BP mishaps

gradygirl

gradygirl

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I had 3 patients last night, two of whom I took BPs for (the third was already being attended by the ambulance by the time we finally arrived.) I got the first pt.'s BP fine, no biggy. The second I couldn't get the diastolic number, and I tried getting it about 3 times (her systolic was about 112.) I'm not sure if it was because of her drunk state (took us no less than 10 min. to wake her up, lightly shaking, sternal rubs, etc.), her physiology, whatever, I dunno.

Any ideas?
 
Yes I have an idea.

2 suggestions....

1. Are you sure you inflated the cuff high enough to rule out hypertensive crisis? The 112 could have been the diastolic...

2. Provided that there was no hypertensive crisis....lets say the pt is totally asymptomatic, the only problem is that you can not hear the diastolic...the solution for that is... So What? As long as the systolic is normal, on most patients I could care less what the diastolic is. You will chart this as follows 112/P. Not being able to hear the diastolic OCCCASSIONALLY is no big deal on most patients.
 
akflightmedic said:
Yes I have an idea.

2 suggestions....

1. Are you sure you inflated the cuff high enough to rule out hypertensive crisis? The 112 could have been the diastolic...

2. Provided that there was no hypertensive crisis....lets say the pt is totally asymptomatic, the only problem is that you can not hear the diastolic...the solution for that is... So What? As long as the systolic is normal, on most patients I could care less what the diastolic is. You will chart this as follows 112/P. Not being able to hear the diastolic OCCCASSIONALLY is no big deal on most patients.
Click to expand...

agreed. sometimes you wont have a distaloic..no biggie
 
There have been times where I haven't been able to get the diastolic on a patient as well. Like the others have said, as long as it isn't something that is an issue the majority of the time you are getting a BP, it isn't a big deal. Sometimes, due to circumstances, it is just difficult to do.
 
First try the other side. We have someone who often has something like 118/78 on one side and 98/0 on the other side. They have looked at several thing including conditions that block an artery or a nerve, usually in the shoulder or axillary. None of those panned out. Docs from Mayo Clinic have noted this condition but don't know what causes it. They think it is hormone related as all of the cases they have seen have been female and it seems to increase or decrease at certain times of the month. The other arm is not affected so try both sides.
 
What do you mean... you couldn't get a diastolic number? When did you stop hearing it?
 
Jon said:
What do you mean... you couldn't get a diastolic number? When did you stop hearing it?
Click to expand...

I pumped the cuff up to 200 like I always do, listened until I heard the systolic at about 112, then it disappeared, not in the typical fade out way, either. The needle stopped bounced once at 112 then stopped after the first bounce and I couldn't hear anything. So, unless you can have a BP of 112/112, it disappeared at 112. -shrugs-

I was, at the time, trying to cover base lines just as the transporting crew walked in. Didn't even care about not getting the BP once they got there. Stupid medic looked at my partner and I and asked "Do we really have to transport this patient? I mean, do we have to?" No, lady, it only took us 10 minutes to wake this kid up, of course you don't have to transport her... :angry:
 
Ok... I've had it fade out, then come back in, and I've had it where I wasn't sure of the diastolic number because of noise, etc... I've got no problem saying "I'm not sure" of a B/P... and I never "fudge" a B/P, espically to the medics.
 
BP's

was it the right size cuff? I will pump up the cuff to 200mm and if the needle starts to bounce, I will take it up at least 10 more points. If you can check the other arm, unless there are other problems ( Dialysis shunts, Picc lines, injuries etc.) If all else fails have some one else check it. I figure if you tried 3 times, you can always ask!
 
We have on Patient that has a masectomy Plus a Dialysis Shunt so we have to take them in her ankle... we never gt a straight reading on her...

I know with my BP it stays So Low it never maxes 90/70 or so typically mine has to be taken 3-4 times to get a decent reading thy have pumped it up to 210 and managed a 90/P I think once they got it up to 100/80 but thats uncommonly High for me...

We also have One Lady that hers usually will sit at 210/120 (shes known for High BP) but it often fluctuates and drops back down when you reassess
 
TCERT1987 said:
I had 3 patients last night, two of whom I took BPs for (the third was already being attended by the ambulance by the time we finally arrived.) I got the first pt.'s BP fine, no biggy. The second I couldn't get the diastolic number, and I tried getting it about 3 times (her systolic was about 112.) I'm not sure if it was because of her drunk state (took us no less than 10 min. to wake her up, lightly shaking, sternal rubs, etc.), her physiology, whatever, I dunno.

Any ideas?
Click to expand...

Well... while B/P is important, you know your patient is alive, she is breathing. You know she has a pulse, she's breathing. As far as worrying about getting a perfect B/P on a patient, it's not always going to happen. Sometimes I just palp a B/P, which only gives you systalic. Sometimes, I don't have time to get a B/P at all. Don't sweat the small stuff. Just get what you can get and don't worry about the rest. As long as your patient is still alive, you know they have a pressure of something. Also, if they have a radial pulse, then they have atleast a pressure of 80 systalic. That is always something to fall back on.
 
I didn't see it addressed, so I will add this....................

Sometimes it isn't the total disappearance of the sound, but a slight change in it.

For instance you may actually be able to hear a B/P all the way to zero. Sometimes it is that little change in sound that is the difference between systolic and diastolic.
 
When you guys take the BP in the forearm or ankle, is it always palpated? Or are you ever able to auscultate anywhere?
 
Diastolic pressure is rarely if ever pertinent in EMS. Get me a good systolic, we can work with that.
 
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