Blood Pressure on the Road

xrsm002 said:
I have even been known to take a bp in the patients house.
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..you er...don't normally do this?

@OP: If you can't get a BP on the move, just have your driver pull over so you can get a proper accurate pressure.
 
Ok am I correct to say two different people taking a blood pressure on the same patient will get different readings? I have one preceptor my head one and his partner. The head one trust my blood pressure. His partner however takes a blood pressure 30 seconds to a minute after I take mine and gets a lower reading. That being said I had the save thing happen with another preceptor but when we got to the ER their NIBP had gotten the reading close to mine just about every time
 
Who would you trust. I've been an EMT for 6 years and am finishing up my medic ride outs
 
I always do one on scene (initial pt contact), one before starting transport, and one upon pulling up at the ED. This will usually suffice for most of the "vanilla" patients I run on. When there is a need for repeat pressures during transport, my Littman works well (as well as years of practice). If all else fails, palp the blood pressure.
 
I use the monitor onscene, enroute.

I rarely take a manual BP.

Honestly I trust the monitor over just about anyone. Just make sure conditions are right for an accurate reading. It is far more capable and sensitive than a human ear.
 
xrsm002 said:
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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I should hope vitals are taken in the house. We had such an issue with crews not starting in the house/bedside that the state issued a series of directives mandating that care begin there. I have no problem with this, I was doing it already and it just makes sense given the fact that the majority of our calls are neither time sensitive nor are we working at an "unsafe scene." I'd rather figure out what's going on with my patient immediately instead of making them feel like they are being herded to the truck.
 
A BP monitor must be nice. Only the boys on the chopper get those here. Those of us on the streets do it manual.
 
med51fl said:
A BP monitor must be nice. Only the boys on the chopper get those here. Those of us on the streets do it manual.
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Dont have a lifepak or equivalent device as a medic?
 
We do have LP-15, but the auto BP is optional (not standard). We also do not use the built in SAO2 on the LP-15. We do manual BPs, use a handheld SAO2, and use the EKG for EKGs. I know it sounds pretty silly, but the intent is two-fold.

First, the more gadgets on a machine, the higher the chances it breaks. The built in BP, SAO2 are nice features, but it is still fluff.

Second, by making crews take BPs it encourages more "hands on" the patients. So many crews today put on the probes, electrodes, and monitors and don't actually put hands on the patients.
 
When I graduate and I work on a truck, I plan on getting a manual on scene in a quiet environment, then hook them up to the monitor so I can work on getting IV and other things (drawing up meds etc) going. Where I'm at it's pick patient up do a manual in back of truck while idling at the scene, get IV then go. I think it takes more time and it doesn't look like the crews are being very caring of their patients. At least in my eyes. I've had calls where the first or second thing out of the crews mouths is what hospital do you wanna to to.
 
med51fl said:
We do have LP-15, but the auto BP is optional (not standard). We also do not use the built in SAO2 on the LP-15. We do manual BPs, use a handheld SAO2, and use the EKG for EKGs. I know it sounds pretty silly, but the intent is two-fold.

First, the more gadgets on a machine, the higher the chances it breaks. The built in BP, SAO2 are nice features, but it is still fluff.

Second, by making crews take BPs it encourages more "hands on" the patients. So many crews today put on the probes, electrodes, and monitors and don't actually put hands on the patients.
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The biggest problem with the handheld devices is that they don't generally give you the ability to see a waveform (pleth). Much like capnography, the number is completely useless unless you have a good, consistent waveform.

My service also choose not to get non invasive blood pressure on our Zoll E series, and i prefer that way. We only deal with 5 to 25 minute transport times and NIBP is really nice for IFT but in the emergent seeing, i prefer the easy way. You also don't get in the habit of dragging in a monitor everywhere and straining your back.
 
LOL i wouldnt trush the needle bumps man... everyone else if giving u good advice... take you feet off the floor, put the patient arm on ur leg, and concentrate on one thing... dont worry about the road, how far u gotta go until u reach the hospital, just watch that dial the needle bumps will still happen even after you stop hearing the BP...
 
Also, do not put the bell of the stethoscope under the edge of the cuff, which i see everyone do, but it is wrong and can cause bad readings
 
What do you all think of using electronic stethoscopes on the road.
 
xrsm002 said:
What do you all think of using electronic stethoscopes on the road.
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Why waste the money. With time and experience bps, lung and heart Sounds will become easier to do/ distinguish......even with a run of the mill scope.
 
xrsm002 said:
What do you all think of using electronic stethoscopes on the road.
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I don't have a problem as long as the person using them knows how to take a manual AND can trouble shoot a bad reading. There's nothing worse than having a hypotensive patient and have everyone fixated on the automatic cuff that's just coming up as an error message.
 
In talking electronic stethoscopes not NIBPs. The ones that amplify the sounds
 
xrsm002 said:
In talking electronic stethoscopes not NIBPs. The ones that amplify the sounds
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Oh, wait I see that now... hehe... opps.

rexst.jpg
 
Head for the Forearm

Many of times I couldn't obtain a BP in a moving ambulance. There are a few techniques that I have picked up over the years that might help.

First one, head for the forearm. By placing your BP cuff between the pt's radial pulse and elbow hinge you can obtain a very dominant palpation BP. Obviously you won't catch a diastolic reading but it's something.

Another method, if the pt can have them make a fist about 2 or 3 times. It can increase blood flow and make it easier to auscultate. Hope this helps!!

-Slick
 
I realize it is very tempting to just use the monitor on your truck. However, if you do not know how the monitor takes a blood pressure I'll explain it like a paramedic explained to me the other day. The cuff inflates like any blood pressure cuff but instead of listening for sounds the cuff will detect the pulse through the brachial. The only problem with this is the fact that you are driving down a road and the cord is bouncing around so it's not accurately feeling the brachial pulse.

The reason I had asked him about this was because the pt's blood pressure was normal then 5 minutes later the diastolic had dropped by about 60 and this made me worried, but he assured me it was fine that it was just a bogus reading and that's why we always use a manual blood pressure.
 
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