# BP Checks



## mcvey7218 (Apr 28, 2007)

I have had the toughest time in class this week, with a procedure that should be simple.  I have been unable to correctly measure BP.  I had the cuff and stethescope correctly placed, but when I pumped the BP cuff up, I was unable to hear the initial beats of the systolic pressure.  I could however begin hearing the "dull thuds" of the dyastolic pressure.  But each time that I thought that I had the systolic pressure correct, it was INCORRECT.  HELP!!


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## SwissEMT (Apr 28, 2007)

http://www.emtlife.com/showthread.php?t=4336

The information is already posted.

Remember: IF YOU HAVE QUESTIONS, ASK THEM IN CLASS. 
You need to learn all the aspects of your job, and that's why you're actually IN EMT school. You're there to make mistakes, you're there to try things and see what works and doesn't work. most importantly, you're there to LEARN. So use the time you've paid for to do so!


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## Ridryder911 (Apr 28, 2007)

I think you need to be sure that you accurate palpate the pulse, then place stethoscope on that pulsation. Like, Swiss described be sure that you ask your instructor and other class mates. Practice makes perfect!

R/r 911


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## Glorified (Apr 28, 2007)

I had really hard time too when I first started.  What helped for me was getting together with classmates after class and practicing on each other.  I also bought a cuff and stethoscope to practice on my parents.


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## firecoins (Apr 29, 2007)

I get as much practise as possible.  I keep taking the bp of friends to get used to taking bps on different arms.


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## medicdan (Apr 29, 2007)

mcvey7218 said:


> I have had the toughest time in class this week, with a procedure that should be simple.  I have been unable to correctly measure BP.  I had the cuff and stethescope correctly placed, but when I pumped the BP cuff up, I was unable to hear the initial beats of the systolic pressure.  I could however begin hearing the "dull thuds" of the dyastolic pressure.  But each time that I thought that I had the systolic pressure correct, it was INCORRECT.  HELP!!



I just (officially) learned how to take BPs (I have been taking them for years for family)-- and one of the things that my instructor said (and it is mentioned in the linked posting) is:
1) NEVER make up numbers, if you cant get the BP, try it again. If you still cant get it, ask someone else to try.
2) NEVER (I mean almost never) report 120/80-- in reality nobody hits the "average" that well. It leads to colleagues not trusting and of the decisions you make. If you get 120/80, try it again. If you continue to get that reading, ask someone else to try it. 
3) BPs are all relative. One reading means nothing-- thats why in the Fx and PE you are told to take BASELINE vitals-- you detect problems or solutions through the changes between readings (whether it be every 5 or every 10 minutes). The same can be said for the electric machines-- they may differ from your readings, but they will always differ by the same factor.

Hope this helps, and enjoy your class!


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## HorseHauler (Apr 29, 2007)

hmmm if i clearly get a 120/80 its getting marked down on the paper... I don't see a reason to re-do a 120/80 5 times...


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## mysterl33 (Apr 29, 2007)

i was told nobody really has perfect 120/80 haha

also, if ur unsure, ask someone else if they can do and ask what they get..


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## Epi-do (Apr 29, 2007)

Like already mentioned, just keep practicing and don't be afraid to ask questions in class.  The more you practice, the easier it will become.  It never hurts to ask someone else to also check a BP after you have done it to see what they get.  If you do that though, wait until after they have checked it to tell them what you got.

Also, keep in mind that some people are just more difficult than others to hear a BP or palp a pulse.  We all have come across patients that we just don't hear it.  I have been on one or two runs where not only could I not hear a BP, my partner just couldn't get it either.  At that point, we tried the auto cuff on the monitor and went with it.  (I personally prefer to get at least one "good" BP the old fashion way before relying on the machine.  In a truck, bouncing down the road, we have found that they aren't always that accurate.)

Hang in there!  You will get it!


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## TKO (Apr 30, 2007)

HorseHauler said:


> hmmm if i clearly get a 120/80 its getting marked down on the paper... I don't see a reason to re-do a 120/80 5 times...



Agreed.  I don't care what people think of me.  If I get 120/80 then that's what I'm reporting.  It happens and that is all there is to it.  I have had it happen too, and I've never heard anyone say a thing about it otherwise.  I'm not going to make up another number or waste time doing it again because I'm afraid of some stigma.

If I can't get a good reading, I'll get someone else to try to confirm (morbidly obese pts always mess with my bp skills) what I did get, or I will go for palp.  I like palp when all else fails because it works well, and systolic is by far the most important number in pre-hospital theatre anyway.


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## stonez (May 2, 2007)

You can get 120/80 readings. I have got them before. And I agree if that is what you get then that is what you report.
Sometimes you will not get a reading that is life.
You can always palpate for a BP, better than nothing.


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## emtd29 (May 6, 2007)

OK, My Advice:


PRACTICE PRACTICE PRACTICE!!!

