Blood pressure advice

[villagegirl127]

Does anyone have some advice on how to get an accurate blood pressure in the back of a moving ambulance?

 

[Shishkabob]

Practice.



Palp it if you have to get a general idea and can't hear.

 

[medicdan]

There have been some great discussions of this in the past, consider searching "Blood Pressure" on this forum.
Off the top of my head, some of the best advice I can offer is to have direct contact with the patient's skin and the Stethoscope's bell, to rest the patient's arm on your legs, and put your legs on the base of the stretcher (so you all get the same bumps/movement together), or simply, to try to get the BP while at a light or before leaving.

Good Luck!

 

[JPINFV]

Practice.

Rest your feet on the undercarriage of the gurney, not on the floor of the ambulance.

Have the patient's arm on the mattress of the cot, not on the side rail.

Clench your teeth to help cut out outside noises.

Look out the front window and time your BP checks with intersections when possible.

 

[gamma6]

if you do have your boot on the floor, use your toe and not the whole foot. i usually rest their arm on my leg. some people use super fancy bells and stuff, the cheap Stethoscope works for me. i have a good one but i can't hear a damn thing out of it.

 

[bunkie]

Practice.

Rest your feet on the undercarriage of the gurney, not on the floor of the ambulance.

Have the patient's arm on the mattress of the cot, not on the side rail.

Clench your teeth to help cut out outside noises.

Look out the front window and time your BP checks with intersections when possible.

I just took notes on that. Thanks for the great advice.

if you do have your boot on the floor, use your toe and not the whole foot. i usually rest their arm on my leg. some people use super fancy bells and stuff, the cheap Stethoscope works for me. i have a good one but i can't hear a damn thing out of it.

I think it depends more on your ears personally. I had a cheap scope that was fine for when I was working on animals, but I couldn't hear BP's with it on people so I had to upgrade (to a littmann) and I love that thing.

 

[NomadicMedic]

All good advice. The big one is keeping your feet off the floor of the truck and holding the pt's arm off of the stretcher rail. Eliminate as many vibrations as you can.

Does a better scope mean you can hear better?

Eh, all of the evidence is anecdotal, but I swear I can hear better with my Littmann than I can with the el cheapo Sprague scopes that are normally in the truck.

 

[MSDeltaFlt]

Does anyone have some advice on how to get an accurate blood pressure in the back of a moving ambulance?

Practice, practice, practice. If you have to, pull over up to and including shutting the truck off. I've done that several times myself and it's perfectly OK to do so.

Palpate only as a last resort.

 

[gamma6]

I just took notes on that. Thanks for the great advice.



I think it depends more on your ears personally. I had a cheap scope that was fine for when I was working on animals, but I couldn't hear BP's with it on people so I had to upgrade (to a littmann) and I love that thing.

true, true....i have a littmann and can't use and that sucks cause it is a nice one and was expensive.

 

[zmedic]

Make sure your earpieces are facing the right way.

Joke.

But get good at getting BP by radial palp. Worst case scenario you at least get a systolic. And for most things that is what you are worried about (as well as you can see the trend). Sure it's not ideal but better than nothing. Also make sure you get a blood pressure on scene. It helps you figure out if your pressure in the rig is crazy talk. (Sure, the patient's pressure could go from 160/100 to 90/40 in five minutes, but they better be bleeding or be looking much sicker. Otherwise it means you screwed up.)

 

[DV_EMT]

get your ears checked...

jk jk

consider a littmann only if the techniques above don't help. My omron is what i carry on my person... but my littmann is always in my pack for extra help.