B/P cuff question

[EMTCop86]

Ok so this is probably a really stupid question but here it goes... When you take a B/P on a patient with a cuff that is too small you get a false high reading...Well if you take a B/P on a patient and the cuff is too big, do you get a false low reading?

Reason I am asking is recently when I was on my ride out I took a B/P of this women who had very thin arms. The cuff was a bit big (I didn't think to get a smaller one) and I was unable to auscultate a B/P. So I palpated one instead and got 104/P. When we got to the hospital they hooked her up to the automatic B/P machine and her B/P was like 124/78. So was I just way off for some reason or would the B/P cuff being too big give me a false low reading?

 

[BruceD]

A big cuff can lead you to a falsely low reading, but I suspect that the number you got was more related to the method used to obtain it.

Make sure you get with someone to ensure you are using the steth and cuff properly, especially if you have trouble getting pressures on multiple patients.

You might also search around for tricks on hearing bps in a moving truck.

Lastly - maybe the patients bp just went up before you hot inside.

Tc, stay safe
-b

 

[PapaBear434]

Ok so this is probably a really stupid question but here it goes... When you take a B/P on a patient with a cuff that is too small you get a false high reading...Well if you take a B/P on a patient and the cuff is too big, do you get a false low reading?

Reason I am asking is recently when I was on my ride out I took a B/P of this women who had very thin arms. The cuff was a bit big (I didn't think to get a smaller one) and I was unable to auscultate a B/P. So I palpated one instead and got 104/P. When we got to the hospital they hooked her up to the automatic B/P machine and her B/P was like 124/78. So was I just way off for some reason or would the B/P cuff being too big give me a false low reading?

Keep in mind that you are always going to get a lower number when palpating a radial pulse than you'd get listening up higher on the arm. Usually about 10 points of difference, give or take a few. The rest could be argued away by changes in the patient enroute to the hospital and the human factor. No two people are going to get the exact same BP.

That said, I am surprised you don't have a pediatric cuff. Don't you have a peds kit, or a "Broslow" bag somewhere available? A lot of elderly ladies have such scrawny arms that they require the children's cuff.

 

[MSDeltaFlt]

Ok so this is probably a really stupid question but here it goes... When you take a B/P on a patient with a cuff that is too small you get a false high reading...Well if you take a B/P on a patient and the cuff is too big, do you get a false low reading?

Reason I am asking is recently when I was on my ride out I took a B/P of this women who had very thin arms. The cuff was a bit big (I didn't think to get a smaller one) and I was unable to auscultate a B/P. So I palpated one instead and got 104/P. When we got to the hospital they hooked her up to the automatic B/P machine and her B/P was like 124/78. So was I just way off for some reason or would the B/P cuff being too big give me a false low reading?

To answer your questions:

1. Yes. You are still learning. Probably in a moving truck. Techique may have been a little off. And/or any combination of the 3.

2. Yes. They have multiple sized cuffs for a reason.

3. Also, there is no such thing as a "dead on accurate" NIBP monitor... period.

4. That being said, a 20mmHg margin of error on BP can be significant, but, at those numbers, not likely. I wouldn't worry about that.

5. Also, pt may have relaxed more by the time you got to the ER anyway.

 

[EMTCop86]

That said, I am surprised you don't have a pediatric cuff. Don't you have a peds kit, or a "Broslow" bag somewhere available? A lot of elderly ladies have such scrawny arms that they require the children's cuff.

Yes there was a pediatric cuff on the rig but this lady was very agitated and kept arguing with the medic and I and it made me a bit nervous so it honestly didn't even cross my mind to get the pediatric cuff until we had cleared the call.

 

[EMTCop86]

To answer your questions:

1. Yes. You are still learning. Probably in a moving truck. Techique may have been a little off. And/or any combination of the 3.

2. Yes. They have multiple sized cuffs for a reason.

3. Also, there is no such thing as a "dead on accurate" NIBP monitor... period.

4. That being said, a 20mmHg margin of error on BP can be significant, but, at those numbers, not likely. I wouldn't worry about that.

5. Also, pt may have relaxed more by the time you got to the ER anyway.

Thanks for your input. I think I was more worried that I horribly screwed up taking a B/P and honestly did not know what I did wrong.

 

[EMTCop86]

A big cuff can lead you to a falsely low reading, but I suspect that the number you got was more related to the method used to obtain it.

Make sure you get with someone to ensure you are using the steth and cuff properly, especially if you have trouble getting pressures on multiple patients.

You might also search around for tricks on hearing bps in a moving truck.

Lastly - maybe the patients bp just went up before you hot inside.

Tc, stay safe
-b

This was the first patient I had trouble getting a B/P on. The medic said all my other B/Ps were fine. Actually he didn't even mention anything about this specific call. So I think it just boiled down to using a B/P cuff that was too big.

 

[reaper]

That is not something that is taught much in our fine EMT schools. That is the biggest reason why people get bad readings on a NIPB too. They use wrong size cuff or put it on loose.

There are lines on all bp cuffs, for sizing. If it falls outside those lines, then changes to the right size cuff.

 

[BossyCow]

Also, may I add, there are no stupid questions. If there is something that puzzles you and you do not seek clarification, that is stupid. Allowing embarrassment, or lack of knowledge keep you in the dark about something easily explained is going to insure that you remain in the dark forever. By asking the question, you just cleared something up for the 18 lurkers who had the same question but were afraid to ask.

 

[Melbourne MICA]

Also, may I add, there are no stupid questions. If there is something that puzzles you and you do not seek clarification, that is stupid. Allowing embarrassment, or lack of knowledge keep you in the dark about something easily explained is going to insure that you remain in the dark forever. By asking the question, you just cleared something up for the 18 lurkers who had the same question but were afraid to ask.

Well said Bossy

MM

 

[PapaBear434]

Also, may I add, there are no stupid questions. If there is something that puzzles you and you do not seek clarification, that is stupid. Allowing embarrassment, or lack of knowledge keep you in the dark about something easily explained is going to insure that you remain in the dark forever. By asking the question, you just cleared something up for the 18 lurkers who had the same question but were afraid to ask.

I don't know, I've heard some pretty stupid questions in my time. This wasn't really one of them, but I've heard them.

I love how at least once per class I seem to take, SOMEONE gets laughed at because they want to know how to treat cardiac arrest but breathing normally.

 

[Sasha]

I love how at least once per class I seem to take, SOMEONE gets laughed at because they want to know how to treat cardiac arrest but breathing normally.

You reattach whatever lead fell off, no more "cardiac arrest"!

 

[PapaBear434]

You reattach whatever lead fell off, no more "cardiac arrest"!

HA! That happened once, except... It was me.

It was one of those practice dummies you attach the leads to, and it gives you a scenario of the instructors choosing. Brand new in the EKG class practicals, and I thought they were throwing a full blown arrest on me. I start asking for pulse checks, drugs, and compressions if there was no pulse, and the instructor just started laughing.

She leaned down, pulled back the dummy's shirt, and showed me the electrode that came off the clip on the upper left side.

I was called the "Premature Resuscitator" for the rest of the semester.