monitors are created equal. This is one more of those cases where the more expensive the equipment, the more reasearch went into its inception. 

The Zoll series monitors are in a lot of cases more acurate than a manual. Ive used LP12's, as well as many other models. Both systems I work for currently use the Zoll M series monitor. The NIBP on this monitor is superbly accurate, and uses a complex series of mathematical calculations to come up with the end result. I run an average of 12-18 calls a shift ( up till recently with my move to a slower station) and Have a lot of experience in this monitor, and plenty of trends to back its accuracy. Thats not to say that it has its moments of confusion like any piece of machinery, but checked against my manual bp's it is highly accurate, and trustworthy.

Cheers!


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## fireemslife

gonna have to go with manual, you can use them easier in a rig,they wont break, and if something happens to them their cheaper to replace, plus i find autos take longer.


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## TNEMT06

Personally, I don't like the automatic BP cuffs, I'd rather use the manual cuff; but we do carry them on our trucks.


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## CrazyCanuck

I prefer auscultation. All of our LP12's are fitted with the auto NIBP's & I do use them occasionally. I like the old rule....treat the pt, not the machine.


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## mikie

What is NI for the BP part (or however it's spelled)?

I think it's more for stable pt's in hospital setting for trending.  especially when in a moving ambulance- it could be inaccurate from a bump in the road (but so could auscultation).


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## JPINFV

NI=Non-Invasive


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## mikie

JPINFV said:


> NI=Non-Invasive



I didn't realize how invasive BPs are...  Maybe we should think of removing it from the BLS curriculum- only for ALS providers!

No, just kidding.  But I get what they mean- and the pt probably doesn't know the difference.


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## JPINFV

mikie333 said:


> I didn't realize how invasive BPs are...  Maybe we should think of removing it from the BLS curriculum- only for ALS providers!
> 
> No, just kidding.  But I get what they mean- and the pt probably doesn't know the difference.



Contrast NIBP to an arterial blood pressure to realize where the NI comes from (in case someone honestly doesn't get it).


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## skyemt

i think it 's important to realize why many EMT's want to use the automatic cuff... because they do not feel they are skilled at taking BP's...

at JEMS, Bob Page gave a lecture just on using the Stethoscope and taking BP's... and was really interesting to see how many do not know the correct technique, not what frequency range the korotkoff sounds are in, nor did many know the difference between between the diaphragm and the bell..

i have seen many emt's improperly place the cuff, tuck the diaphragm of the scope underneath the lower part of the cuff, which will give an inaccurate number...

also, where is the arm? bent or straight? above or below the heart? is the patient sitting up or supine? all of these will affect the BP readings you get...

the automatic machines are not the only things subject to wild inaccuracies... if you are not sure, next time on the way back from a call, have a few different people take bp's on someone... especially with newer emt's, who haven't taken  thousands of bp's, you might be surprised how large a range you can get.


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## Kimmy Schaub

The have the auto BP cuffs in the ER at the hospital I work @ but I've never heard of them being real popular in field work. As far as I know, they are very reliable, but i think its a bit easier in field work to just use the mechanical ones because there is more to them


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## Explorer127

Kimmy Schaub said:


> The have the auto BP cuffs in the ER at the hospital I work @ but I've never heard of them being real popular in field work. As far as I know, they are very reliable, but i think its a bit easier in field work to just use the mechanical ones because there is more to them



same with the ER i volunteer at....we use the auto BP's..

unless we get some really high or low number, then the nurse confirms it with a manual bp, SOMETIMES..


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## mdkemt

Our company uses them as well.  I hate them and find them to not be accurate at all.  But the nurses love them for flights seeing as most flights are a min of 2 hours.  I would always trust your ears over a machine.  Treat your patient not the machine!


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## Belgian EMT/nurse

We have LP12 and HP monitors.. We use the automatic cuffs most off the time and my experience is that they are pretty accurate. But on bumpy rides it's useless and my biggest point of ignorance is that most of the time it takes forever to take bp. So I'm thinking about taking a stethoscoop and cuff and go manuel in the future.


