BP Sounds

JJR512

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I have been getting some conflicting information on auscultating blood pressures lately, and how to interpret to Korotkoff sounds.

One of my fellow EMTs at my station (let's call him John) became concerned when I was unable to auscultate a BP on two different patients. Because I've only been on two calls with this particular EMT, he therefore assumed that I'm unable to auscultate a BP 100% of the time. Thus, he had me practice on him, with checking done by another EMT (let's call her Jane). I don't mind the practice, although I do resent his assumption, but that's another matter.

Anyway, I auscultated a systolic BP of 140 on John, while Jane got 120. John said 120 is consistent with what his BP "always" is.

I know I heard something at 140. I know I heard a faint thumping. I heard it for several mmHgs but it was very faint, started to become louder at around 130 and reached peak volume just over 120.

What little I know about interpreting Korotkoff sounds came from Wikipedia, which I know is not a respected resource around here, regardless of the quality and reputation of the sources actually used...but that's another topic. Anyway, from what I can tell, the systolic pressure should be the pressure at which rhythmic tapping is first heard.

My stethoscope is the Littman Master Cardiology. It's pretty much the best stethoscope available without going electronic. I wonder if I'm hearing more, due to the quality of my scope, then others are hearing with the cheapo scopes supplied by the station. On the other hand, John reports 120 mmHg is consistent with what he gets in checkups by doctors, and whether it's an actual doctor or nurse checking his BP, I'm going to assume that they're probably better at it than me.

So is the systolic BP truly the highest pressure at which rhythmic tapping or thumping is heard, or is it the point at which it reaches maximum volume, or what?
 

dixie_flatline

Forum Captain
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I have been getting some conflicting information on auscultating blood pressures lately, and how to interpret to Korotkoff sounds.

One of my fellow EMTs at my station (let's call him John) became concerned when I was unable to auscultate a BP on two different patients. Because I've only been on two calls with this particular EMT, he therefore assumed that I'm unable to auscultate a BP 100% of the time. Thus, he had me practice on him, with checking done by another EMT (let's call her Jane). I don't mind the practice, although I do resent his assumption, but that's another matter.

Anyway, I auscultated a systolic BP of 140 on John, while Jane got 120. John said 120 is consistent with what his BP "always" is.

I know I heard something at 140. I know I heard a faint thumping. I heard it for several mmHgs but it was very faint, started to become louder at around 130 and reached peak volume just over 120.

What little I know about interpreting Korotkoff sounds came from Wikipedia, which I know is not a respected resource around here, regardless of the quality and reputation of the sources actually used...but that's another topic. Anyway, from what I can tell, the systolic pressure should be the pressure at which rhythmic tapping is first heard.

My stethoscope is the Littman Master Cardiology. It's pretty much the best stethoscope available without going electronic. I wonder if I'm hearing more, due to the quality of my scope, then others are hearing with the cheapo scopes supplied by the station. On the other hand, John reports 120 mmHg is consistent with what he gets in checkups by doctors, and whether it's an actual doctor or nurse checking his BP, I'm going to assume that they're probably better at it than me.

So is the systolic BP truly the highest pressure at which rhythmic tapping or thumping is heard, or is it the point at which it reaches maximum volume, or what?
Was there a reason you didn't use the LP12 as an objective third party?
 

ArcticKat

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What little I know about interpreting Korotkoff sounds came from Wikipedia,
Okay, that's the first alarming section of yout post. Your school didn't teach you anything about Korotkoff sounds and how to interpret them?

Get your tuition money back.

I know I heard something at 140. I know I heard a faint thumping. I heard it for several mmHgs but it was very faint, started to become louder at around 130 and reached peak volume just over 120.
My SCHOOL taught me that the systolic BP should be the number at which you first hear the korotkoff sounds, even if they fade and return or are very faint. If you heard them, they count.


Anyway, I auscultated a systolic BP of 140 on John, while Jane got 120. John said 120 is consistent with what his BP "always" is.
How did you and Jane check John's BP? Were you and Jane taking John's BP on the same arm at the same time with two different stethescopes? Did she do one arm while you did the other? Did she check his BP before or after you checked it?

The only way to obtain a true comparison is to use a set of training tubes with two sets of ear pieces. That way there is no variation in bell placement, time, or physiological changes. The only variable left is the auditory capabilities of the listeners.
 

silver

Forum Asst. Chief
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You never know, <10 mmHg variation in blood pressure through the respiratory cycle is normal.

My SCHOOL taught me that the systolic BP should be the number at which you first hear the korotkoff sounds, even if they fade and return or are very faint. If you heard them, they count.
always take note if they fade on inspiration and return on expiration (>10 mmHg). This is pulsus paradoxus and could be used diagnostically.
 

ArcticKat

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you never know, <10 mmhg variation in blood pressure through the respiratory cycle is normal.



Always take note if they fade on inspiration and return on expiration (>10 mmhg). This is pulsus paradoxus and could be used diagnostically.
+1a
 
OP
JJR512

JJR512

Forum Deputy Chief
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Okay, that's the first alarming section of yout post. Your school didn't teach you anything about Korotkoff sounds and how to interpret them?

