Accuracy/reliability - Manual BP vs. Automated.

[Akulahawk]

Am I the only one who has seen denial be a huge issue with manual B/Ps?

I have seen it a few times with some partners I've had. Sometimes it's been with both auto and manual BP's on the same patient! I'm more surprised that I can't get a BP on a patient rather than one that is higher or lower than I would expect.

Early on in my time as an EMT I had a couple times that I was in utter disbelief that my patient was absent vital signs... :blink: That has since corrected itself.

 

[Ewok Jerky]

we usually get a manual and switch to auto during transport.

I have noticed issues with bouncy roads/crazy driving tends to lead to falsely elevated BPs.

interestingly enough I trust (or have less issues with * anecdotally?*) the LP12 way more than the LP15.

 

[usalsfyre]

Denial? As in "Oh, I got ###/##, that can't be right."?

Exactly. The LP will give a 70 over nothing. A manual is taken. 128/82....on a patient who is pale, cool and diaphoretic with a heart rate in the 130s and an acute pathology. I've run into this quite a bit.

 

[fortsmithman]

In my service before we use the lifepack for BP and pulse we have to get a manual BP and pulse first. After we get it manulally then we can use the machine.

 

[rmabrey]

My service quit buying NIBP cuffs cause people were tearing them up, or not using manuals at all.

Also per protocol, only Medics are smart enough to use an NIBP. There are obvious ways around getting an NIBP cuff, but Ive become pretty accustomed to doing things manually, then again I'm not the medic doing three things at once. I generally have no reason to take a manual on a psych patient in a moving ambulance.

 

[Akulahawk]

Exactly. The LP will give a 70 over nothing. A manual is taken. 128/82....on a patient who is pale, cool and diaphoretic with a heart rate in the 130s and an acute pathology. I've run into this quite a bit.

Not having used the LP series NIBP feature... I can honestly say I've never seen that. I have, however, seen a ProPaq Encore fail to get a BP, but that was almost invariably due to not using the EKG at the same time. The darned thing would either give us numbers that were pretty close to manual or it would not give us any numbers at all. That 70/?? was something I never saw, ever, with it. Those things were nifty little monitors...

 

[mycrofft]

My cardiologist won't use machines in his office. If the pulse is very irregularly-irregular, the BP can be off and the pulse count WILL be off. A person would take one or two more to sort of average it out.
We had them where I worked and they were fine for normal patients. Like a fire extinguisher that's good for things that aren't on fire.

 

[EpiEMS]

Exactly. The LP will give a 70 over nothing. A manual is taken. 128/82....on a patient who is pale, cool and diaphoretic with a heart rate in the 130s and an acute pathology. I've run into this quite a bit.

I've seen that, as well, but never in somebody who was in serious distress, fortunately. I wonder why that happens.

 

[Aidey]

All of the ALS agencies here have LP15s with NIBP. The two biggest both have the attitude that manual is still better, and I almost never ever see them use their NIBP.

Frankly, when used right I have no issue with getting bizarre numbers. If the cuff isn't the right size, isn't on right, is over 4 layers of clothing, or is up against something (like the gurney railing) I've noticed it gives absurdly high diastolic results, but assuming it is being used right I don't see why people don't believe them.

 

[mycrofft]

I know how to make the machine work properly. Take the BP manually on the other side simultaneously to demonstrate how far off it is.

 

[Veneficus]

I know how to make the machine work properly. Take the BP manually on the other side simultaneously to demonstrate how far off it is.

No good boss,

Under textbook conditions you should take a BP on both sides and use the worst reading. (particularly in HTN)

Because vascular occlusions and even A/B indexes don't distribute uniformly, you may get 2 wildly different readings that are both accurate.

 

[usalsfyre]

I've seen that, as well, but never in somebody who was in serious distress, fortunately. I wonder why that happens.

My example is called "optimism" lol.

 

[OSMedic]

How can you be sure the automated BP is the wrong one?

You can never be 100% sure. But the age old adage has always been, Treat your patient and not the machine.

This doesn't work for all cases but if you get a manual BP of 128/82 initially. And then with no change in your patient condition what so ever, 10 minutes later while driving to the hospital, an automated BP gives me a reading of 142/98. I would venture to say the automated BP is wrong. Especially if the patient is resting.

If I am transporting a patient a getting odd numbers from an automated machine I will always try to get a palpated BP along with it.

 

[usalsfyre]

You can never be 100% sure. But the age old adage has always been, Treat your patient and not the machine.

This doesn't work for all cases but if you get a manual BP of 128/82 initially. And then with no change in your patient condition what so ever, 10 minutes later while driving to the hospital, an automated BP gives me a reading of 142/98. I would venture to say the automated BP is wrong. Especially if the patient is resting.

If I am transporting a patient a getting odd numbers from an automated machine I will always try to get a palpated BP along with it.

Depending on ambient noise, patient history, anxiety level and many other factors I'd say the manual might be wrong or they might both be right. I have seen many times we vastly overestimate our prowess and the accuracy of our tools with things like B/P measurement. My NIBP cuff is calibrated at least every six months. When was the last time your manual cuff was checked?

 

[OSMedic]

When was the last time your manual cuff was checked?

That is a very good point. I think I am going to look into that.

 

[OSMedic]

Does anyone here use this? Check it out seems pretty cool. Pretty expensive though.

http://www.statmap.net