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## Topher38

My dad has an automatic BP cuff. And I always tell him to get rid of it. I don't like putting the trust in a machine that runs on AA batteries. My dad has hypertension too so everytime he wants to take his b/p I do it for him =]

The only time I would ever trust one is when the pt is in the hospital and they have some super mega bp cuff. =/


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## mikeylikesit

I think those life packs are about the most worthless things out there. unless, my patient did really have a SPO2 of 86 yesterday? no they do have the benifits but i still prefer my ears and a good steth.B)


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## Mercy4Angels

*thoughts on auto bp cuff*

ive seen the small automatic wrist bp cuffs are they any good ? looks small enough to carry around. thoughts ?


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## CFRBryan347768

Im pretty sure their was a thread on this allready, but i find my BP's to be difrent when the auto one is used compared to some one taking it.


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## kayrules5340

No...we have one because my dad has hypertension, but they give you completely different readings.....It makes no sense, it was a waste of like 30 bucks. I would get like 100/60, then like 75/35 then like 150/90 all like on the same day, like 10 minutes apart.


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## fma08

buy a decent manual and steth if you are gonna carry somethin around


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## NJN

Don't get an auto bp cuff. Especially those wrist ones. Got one for my mother (hypertension) first time i tried it i got a reading that i thought was odd, i forget what the exact numbers were but they were high enough that i was about to call medics. Went again with a manual, it was within normal limits. Now i just use my littman and a manual.


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## KEVD18

try a search. it will do wonders for your posture.


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## BossyCow

The ones that are affordable aren't worth it. They are notorious for inaccurate readings.


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## mikeylikesit

worthless pieces of crap. i could get a more accurate BP with the ones at  the pharmacy mounted to the wall then those stupid things. they don't make things easier trust me. i can do a manual BP just as fast. practice.


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## Mercy4Angels

i got ya ill just get a finger pulse ox and use my manual cuff..


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## KEVD18

Mercy4Angels said:


> i got ya ill just get a finger pulse ox




here we go again. round two: ding ding ding


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## ffemt8978

Why do you even need a finger pulse ox?  What treatment modalities are you going to implement based upon a pulse ox reading, or how is it going to change your treatment of the patient?


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## Jon

Also.. why do YOU need to buy one? doesn't your service have one, if you need it?


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## BossyCow

My favorite pulse ox is my eyes! I took in a pt the other day with a pulse ox of 86. She was talking in full sentences, had good color and nice cap refill. No edema to extremeties, no hx of cardiac or respiratory compromise. I put I put her on a n/c at 4lpm. 

The pulse ox was wrong and the doc in the ER agreed with me.


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## CAOX3

Ok, I havent been here long enough to draw any conclusions about anyone.  I am sure you are all wonderful providers.  If I could Bossy.

If she was pink, warm and dry, speaking in full sentences with no hx, why the O2?

Not being an *** here just wondering what your thoughts were.

How about lung sounds? 

Do they still teach EMTs to assess cap refill in adults? CRT is age/temperature dependent.


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## Hastings

CAOX3 said:


> Ok, I havent been here long enough to draw any conclusions about anyone.  I am sure you are all wonderful providers.  If I could Bossy.
> 
> If she was pink, warm and dry, speaking in full sentences with no hx, why the O2?
> 
> Not being an *** here just wondering what your thoughts were.
> 
> How about lung sounds?
> 
> Do they still teach EMTs to assess cap refill in adults? CRT is age/temperature dependent.



Because oxygen is a wonderful drug that is beneficial even when given to a healthy individual. 

And yes, they still teach EMTs to assess cap refill in adults. However, when you get to paramedic level, they tell you that cap refill is only really a significant finding / vital sign in young children.



ffemt8978 said:


> Why do you even need a finger pulse ox?  What treatment modalities are you going to implement based upon a pulse ox reading, or how is it going to change your treatment of the patient?



As one example, PE. One of the most telling signs of a PE is a pulse ox reading that does not improve with the administration of O2 (depending on the type of PE, of course). I know that there are other signs, but personally, any clues that will cause the EMS provider to realize that this is an IMMEDIATE emergency quickly is okay with me. In this case, it's the difference between trying to convince a patient to calm down and stop hyperventilating and hauling to the hospital so the patient can get into the OR immediately.


