# Blood Pressure question



## Small_Town_EMT (Jul 30, 2009)

A few days ago a co-worker at the place I work - I am a volunteer for our local ambulance - took the blood pressure of a resident, and came up with a bp of 70/0.  I am still pretty new, but I am pretty sure a diastolic bp of 0 is not possible under normal circumstances.  I did some research, and it appeared that it is possible under certain circumstances during pregnancy.  I would like some feedback as to if this is possible or not.


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## Shishkabob (Jul 30, 2009)

I have not been able to find anything pertaining to what you said aside from an anectdotal reply on a Wiki answers site, which of course means it has no proof;


> In many pregnant women, the 4th phase karatkoff sound is audible even though there is no pressure in the cuff. Hence, this leads to a 5th phase karatkoff sound (diastolic pressure reading) of 0. So yes, a systolic reading of 110 and a diastolic of 0 is possible - an example would be in pregnancy.





But do know this;

Many times when taking a BP. people are told "listen for the diastolic bp until it disappears" and go all the way to zero and can still hear it.

When that happens, you listen until you hear a notable tone change in the diastolic, and that is the true value.  If you hear "WOOSH WOOSH WOOSH" and all of a sudden it gets lighter to "wish wish wish", that's the diastolic.


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## Small_Town_EMT (Jul 30, 2009)

That is exactly what I had found, but I tend not to put much trust in what Wiki says.  It is nice info, but I definitely like more credible sources.  I am looking for someone with real life experience, or some hard evidence.  The co-worker says that she was a former EMT - which I have no proof of, as well as years of experience as an RN - again which I have no proof of.  She says that she used to see a 0 diastolic all the time, but my best guess is that if someone has a 0 diastolic it would mean death, or near death.

The whole situation was a bit weird, and I didn't feel it was my place to question her in  front of other co-workers and residents.  When I took the residents bp when I got to work, it was roughly 117/70.  I can't remember exactly what it was, but that is close enough for our discussion.


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## 8jimi8 (Jul 30, 2009)

I've seen it all the time and I used to be an EMT are logical fallacies.

Good thing you checked it yourself.


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## MMiz (Jul 30, 2009)

Small_Town_EMT said:


> A few days ago a co-worker at the place I work - I am a volunteer for our local ambulance - took the blood pressure of a resident, and came up with a bp of 70/0.  I am still pretty new, but I am pretty sure a diastolic bp of 0 is not possible under normal circumstances.  I did some research, and it appeared that it is possible under certain circumstances during pregnancy.  I would like some feedback as to if this is possible or not.


Interesting question.  I think you need to take it again or have someone else try.  As they say, "If a tree falls in a forest and no one is around to hear it, does it make a sound?"  Just because you can't get an accurate BP doesn't mean others can't.

Recording the diastolic pressure use phase V Korotkoff (disappearance of sound). _Use phase IV Korotkoff (muffling of sound) only if sound continues towards zero but does not cease_.  Source.


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## MendoEMT (Jul 31, 2009)

I agree with MMiz, try again or get someone else to.  It can take a while to get really good at taking BPs (especially in the back of a moving ambulance) so keep practicing.  And the only time I've seen a BP of 0 is....  a code??


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## rescue99 (Jul 31, 2009)

Having a blood pressure tick all the way down is very common, especially in the elderly. 
In this event, take the last sound you hear that is audibly softer than the first sound...kinda TICK TICK TICK tick tick tick tick tick tick. 

You can also write the systolic and diastolic exactly as you heard it....70/0. By the way, that's pretty low!


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## mycrofft (Jul 31, 2009)

*First reference to Korotkoff sounds! Great!*

Other reasons for that sort of BP:
1. EMT hearing deficit, especially blockage or tinnitus.
2. Pt arm very soft and/or odd blood vessel placement.
3. Noise issues.
4. Stethoscope head moving or improperly placed for that pt.
5. Dinkydau automatic $^%* vital sign machine or automatic cuff instead of human ears.


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## Shishkabob (Jul 31, 2009)

mycrofft said:


> 3. Noise issues.




Thanks for joining the convo!


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## rhan101277 (Aug 1, 2009)

It is also possible not to get a blood pressure, if systolic and diastolic are the same or pretty close (110/108) or some such.  I forget what it is called.


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## FFMckenzie (Aug 1, 2009)

rhan101277 said:


> It is also possible not to get a blood pressure, if systolic and diastolic are the same or pretty close (110/108) or some such.  I forget what it is called.



Narrowing? 


70/0? even if it was 70/p    70 is a pretty low systolic I know personally I would have wanted to go have a look for myself. 

I think the moral here is if something seems not right and it is second hand information you should most likely have a first hand look. 

I know it can be hard to hear sometimes in certain environments and some patients are harder than others to get an accurate reading from. If I get a B/P that seems off (or out of what I think is normal for the moi/noi and my general impression)I usually check it twice just to compare. 

Just my 2 cents.


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## MrBrown (Aug 1, 2009)

You weren't using the Lifepak 12 or another automated blood pressure monitor were ya? If so 70/0 wouldn't suprise me


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## EMTinNEPA (Aug 1, 2009)

rhan101277 said:


> It is also possible not to get a blood pressure, if systolic and diastolic are the same or pretty close (110/108) or some such.  I forget what it is called.



A narrow pulse pressure (pulse pressure = systolic - diastolic).  And it's generally considered a bad thing.  That is, unless your patient is stable otherwise, then it's probably operator error.


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## SeeNoMore (Aug 1, 2009)

Was the BP taken again during your care? If so by you, another EMT/I/P or automatic?  Was it similar the second/third time?


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## EMT1 (Aug 2, 2009)

rhan101277 said:


> It is also possible not to get a blood pressure, if systolic and diastolic are the same or pretty close (110/108) or some such.  I forget what it is called.



When the systolic and diastolic reach the same, its called pericardial tamponade. This happens when fluid or blood fills the pericardium sac around the heart an puts pressure on the heart not allowing it to refill with blood.


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## Kage (Aug 5, 2009)

It is entirely possible, and in fact common in the elderly as rescue99 pointed out, to never reach a phase V (complete disappearance of Korotkoff sounds) when trying to determine diastolic.

When this occurs, most clinical groups (American Heart Assoc, British Hypertension Society, etc) recommend using phase IV to determine DIA. Phase IV is when the K-sounds suddenly become muffled or softer.

A good resource to check out would be the most recent published recomendations for BP measurement from the AHA. You can get their free pdf download here

It's a pretty good review of manual (auscultatory) BP measurement but there is also some helpful info on the oscillometric technique used in most automated monitors and defibs. Mr Brown may find this helpful with his Lifepak 12.


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