Automatic blood pressure cuffs...

[Hastings]

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.

 

[mikeylikesit]

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.

 

[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.

 

[VentMedic]

"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?

 

[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.

 

[Hastings]

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.

 

[emtd29]

Automatic cuffs suck

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

 

[KEVD18]

well gee im glad this one was brought up again.


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

 

[emtd29]

 

[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

 

[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.

 

[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.

 

[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.

 

[mikeylikesit]

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.

 

[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.

 

[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.

 

[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?

 

[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.

 

[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?)

 

[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.