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## KEVD18

except for the problem that multiple reasons can cause completely erroneous readings and should never be used to unilaterally determine treatment.

and if a provider(of any level) waits for a pulse ox reading to determine they need to scoop and screw with a pe, they need to turn their ticket in. any of the prevailing symptoms of a pe by themselves scream for immediate transport. add them all up and you can call that one with no electronics whatsoever.


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## Hastings

KEVD18 said:


> except for the problem that multiple reasons can cause completely erroneous readings and should never be used to unilaterally determine treatment.



Absolutely not. That's the point I was getting at. It's simply one more diagnostic tool which, when added to the list of other diagnostic procedures done, can nail in a (dare I say) diagnosis quickly. It takes 5 seconds to put on, and it can be one more step to finding out what's wrong and getting to treatment quickly. Why pass it up?


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## VentMedic

Hastings said:


> As one example, PE. One of the most telling signs of a PE is a pulse ox reading that does not improve with the administration of O2 (depending on the type of PE, of course). I know that there are other signs, but personally, any clues that will cause the EMS provider to realize that this is an IMMEDIATE emergency quickly is okay with me. In this case, it's the difference between trying to convince a patient to calm down and stop hyperventilating and hauling to the hospital so the patient can get into the OR immediately.



Shunting and heart defects in the newborn and in rare cases in the adult do not respond to O2 therapy.  Pts with severe pulmonary hypertension may also appear to be nonresponsive to O2 therapy but is a very different treatment pathway from PE.  O2, however,  will stil be the administered.  

A PE is not a good example either since oxygen can improve oxygenation.  One would not know the A-a gradient in the field to actually know the degree of hypoxia.  Clinical correlation, pt hx and what they are telling you will still dictate care.    

In the ED, we will often get strange looks from the EMS providers who bring in a patient with an SpO2 of 100% on a NRBM and we will immediately intubate after the ABG based on an A-a gradient.   Likewise, if the person's SpO2 is 100% on room air but a severe metabolic acidosis that can not be contributed to DKA there may be an ETT in their future.    

The assessment of the patient can be skewed by seeing that 100% on a pulse ox and a true emergency can be missed. 

"Hyperventilating" is another over used and misunderstood term in EMS.  Again good assessment, reassurance and a little oxygen may improve that situation.  Many patients with a variety of disease processes (DKA, sepsis, renal failure)  "hyperventilate" in the truest sense of reducing their PaCO2 to maintain a pH compatible with life.   Other patients are "tachypneic" without hyperventilating because respiratory failure is setting in and they no longer can blow off their CO2 no matter how hard they try.


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## CAOX3

"Because oxygen is a wonderful drug that is beneficial even when given to a healthy individual." :unsure:

Interesting......

Hastings, I guess we can just disagree on this.

After assessment a healthy oxygenating patient would not require nor would they recieve oxygen in my care.


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## Hastings

VentMedic said:


> The assessment of the patient can be skewed by seeing that 100% on a pulse ox and a true emergency can be missed.



Can, by a poor medic.

A good medic should never rely on machines, but should merely use them as an extra test. And that is where a pulse ox can never hurt. Along with other signs in the assessment, it can help confirm a diagnosis. But it must, like all diagnostic tools, be a small part of an assessment. It should not BE the assessment.



> After assessment a healthy oxygenating patient would not require nor would they recieve oxygen in my care.



Why not? Because it's too expensive? Really, oxygen is awesome. Stimulates the mind! And all that nice junk.

Seriously though, I wouldn't give oxygen to any young adult that wasn't having any signs of distress, but I do give it, for instance, to elderly patients that show no signs of distress. Or all patients with even the mildest sign of distress. Why? Because our bodies love oxygen, and again, it has beneficial effects even in the healthy and mildly distressed.


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## mikeylikesit

Hastings said:


> Can, by a poor medic.
> 
> A good medic should never rely on machines, but should merely use them as an extra test. And that is where a pulse ox can never hurt. Along with other signs in the assessment, it can help confirm a diagnosis. But it must, like all diagnostic tools, be a small part of an assessment. It should not BE the assessment.
> 
> 
> 
> Why not? Because it's too expensive? Really, oxygen is awesome. Stimulates the mind! And all that nice junk.
> 
> Seriously though, I wouldn't give oxygen to any young adult that wasn't having any signs of distress, but I do give it, for instance, to elderly patients that show no signs of distress. Or all patients with even the mildest sign of distress. Why? Because our bodies love oxygen, and again, it has beneficial effects even in the healthy and mildly distressed.


