BP Sounds

ArcticKat

Forum Captain
470
0
0
+1, My first BP on a patient is done with my ears. The LP12 then cycles subsequent BPs. If I get one from the LP12 that does not fit the clinical picture it's back to verification with my ears.
 

traumaluv2011

Forum Lieutenant
203
1
0
If we have time to do a manual BP before we go to the hospital I will auscultate the BP to be sure. However, if we have a priority I will try to get the blood pressure by watching the needle. If you let out the air slow enough, you will see the needle bounce instead of smoothly going down. That is probably a little less accurate, but is useful since it's a little difficult to hear the thumping when the ambulance is moving on these bumpy roads. I'm sure you all know that technique though.

We have an automatic BP/Pulse/SPO2. It's not a lifepack, I don't remember the brand name. Sometimes it will work and sometimes we have to run it two or three times before it gets a reading. Especially when we're moving.
 

Anjel

Forum Angel
4,548
302
83
If we have time to do a manual BP before we go to the hospital I will auscultate the BP to be sure. However, if we have a priority I will try to get the blood pressure by watching the needle. If you let out the air slow enough, you will see the needle bounce instead of smoothly going down. That is probably a little less accurate, but is useful since it's a little difficult to hear the thumping when the ambulance is moving on these bumpy roads. I'm sure you all know that technique though.
I really dont think thats a good thing to get in the habit of. Take it over palp. Or take 30sec before u leave to take it.
 

FreezerStL

Forum Crew Member
87
0
0
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.
Absolutely.

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.
I'm just saying I've seen too many medics rely on NIBPs alone.
Hospitals have the benefit of not dealing with the kind of "interference" that we do.
 
Last edited by a moderator:

usalsfyre

You have my stapler
4,319
108
63
If we have time to do a manual BP before we go to the hospital I will auscultate the BP to be sure. However, if we have a priority I will try to get the blood pressure by watching the needle. If you let out the air slow enough, you will see the needle bounce instead of smoothly going down. That is probably a little less accurate, but is useful since it's a little difficult to hear the thumping when the ambulance is moving on these bumpy roads. I'm sure you all know that technique though.
Bad habit to get into, needle bounce doesn't always correlate to BP. Plus you'll find your scenes run a lot smoother if you slow down a bit and focus on smoothness rather than speed. Getting in a hurry actually ends up wasting time more often than not, and leads to mistakes.

Rarely does a couple of minutes matter.
 

traumaluv2011

Forum Lieutenant
203
1
0
Bad habit to get into, needle bounce doesn't always correlate to BP. Plus you'll find your scenes run a lot smoother if you slow down a bit and focus on smoothness rather than speed. Getting in a hurry actually ends up wasting time more often than not, and leads to mistakes.

Rarely does a couple of minutes matter.
Yea, I'm definitely not making a habit of that. I've only used that on like one or two trauma calls. Most calls weren't that serious.
 

Tigger

Dodges Pucks
Community Leader
7,221
2,193
113
Yea, I'm definitely not making a habit of that. I've only used that on like one or two trauma calls. Most calls weren't that serious.
If the call is "serious," doesn't that warrant an accurate set of vital signs?

Then again, don't all calls warrant an accurate set of vital signs?
 
OP
JJR512

JJR512

Forum Deputy Chief
1,336
4
36
My jurisdiction does have a policy to always get a manual BP first, then do automatics after that and as long as the automatics seem in line with what's expected based on the manual, it's OK to keep using automatics.

Does everyone follow that policy? Of course not. Violation runs rampant at all levels.

I'm not absolutely sure if this is a true "policy" or not. I've skimmed through the department's general orders and didn't see one that seemed to state that. It might be an unwritten rule, or it might just be what my instructor felt like saying is what should be done, sort of a "best practice" only described as a policy instead, perhaps to try to get more of us to follow it, knowing many of us probably wouldn't.

So let me be absolutely honest and describe when I do and don't take manual BPs.

When it seems like an utter BS call, as in "ow my hangnail hurts", we have a tendancy to strongly hint to the patient that perhaps seeing their doctor, or getting a relative or friend to provide the ride to the hospital, is a better course of action. We always include a statement of "but we'll be happy to take you if that's what you want us to do", of course. For these patients who insist on going with us to the hospital, we have them walk into the ambulance. Very little time is spent on scene, and we don't do vitals on scene. We let the LP12 get the vitals it can get.

When calls seem a bit more complicated once we get to the scene, but didn't seem so complicated from the dispatch that we didn't bring the LP12 in with us, THAT is when we do a manual BP. Why do we do it then? Because at that point, it's just easier to do the manual BP rather than go back to the ambulance for the LP12, of course.