Get your tuition money back.



My SCHOOL taught me that the systolic BP should be the number at which you first hear the korotkoff sounds, even if they fade and return or are very faint. If you heard them, they count.
One thing I didn't need SCHOOL to teach me was not to make assumptions. Like assuming that an EMT-B became one in a school, or that an EMT-B paid tuition for the EMT-B training program, or that someone asking for clarification on a topic wasn't taught "anything" about that topic. For the record, I was taught at my county fire department's training academy. My training was free. And we were taught what to listen for, but since then, I have heard and read many conflicting opinions, and I was hoping to get set straight on this topic.

:)

How did you and Jane check John's BP? Were you and Jane taking John's BP on the same arm at the same time with two different stethescopes? Did she do one arm while you did the other? Did she check his BP before or after you checked it?

The only way to obtain a true comparison is to use a set of training tubes with two sets of ear pieces. That way there is no variation in bell placement, time, or physiological changes. The only variable left is the auditory capabilities of the listeners.
I was not in the room when Jane checked John's BP. I am aware that a training stethoscope would have been the ideal way to test, but one wasn't available in our station. I believe we used the same arm; she went first; John did not move or change position between tests; I tested approximately two minutes after Jane.
 

Anjel

Forum Angel
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For the record ive never heard.of kortocoff or whatever that is. But im very good at getting bps. Ive been doing it for the last 5 years.

So just thought id throw that out there...and now I go google.
 

lightsandsirens5

Forum Deputy Chief
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Be nice.


Sent from a small, handheld electronic device that somehow manages to consume vast amounts of my time. Also know as a smart phone.
 
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JJR512

JJR512

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Well, THERE'S yer problem.
And there's YOUR problem. Specifically, your arrogance-driven predilection to make assumptions when you don't know the facts.
 

usalsfyre

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And there's YOUR problem. Specifically, your arrogance-driven predilection to make assumptions when you don't know the facts.
Considering at least one large fire-based system in MD is dealing with a scandal regarding it's EMS training, and MIEMSS is not lauded as a top notch state entity by most in EMS with allegiance outside the fire service I'd be careful to be too quick to defend MD EMS educational offerings at the moment.
 

ArcticKat

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I mean it. Last warning. This thread is about BP sounds. Not the merits (or lack thereof) of fire based EMS.
My apologies, my intent was not to derail the thread to yet another Fire vs EMS thread. Both systems have merit. I too, am a firefighter/paramedic. Unfortunately, tone and inflection don't translate well through text. Just imagine Adam or Jamie saying it on Mythbusters...then you might not be quite as offended.

My comment was actually regarding the quality of an education system that did not competently instruct the students in proper BP acquisition. Incompetent instruction gets what it teaches. A proper school with instructors who have university degrees in education as well as many years as field medics and competently teach their students are far superior than the department education guy teaching their EMTs in the back room of the fire hall.

But, this is about BP sounds, not quality of education.
 
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FreezerStL

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I'll try to point us back on topic...

Anyway, I auscultated a systolic BP of 140 on John, while Jane got 120. John said 120 is consistent with what his BP "always" is.
how did both your diastolic readings compare? If both were close it'll give you a good indication of accuracy.

Although a variation of ~20 mmHg is unlikely, many variables can skew a BP reading. All should be taken into consideration when trying to evaluate a "true" BP.

How is the arm placed?
Where is the bell?
How is the provider's hearing?
What is the external enviroment?
Is the patient under stress? (duh, always)
How quickly is the cuff deflated?
Are you both using the same stethescope?

These are just a few in a broad list.

on a side note:

Lifepak NIBP's are nice, however I've seen them be off by quite a bit. I would trust my pt. eval more.
 
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DrParasite

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For the record ive never heard.of kortocoff or whatever that is. But im very good at getting bps. Ive been doing it for the last 5 years.
good, and I thought it was just me. and I have been doing this for only 11 years.

oddly enough, if I did know what the sounds were called, it probably wouldn't have had any affect of my treatment of assessment of any patients.
 

DrParasite

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Lifepak NIBP's are nice, however I've seen them be off by quite a bit. I would trust my pt. eval more.
and yet, almost every hospital I have ever been to uses NIBPs as their standard BP taking devices, instead of a manual scope and cuff. I wonder why that is.
 
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JJR512

JJR512

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good, and I thought it was just me. and I have been doing this for only 11 years.

oddly enough, if I did know what the sounds were called, it probably wouldn't have had any affect of my treatment of assessment of any patients.
Absolutely. What the sounds are called is irrelevant. I originally learned what they were called here at EMTLife.com.
 

usalsfyre

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NIBP's are nice, however I've seen them be off by quite a bit. I would trust my pt. eval more.
Hmmm, two words that are massively important where vital signs are concerned. "Corelate Clinically".

I've seen automated NIBPs be off. I've also seen the LPs obtain a pressure the provider didn't like, the provider get a number that was "better" and BLS the patient when the higher or lower number was indeed correct. Don't immediately distrust technology, if it seems off investigate deeper rather than writing it off as "wrong". You might find the patient fits the machine.
 

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