When the hell did we learn to diagnose? i must have missed those 6 years of the program.


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## Hastings

I put the "(dare I say)" in there because I know, we don't "diagnose." But it's the closest term I could find at the moment to describe realizing the physiological problem.


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## VentMedic

CAOX3 said:


> "Because oxygen is a wonderful drug that is beneficial even when given to a healthy individual." :unsure:
> 
> Interesting......
> 
> Hastings, I guess we can just disagree on this.
> 
> After assessment a healthy oxygenating patient would not require nor would they recieve oxygen in my care.



Why would a healthy patient need your services?

A pulse ox can confirm a patient is hypoxic.   Hopefully one does not need the pulse ox to know if a patient needs oxygen.   A clinical assessment will assist in the direction of the field diagnosis which may still be just treating the symptoms since there are too many disorders of the cardiopulmonary system to pinpoint except in generalities. 

Being short of breath does not necessarily equate to hypoxia or a change in PaO2.   

A change in carrying capacity which again, one in the field may see an SpO2 of 100% and not know the Hb is 5 gm/dl.  Will extra O2 help or hurt?  Probably neither but then, again, you may not recognize this situation and the 100% SpO2 may skew your assessment.  

The elderly septic patient may have a good SpO2 but have a very low SvO2 and the tissues are starving.  Would you withhold O2 based on the SpO2.  

Anybody every hear of the Oxyhemoglobin Dissociation curve?


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## tydek07

Use a good old manual cuff and stethoscope... they work all the time, if you know how to use them. I never trust the automatic ones, they are nice to get you in the right area (sometimes), but I always try to take one the good old fashion way.


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## Hastings

tydek07 said:


> Use a good old manual cuff and stethoscope... they work all the time, if you know how to use them. I never trust the automatic ones, they are nice to get you in the right area (sometimes), but I always try to take one the good old fashion way.



We only use them on transfers and if we are unable to get a BP the manual way.


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## emtd29

Automatic cuffs suck

 Hence is why we are taught to take a manual BP in EMT school.


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## KEVD18

well gee im glad this one was brought up again.


everytime this topic comes up, i die a little inside....


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## emtd29




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## wlamoreemtb

our rigs have them and i refuse to use them REFUSE I hate them they suck and take forever and dont work half the time


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## rhan101277

I have had one used on me before, you gotta keep it at a certain level, be very still etc.  Its funny how few medical folk don't use the manual way anymore.  Know this is in a Dr. office setting, maybe in the field its different.


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## daedalus

I hate the phrase "How would it change your treatment". On that line of thought, why not screw the BP cuff and stethoscope too. And lets throw out the penlight and the glucometer. Lets go back to the days of rushing a patient with no field treatment, that way we don't waste any time. I know my response seems a little extreme, but lets break this down.

While, most of the time, an EMT or Paramedic, even an Intensivist in the ICU (MD) could do without the Pulse Oximeter, it was invented for a reason. In A&P I saw a video about heart surgery in south america. The post surgical care unit was not equipped with the fancy monitoring systems we have here, so all of the patient's feet were exposed. Why? Because looking and warm, pink feet was an excellent diagnostic tool for these ill-equipped ICUs. Even thoracic surgeons can apparently go without oximeters and NIBPs and invasive monitoring.

If these doctors had Oximeters, would they use them? You bet they would. In the field, does seeing a O2 sat matter to me? You bet it does. So does seeing good signs of perfusion, and feeling a good temp. Do those lung sounds help out with my assessment? You bet they do. Will they change my treatment? No.

I like going into the ED with a 14 y/o female pt and telling the nurse "This is Dana, she is 14 y/o and called EMS for some difficulty breathing. Dana has a history of asthma since as long as she can remember. upon arrival we noticed moderate difficulty breathing and some accessory muscle use. She was alert and oriented and could speak in full sentences most of the time. Her O2 sat before treatment was 92. We noticed wheezes when listening to lung sounds. After some O2 and a round of her inhaler patient stated she felt improvement, and her sat rose to 98."

Paints a better picture? You bet.