Is this ideal? Is it even close to being decent? No, not really; I'll be the first to admit it. It's pretty darned lazy, in fact.

This is not true for every provider I've worked with, just for the record. And it isn't necessarily how I, personally, will be running calls when it's my turn to run them as a primary provider (up until now, I've just been a third).
 

usalsfyre

You have my stapler
4,319
108
63
Y'all aren't taking a monitor to bedside on every patient?

Yikes...
 
OP
JJR512

JJR512

Forum Deputy Chief
1,336
4
36
Y'all aren't taking a monitor to bedside on every patient?

Yikes...
No. This county seems to prefer to play in the back of the medic unit rather than on scene. Not that we just load the patient and get going, mind you; often, we get the patient in the back, then start doing stuff.

We do bring the LP12 in whenever information from dispatch provides any hint that it might be a good idea to do so.

Similarly, we don't bring the ALS bag in on every call, either.
 

usalsfyre

You have my stapler
4,319
108
63
No. This county seems to prefer to play in the back of the medic unit rather than on scene. Not that we just load the patient and get going, mind you; often, we get the patient in the back, then start doing stuff.

We do bring the LP12 in whenever information from dispatch provides any hint that it might be a good idea to do so.

Similarly, we don't bring the ALS bag in on every call, either.
Been burned way too many times to play this game. Let me give you some of the P2 calls(lower priority calls that we're not required to bring equipment in on) I've had in just the last two weeks.

1. P2 to the NH on altered LOC. His LOC was altered because of afib w/RVR at 240 with resultant severe pulmonary edema. Required bedside cardioversion.

2. P2 to a different NH for altered lab values. The altered lab was a K+ of 1.6. Pt found to be in a 3rd degree AV block at a rate of 40. Hemodynamicly stable.

3. P2 to a residence for abdominal pain. Abdominal pain was due to DKA.

Cardiac monitor, airway equipment and suction go to the bedside of every 911 patient because of stuff like this, unless their ambulatory at the curb. I know you don't have control over this as your not running you own unit. But to me the mark of a professional is coming ready to play and not having to run back to the truck when presented with something they didn't expect. What's carrying the stuff in gonna hurt? It's kinda like laying a line on a possible structure fire.
 

traumaluv2011

Forum Lieutenant
203
1
0
Y'all aren't taking a monitor to bedside on every patient?

Yikes...
I'd love to have a monitor, but a BLS unit with minimal funding doesn't see a need for one.
 

Tigger

Dodges Pucks
Community Leader
7,221
2,193
113
Different situation, although you do have an AED right?
Yes, and I don't care how hard my partner laughs at me, it comes in on every call, along with the massive first in/o2 bag. Going on with the original topic, I try and get a set of vitals on scene if practical before getting the patient to the truck...that way we can slow down the pace of the call a bit and make sure we aren't needlessly rushing out the door and missing something. Also, people's houses are much quieter than the back of the bus.
 
OP
JJR512

JJR512

Forum Deputy Chief
1,336
4
36
Been burned way too many times to play this game. Let me give you some of the P2 calls(lower priority calls that we're not required to bring equipment in on) I've had in just the last two weeks.

1. P2 to the NH on altered LOC. His LOC was altered because of afib w/RVR at 240 with resultant severe pulmonary edema. Required bedside cardioversion.

2. P2 to a different NH for altered lab values. The altered lab was a K+ of 1.6. Pt found to be in a 3rd degree AV block at a rate of 40. Hemodynamicly stable.

3. P2 to a residence for abdominal pain. Abdominal pain was due to DKA.

Cardiac monitor, airway equipment and suction go to the bedside of every 911 patient because of stuff like this, unless their ambulatory at the curb. I know you don't have control over this as your not running you own unit. But to me the mark of a professional is coming ready to play and not having to run back to the truck when presented with something they didn't expect. What's carrying the stuff in gonna hurt? It's kinda like laying a line on a possible structure fire.
For #1 (LOC) and probably for #2 the monitor would have gone in. Probably not for #3.

I have to give our 911 call center personnel credit for doing a very thorough job on getting information and relaying it to the ambulance/medic crews. Very rarely have I ever seen a call go out as just "abdominal pain". That may be all that's announced over the dispatch radio but in the MDT there's almost always a lot more information, and it's this supplemental info that usually helps the crew decide what to bring in. I've been living at the station for about two months and have been running third on at least 75% of all medic calls and can't recall the medic ever asking for the monitor to be brought in when it wasn't originally.
 

DrParasite

The fire extinguisher is not just for show
5,224
1,410
113
Been burned way too many times to play this game. Let me give you some of the P2 calls(lower priority calls that we're not required to bring equipment in on) I've had in just the last two weeks.