AND then when you think you have got it down pat...

PRACTICE SOME MORE ! ! !

Practice on parents, friends, other members of your family. and if you have access to a pediatric sized cuff practice on the kids.

and if you can't get a reading, well, sometimes that just happens.
but never EVER make up numbers. palpate if you really have to.

oh, and DON'T be afraid to ask questions. The only stupid question out there is the one that is NOT ASKED

good luck on your journey to becoming an EMT


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## Gbro (Jun 5, 2007)

Ok,
How many of you have seen a crew member take a B/P over clothing? By this i mean not exposing the arm for the stethoscope. Maybe it my ears that aren't as good as others, but i always bare the full arm for cuff and scope.

Additionally, we average 25 min. transport time, and roads are ruff. 
I started a team approach to taking a B/P by palpation. This is done when stopping is impractical and road noise prevents auscultating.
I will concentrate on the pulse and my partner will pump and release, i indicate when to start pumping and when to start bleed down and then the mark we are after. 

Rid,
In your link there was reference to a change in tone for the diastolic pressure in children. I remember from long ago that procedure, but i don't remember it being limited to children. Maybe i was taught wrong? 
I have been using the change in tone for the diastolic pressure always on all pt's.


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## Easy (Jun 5, 2007)

If you have a bell side on your stethoscope, try listening with that side if you can't hear it with the diaphragm (flat) side.  That works for me 9 outta 10 times.


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## Jay114 (Jun 7, 2007)

Gbro said:


> Rid,
> In your link there was reference to a change in tone for the diastolic pressure in children. I remember from long ago that procedure, but i don't remember it being limited to children. Maybe i was taught wrong?
> I have been using the change in tone for the diastolic pressure always on all pt's.



From my studying, I believe that it isn't limited to children, but is much more prevalent in them.


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## rescue_dog (Jun 12, 2007)

Here's something that helped me: take your own BP.  It's kind of awkward trying to hold the stethoscope on your own arm and pump too, but it works really well.  When you're getting your blood pressure taken, you can usually feel each beat.  It will at least give you an idea of how to pick out the sounds and what is just interference.


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## Jay114 (Jun 12, 2007)

emtd29 said:


> OK, My Advice:
> 
> 
> PRACTICE PRACTICE PRACTICE!!!
> ...




Just to say, I have been using this post as a mantra for all my learning in class, thanks!


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## DocHoliday (Jun 22, 2007)

*BP question*

I have known that you need to use even numbers with BPs but what is the reason behind that?

Thanks


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## Ridryder911 (Jun 22, 2007)

Because manual B/P's has only even numbers on the dial. You show me a person that gives me a BP of 129/83 on a manual sphygmomanometer and I will doubt their accuracy on BP checks...  digital is different. 

R/r 911


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## MMiz (Jun 22, 2007)

Ridryder911 said:


> Because manual B/P's has only even numbers on the dial. You show me a person that gives me a BP of 129/83 on a manual sphygmomanometer and I will doubt their accuracy on BP checks...  digital is different.
> 
> R/r 911


That's when I know my ride-along is making things up


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## Guardian (Jun 22, 2007)

yea, same with pulse rate and RR...when they count a rate for 15 secs and give you back an odd number.  Sorry, but when you multiply something by 4, your going to get an even number.


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## BAMAMEDIC (Jun 23, 2007)

Get a quality stethoscope, this will help a lot. Littman Cardiology III, Master Cardiology or something better than the ones your service or school has.


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## Ravamedic (Jun 24, 2007)

BAMAMEDIC said:


> Get a quality stethoscope, this will help a lot. Littman Cardiology III, Master Cardiology or something better than the ones your service or school has.



- you can get a BP with any old stethoscope!


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## DocHoliday (Jun 25, 2007)

*Know what to listen for*



Ravamedic said:


> - you can get a BP with any old stethoscope!



As long as you know what to listen for, I find that you can use any type.  Getting a nice steth could help when listening to Lung sounds.


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## disassociative (Jul 2, 2007)

Alot of times I put on the first line for vitals BP: 120/80 blah blah; and if the BP stays around the same--I put WNL and make sure to document in the text that the BP remained stable within (n)mmHg. Remember--if you didnt document it--it didn't happen.


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## Onceamedic (Jul 2, 2007)

I had real trouble hearing the pressure with the stethoscopes at school.  I went and got a littman III and still had trouble.  The problem -  I have narrow ear canals and I was not getting the standard sized ends into my canals properly.  The littman came with interchangable tips..  and when I put in the smaller ends - VOILA !!!

Darn - could have saved a hundred bucks and used a cheaper scope - oh well -


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## RedZone (Jul 2, 2007)

The only other thing I can add here is, make sure you bend the ear-pieces of your stethescope forward before putting them in your ears.  Our instructor showed us this in my EMT class, but I remember having trouble hearing until I realized I wasn't doing this correctly.


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