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## KEVD18

your missing the point. what we(that is, the folks on my side of this one) are saying is that sure, its a good thing to have, but it doesnt change treatment. a bad emt wont give o2 to the diff breather with a sat of 98% because they dont know that theres are a dozen different reasons why you cant rely on a pulse ox.

nobodies saying that they arent a handy thing to have. and yes, its a good thing to be able to measure the efficacy of treatment as long as reliance on a notoriously inaccurate device is avoided.


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## mikeylikesit

KEVD18 said:


> your missing the point. what we(that is, the folks on my side of this one) are saying is that sure, its a good thing to have, but it doesnt change treatment. a bad emt wont give o2 to the diff breather with a sat of 98% because they dont know that theres are a dozen different reasons why you cant rely on a pulse ox.
> 
> nobodies saying that they aren't a handy thing to have. and yes, its a good thing to be able to measure the efficacy of treatment as long as reliance on a notoriously inaccurate device is avoided.


 indeed Kev. i know a few EMT's that have been EMT's for a while that don't even remember what to listen for when taking a manual BP. they have grown so accustomed to the auto's that they depend and even worse treat the monitor. i have seen guy who were dizzy, i asked " i said let me see, checked it with my manual and steth, sure enough 96/42.


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## CAOX3

You guys have it good, automatic bp cuffs, pulse ox's, atutomated this, automatic that.

We have a pulse ox, but its been out of service for a while.  Auto BP cuffs?  Whats the point? There expensive, innacurate in our enviorment, and usually once dropped never work right ag

Call me old fashion but I will stick to the basics.

If it isnt broken, dont fix it.


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## skyemt

it always seems to be the same thing here with pulse-ox..."absolute numbers" to "confirm" a diagnosis,etc... not needed for that... as stated before, a good clinical exam will make that decision for you...

however, in a sick person, trending is the most useful thing a pulse-ox can do... tell you if the pt is sick? no, you knew that already.. but deteriorating? perhaps... can the pulse-ox help with that? yes... trending over time enroute to the hospital...

yet while this IS the most useful aspect of the pulse-ox pre-hospital, it is rarely, if ever mentioned.


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## EMTSteve

*Electronic BP Cuffs?*

Everyone that works on an ambulance knows how difficult it is to get an accurate BP in a moving/code 3 rig.

I've thought of getting an electric bp unit to use. It would be nice to slip on the cuff, hit go and continue my physical assessment or paper work.

I've heard different things from different people along the lines of electric units not being accurate and what-not.

I figure it will be far more accurate then a standard unit.

Here is a unit I’ve looked at.
http://www.allheart.com/bvua767p.html
*I in no way condone purchasing ANYTHING from allheart. Done it once, and never again.

What is your take on it?


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## mycrofft

*I don't like automatic cuffs.*

I've used the ones by ITEK and Welch Allyn, and a coworker used some brand from Riteaid Drug Store that clamped on your forearm.
Each used a microphone either in the cuff (ITEK) or inside the unit listening through the inflation hose (Welch-Allyn) for the appearance and disappearance of pulse noise. Patient speech, velcro releasing noise, or bumping the cuff while taking other VS's at the wrong moment can cause the cuff to reinflate again to a higher level, and the results are wrong a significant part of the time no matter what if the unit gets rough useage...or sometimes, even without rough usage.
Additionally for our field-weenie bretheren and sisteren, if they break, you're out of luck. They can break mechanically, or there can be power issues or electronic gremlins. Not much to fix, whereas a cheap manual unit can sometimes be fixed by whacking it, or have another one as a replacement since they cost a LOT less.
Good news: if you are stuck with a bunch of their funny one-tube cuffs for Welch-Allyn, you can use a 1/4 inch drip irrigation "T" to hook up an aneroid and an inflation bulb to make a manual unit. And if you scavenge the inflator pump out and get the voltage rating, you can use it with a battery to circulate air in your bait well for bass fishing.


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## EMTSteve

So you say a semi-mechanical one would work better. (ones that you need to pump manually then it does the rest on its own?)


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## KEVD18

no please for the love of god no. not again!!!

this ones been covered at least a dozen times. nothing has changed. please dont do it again. everytime this questin comes up, i have flash backs for a month. pkus its causes my ibs to act up.