1. P2 to the NH on altered LOC. His LOC was altered because of afib w/RVR at 240 with resultant severe pulmonary edema. Required bedside cardioversion.

2. P2 to a different NH for altered lab values. The altered lab was a K+ of 1.6. Pt found to be in a 3rd degree AV block at a rate of 40. Hemodynamicly stable.

3. P2 to a residence for abdominal pain. Abdominal pain was due to DKA.

Cardiac monitor, airway equipment and suction go to the bedside of every 911 patient because of stuff like this, unless their ambulatory at the curb.
are you kidding me? you bring all that stuff for a sprained ankle? or a hangnail? or a 3 year old who is sick?

call #1 would def get a monitor altered mental status is an automatic ALS dispatch. call #2 would probably get a monitor. but if the only complaint on dispatch was altered labs, maybe not. depending on what the assessment finds would determine if ALS was needed (and if the patient's heart rate is 40, are they really hemodynamicly stable?). and call #3, def no monitor.
I know you don't have control over this as your not running you own unit. But to me the mark of a professional is coming ready to play and not having to run back to the truck when presented with something they didn't expect. What's carrying the stuff in gonna hurt? It's kinda like laying a line on a possible structure fire.
actually, it's kinda like laying a line on a activated fire alarm.

if you think it might be needed, than bring it. you got smoke showing from the house, might be a good idea to lay the line. if you are told multiple calls, might be a good idea to lay the line. you get a reported structure fire, and when you show up there is nothing showing, are you going to be laying a line and pulling hose lines off the truck? probably not.

Have I been burned? sure. i remember being on the (ALS) FD engine, and got dispatched for back pain. when we got there, the patient is also having check pains. what did the lead medic do? told me to get the ALS bag and monitor, and found he had PVCs on his 4 lead. the patient eventually RMA AMA, even after he spoke to the doctor who was unable to convince him to go to the hospital.

going back to your fire analogy, have I gone to an AFA, and when we arrived, found smoke showing? yeah. still doesn't mean I'm going to lay in to every AFA.

BTW, I have been to sick person calls/abdominal pain/falls that needed a monitor, and diff breathing calls where the patient met us at the curb and needed a taxi ride. there is no real consistency or hard and fast rule, except if you think you will need it, take it with you.
 
Last edited by a moderator:

usalsfyre

You have my stapler
4,319
108
63
So how many of you would be a patient at an ED where the crash cart had to come from upstairs?

Is it that much of a problem to carry the bags in?
 
Last edited by a moderator:

DrParasite

The fire extinguisher is not just for show
5,224
1,410
113
So how many of you would be a patient at an ED where the crash cart had to come from upstairs?

Is it that much of a problem to carry the bags in?
your questions really isn't the same as what you are asking

an equivalent question would be "how many of you would be a patient at an ED where the crash cart was not located in your room?"

and I'll even respond to your question, if I was in the ER for a sprained ankle, I wouldn't worry to much if the crash cart was upstairs.
 

usalsfyre

You have my stapler
4,319
108
63
are you kidding me? you bring all that stuff for a sprained ankle? or a hangnail? or a 3 year old who is sick?
Yep, three items. The stretcher, the monitor and our airway bag which has a compact battery powered suction in it.

(and if the patient's heart rate is 40, are they really hemodynamicly stable?)
Don't confuse "bradycardia/cardiac rhythm disturbance" with "decompensating". Two different things. We had a nice conversation on the 40min ride to her ED. What she needed was potassium, which I couldn't provide.


actually, it's kinda like laying a line on a activated fire alarm.
The difference is AFAs are not a confirmed complaint. It's an automatic activation. If someone calls 911 and ask for an ambulance, something is wrong in their eyes.

if you think it might be needed, than bring it. you got smoke showing from the house, might be a good idea to lay the line. if you are told multiple calls, might be a good idea to lay the line. you get a reported structure fire, and when you show up there is nothing showing, are you going to be laying a line and pulling hose lines off the truck? probably not.
Several departments I've worked with and around do just that. Why? Because it's flaking a bit of hose on the ground and keeps you from being behind. And no, it's not just little rural departments either.

Have I been burned? sure. i remember being on the (ALS) FD engine, and got dispatched for back pain. when we got there, the patient is also having check pains. what did the lead medic do? told me to get the ALS bag and monitor, and found he had PVCs on his 4 lead.
going back to your fire analogy, have I gone to an AFA, and when we arrived, found smoke showing? yeah. still doesn't mean I'm going to lay in to every AFA.
And if the patient had hit an R on T as you walked on the door? Show up ready to work. Expect to have to control an airway, work an arrest, ect everytime you walk in the door and you won't end up behind the 8-ball.
 

Top