Blood Pressure on the Road

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bnn987

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Attempting to get an accurate blood pressure reading in the back of a moving ambulance isn't the easiest task. Do you guys have any tips for getting use to hearing a pressure while moving?

Normally I'll feel for the strongest point on the brachial pulse prior to pumping the cuff. I'll begin to pump the cuff while holding the radial pulse. After losing the radial pulse I'll pump it up 30 mg higher. I'll then slowly lower the pressure until I get the best reading.

Any other field tips?
 
bnn987 said:
Attempting to get an accurate blood pressure reading in the back of a moving ambulance isn't the easiest task. Do you guys have any tips for getting use to hearing a pressure while moving?

Normally I'll feel for the strongest point on the brachial pulse prior to pumping the cuff. I'll begin to pump the cuff while holding the radial pulse. After losing the radial pulse I'll pump it up 30 mg higher. I'll then slowly lower the pressure until I get the best reading.

Any other field tips?
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If you have a monitor on your truck, you could use that. I'll may get crap for saying this but watch the needle bumps.
 
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One tip I got off of here (mycrofft I think gave it to me): try to "isolate" yourself from the ambulance. Feet off the floor, patient's arm off the gurney, and so on
 
Sorry for being redundant. I found a similar forum in March of this year. Sorry!
 
Achilles said:
If you have a monitor on your truck, you could use that. I'll may get crap for saying this but watch the needle bumps.
Click to expand...

DON'T find a BP by this manner. It will help give you a ballpark of around when the Phase I Korotkoff will start, but is by no means a correct way to take a BP.
 
The bouncing needle could be from muscle spasms so I wouldn't use that but I usually find my spot pump it up between 100-140 and listen for it. Then if I find a good pulse I continue on but if not I find another spot until I can find a good enough one. This has worked for me very well even on the PT who has a very faint pulse.
 
put your foot in the bottom of the stretcher and the patients arm on your leg then take the bp. If nothing take a palpation
 
adamjh3 said:
One tip I got off of here (mycrofft I think gave it to me): try to "isolate" yourself from the ambulance. Feet off the floor, patient's arm off the gurney, and so on
Click to expand...

This is my method of choice as well.
 
Lots and lots of practice. It took my a while when I first started. Now it's no problem getting a b/p rolling code 3. You'll get it eventually.
 
dawgsfan11 said:
Practice, Practice, Practice
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Practice does not make perfect. Only perfect practice makes perfect.
~Vince Lombardi

Make you sure you're setting yourself up properly every time. Isolate yourself and the patient as much as you can. If the patient or someone is talking, see if you can make them shush. Personally I pump it up to 200 since many of my patients have less than well controlled hypertension. Let the air out slowly. It's better to get it on the first time and go slow than have to try multiple times.

Eventually you'll have your ears trained to hear the sounds, and you can isolate them no matter what the environment.
 
Invest in a good stethoscope, such as a Littman, etc. While not necessary, they are definitely much better at picking up sounds, and the earbuds do an excellent job of cancelling noise, much better than the stock ones on the truck (if your service is anything like ours).

Again, you don't have to, but I'm a fan of anything that works well and still makes my life easier.

Plus you know where the earbuds have been.
 
Good scope and good ears, know what you are listening to and be able to hear it.

Feet off the floor.

When all else fails palpation is perfectly acceptable. Do not use needle bounce (in a moving ambulance are you kidding me?)
 
Get a good stethoscope, that will help isolate the noise, and amplify sounds to make everything louder.from the bell. It makes a huge difference.
 
hyperlyeman1 said:
Get a good stethoscope, that will help isolate the noise, and amplify sounds to make everything louder.from the bell. It makes a huge difference.
Click to expand...
+1
The $10 cheap-o scopes that are provided by my service are horrible. They work when I forget to bring my personal scope, but my Littmann makes it waaaayy easier to hear the korotkoff sounds. $70 scope vs a $10 scope is night and day in my opinion. I'd mostly attribute it to both increased sensitivity and the excellent noise canceling ability.
 
Alot of great tips to go around, so I guess I'll add my two cent also. Before I even begin usually with a bloody or (insert body substance here) person I keep a disposable pillow case behind me and fold it over my knee like a napkin. Have the pt relax their arm with their elbow resiting on your knee. I then put my ears around my neck and then put the BP cuff on high over the antecubital space. Every time I palp the brach artery to find where my steth is going. (You can either just palp it and go straight into your bp or get your pulses first and then go into your BP, for me it is easier to remember the numbers that way, your preference) Get your BP and your good. If you are having a gnarly trauma or pt with low bp, I personally will attempt once or twice, then fully deflate the cuff, wait a few seconds, re inflate and close my eyes to zone out any noise I can and hopefully hear it then open to see where the number was. If all goes out the window, go for a palp.

Since we are discussing a few tips here I recently got an amazing tip from a fire Captain for getting an accurate heart rate count on a ped. Put your steth on the center of their chest. Close your eyes, zone out, and start tapping the beat of their heart with your other hand on your knee. Once you have the rhythm down, open your eyes while still tapping your knee and count your taps with the seconds on your watch, works every time. Congrats, you got a pediatric heart rate.
 
Isolate the patient's arm from the truck by resting it on your leg, and your feet on the stretcher. Expose the patient's arm as much as possible. Palpate the patients arms for a good brachial pulse. Put the stethoscope directly over that spot. If you can, lift the arm above your leg with the same hand holding the stethoscope head and take the BP.
 
I'd have to say practice...I used to have a lot of trouble taking it in the back of the truck, but it has gotten easier. A good stethoscope does wonders also :) And don't be afraid to admit you can't hear it...there is no point in giving the hospital an incorrect reading...
 
Using the needle bounce on a Bp cuff is extremely inaccurate. I put my feet on the bottom off the stretcher, patients arms in my lap and feel for the brachial pulse, so I know where to place my stethoscope. Also if it's not a critical patient, you can wait till you are stopped at a signal light then take one. I have even been known to take a bp in the patients house.
 
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