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## mycrofft

*K, stop with the generic beer!*

......:wacko:


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## KEVD18

http://www.emtlife.com/showthread.php?t=8069&highlight=cuff
http://www.emtlife.com/showthread.php?t=7546&highlight=cuff
http://www.emtlife.com/showthread.php?t=5474&highlight=cuff

heres the first three i found(with a thirty second search btw) that had auto bp cuff in the title. that doesnt count the three or four HUNDRED times it comes up in other threads.


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## KEVD18

ok im pretty ashamed that i let that first post get out without a quick spell check. but i blame it on the flash back i was having at the time....


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## JJR512

Practically all automatic BP units use an oscillometric method to determine the pressure. They have a pressure sensor that senses the pressure in the cuff. When the cuff is inflated to a pressure within the range of DP to SP, the pressure in the cuff will be affected by the pulse pressure. Below DP or above SP, the pressure in the cuff would remain constant, or without oscillation. The computer in the unit observes the pressure when the oscillating starts and when it stops, and computes SP and DP from that data.

I don't know what specific ITEK or Welch-Allyn units were being mentioned earlier, but I have a high index of suspicion that the described method of their operation is incorrect, that they do not use an ausculatory method, but do in fact use the oscillometric method that's standard in automatic or electronic BP units.


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## firecoins

Som lifepaks and other machines come with an electronic bp.  Only have used it on scene or when the rig isn't moving.


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## mycrofft

*Oscillometric, microphone...velcro noise and external tapping still set it off.*

Technically speaking, a microphone is an oscillometric transducer which operates within the frequencies of sound waves. I tore open an ITEK and looked at the mechanism...essentially a microphone, a flexible component coupled with a component designed to produce electronic signals. A human auditory canal sealed with a decent stethoscope and earpiece is analogous, except you and I can tell velcro noise from a heartbeat.
The point it that the auto cuffs are not as good nor as cost effective as a trained person with good hearing, the proper scope, and a decent BP cuff. "It is what it is" and "Badda bing".

And the rolling stands they come on make good carts for manual vital sign equipment, too.


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## TransportJockey

My service carries Zoll M-series w/ NIBP cuffs. I do a baseline manual and will use the NIBP only if it is in the same range as the manual


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## LucidResq

I work at a clinic that supplies only electronic BP cuffs. I'd say that 40% of the readings I get are glaringly inaccurate. I'm strongly considering purchasing a cuff to bring to work so I can take manuals. I don't care if it takes a little more time.


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## Jon

So... The Serial Merger is back again.

I've got 4 similar threads here now.


The long and short of it:

The cheap ones you get at a drug store are crap. I hate it when "Skilled" nursing homes use them, then call 911 for "extreme" hypo/hypertension... when I arrive and check with a normal cuff... B/P is normal.

Even the cuffs in the LP12's aren't always accurate. In fact, at least one medic I work with won't use the LP12's NIBP until he's taken a baseline manual pressure.


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## marineman

Jon said:


> So... The Serial Merger is back again.
> 
> I've got 4 similar threads here now.
> 
> 
> The long and short of it:
> 
> The cheap ones you get at a drug store are crap. I hate it when "Skilled" nursing homes use them, then call 911 for "extreme" hypo/hypertension... when I arrive and check with a normal cuff... B/P is normal.
> 
> Even the cuffs in the LP12's aren't always accurate. In fact, at least one medic I work with won't use the LP12's NIBP until he's taken a baseline manual pressure.



That's in the protocols for the service I ride with, first BP is always always always never fail manual by ausciltation unless extreme circumstances won't allow then palpation is fine. After that we can use the automatic cuff on the Zoll monitor but if it's more than 20mm Hg different than our manual pressure we toss it and take another manual.


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## mycrofft

*I spoke with a Welch Allyn support tech today...*

about a 300 series VS monitor.
He acknowledged that noise will cause the machine to restart and pump up a higher level, that it can adversely affect readings, but here was the capper:
A ten mmHg range is considered "acceptable" for these machines, and that they are "not designed" (his words) to direct patient treatment, but are for screening only.
I have recommended that we get rid of these expensive little friends. Check your manufacturers too about "acceptable" accuracy and what THEY intend for these to be used for.


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