BP - Auscultation over Radial?

[JPINFV]

To calculate MAP is sys + dia + dia/3. Will you have time to calculate that enroute to ER? No.

If you can do math in your head, you should be able to. Add up the numbers as above and round to the nearest number divisible by 3. Remember that with numbers that are divisible by three, the sum of each individual number will also be dividable by three. For example, 153/3=51. 1+5+3=9 9/3=3.

So, real life example:

126/74 MAP=(126+74+74)/3=274/3 Now, 2+7+4=13. 2+7+3=12 12/3=4. 272 is close enough to 273 for an approximation. So 273/3=91. MAP~91 (91.333 to be specific).

On the other hand, there's a second equation (same equation, actually, just shuffled around a bit).

PP/3+diastolic

PP=Pulse Pressure= Systolic-Diastolic. Using the same example

(126-74)/3+74 = 52/3+74 Use the same technique to approximate a division by 3. 5+2=7. 7/3 is not a whole number. 6 is, so use 51. 51/3=17

17+74=91 Since you rounded down, the number is 91.333 if you want to be specific.

Decimals are actually pretty easy. If you round down a number, add 0.3333. If you rounded up, subtract 0.3333.

 

[JPINFV]

Another thing about the palp. vs. auscultation...

What about the pulse-pressure- you can't get that via palp.? I recall learning about that, but not in enough detail. Could someone give some more detail about it and its use for 'us' (prehospital providers)?

Pulse pressure is just simple the difference between the systolic and diastolic. Since you can't measure diastolic via palp, you can't calculate pulse pressure. PP is important in a variety of chronic and acute conditions involving the cardiovascular and neurological systems, with the well known example being the widening of PP in Cushing's Triad. Patients with arteriosclerosis will have a wide PP since the arteries will be unable to absorb the pulse energy like it should (smaller dicrotic notch).

Heart diseases/conditions that decrease cardiac output (e.g. CHF) will have a low PP.

 

[AnthonyM83]

If they're HYPERtensive and critical, then you will need BOTH sys and dia BP's. BP by palp is useless. If your pt is HYPOtensive and critical, then you need to know where you can and cannot feel a pulse. Again, BP by palp is useless; kinda like mammary glands on male swine.

Could you talk more about how knowing the diastolic will affect treatment for hypertensive and hypotensive patients?

I know it's useful for things like MAP and Cushing's, but as far as straight hypertensive and hypotensive patients, I'm a little lost. I can understand knowing diastolic just to know if they're hypertensive...

 

[MSDeltaFlt]

http://www.highbloodpressuremed.com/blood-pressure-chart.html

Looking at the chart, you can see that it wouldn't take much to make any person clinically hypertensive. There are many reasons that would cause a pt to be hypertensive. Pain is one thing. In a healthy person, there are two things that will change in ANY compromise:

HR
BP

The majority of us healthy people will show a rise in diastolic first.

Also, for those pts on multiple meds for multiple reasons (say cardiac), along with advance in years, you won't see a rise in HR. You'll only see a rise in BP. You always treat pain.

Also, on some high BP's are around 180 sys, but severe hypertension is anything over 220 sys OR 130 dia. The "or" is the operative word here.

That's just a few reasons on the medical side. What about traumas?

This is where you REALLY need both.

Unrestrained headon collision c/o chest pain. You palpate the BP at 150/P. What about the diastolic? What if its 130? Traumatic chest pain with BP = 150/130, I'm thinking cardiac tampenade until proven otherwise.

If there is anything else I can do, please let me know.

 

[AnthonyM83]

Thank you sir.

Anything on hypotensive?


Also, I once had a medic tell me the bottom number was more important. Why would that be? Is it really more important or does it depend on the situation and what you're looking for. I think his reasoning was that if you're diastolically hypertensive that's a lot of CONSTANT strain on your body. Would you guys agree?

 

[MSDeltaFlt]

http://www.revolutionhealth.com/con...n=section_02&s_kwcid=ContentNetwork|971598174

I got the following from the above link. I was looking on how to best phrase this, but they did such a good job I decided to let them do all of the talking.

"Blood pressure: How low can you go?
Current guidelines identify normal blood pressure as lower than 120/80 - many experts think 115/75 is optimal. Higher readings indicate increasingly serious risks of cardiovascular disease. Low blood pressure, on the other hand, is much harder to quantify.

Some experts define low blood pressure as readings lower than 90 systolic or 60 diastolic - you need to have only one number in the low range for your blood pressure to be considered lower than normal. In other words, if your systolic pressure is a perfect 115, but your diastolic pressure is 50, you're considered to have lower than normal pressure.

Yet this can be misleading because what's considered low blood pressure for you may be normal for someone else. For that reason, doctors often consider chronically low blood pressure too low only if it causes noticeable symptoms.

On the other hand, a sudden fall in blood pressure can be dangerous. A change of just 20 mm Hg - a drop from 130 systolic to 110 systolic, for example - can cause dizziness and fainting when the brain fails to receive an adequate supply of blood. And big plunges, especially those caused by uncontrolled bleeding, severe infections or allergic reactions can, be life-threatening."

There's a RN in the town I live in, and she enjoys freaking out the local nursing students when they take her BP because it normally runs 70/40 and she's asymptomatic and takes no routine meds. If she's 90/60, she's stressed or pissed and hypertensive.

As far as which number is more important, it's all 3: Sys, Dia, and MAP.

Always listen to your patient, both figuratively and literally. Keep your stethescope on you at all times.

Unless Vent or Rid can add anything, I believe that should cover it. Let me know if it doesn't and I'll do my best to get you the information you need.